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DOJ says Missouri violated ADA by unnecessarily institutionalizing adults with mental health disabilities

The Justice Department announced its findings that the State of Missouri violated Title II of the Americans with Disabilities Act (ADA) by unnecessarily institutionalizing adults with mental health disabilities in nursing facilities. The investigation also examined the role of guardianships in such institutionalization.

The Justice Department determined that there is reasonable cause to believe Missouri violates the ADA by failing to provide the community-based services adults with mental health disabilities need in order to remain in their communities. It also found that the state is improperly relying on guardianship and that this leads to people entering nursing facilities even though community-based services are appropriate for their needs.

“People with mental health disabilities should not have to be confined to a nursing facility because they cannot access the community-based services they need,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “The Civil Rights Division will safeguard the rights of people with disabilities to participate fully in their communities. The state’s reliance on guardianships that serve as a pipeline to nursing facilities, rather than engaging people in community-based mental health services, has led to violations of the ADA.”

Missouri Governor Mike Parson told reporters that while he hasn’t looked at the exact details of the report, he is unsure if those accusations are correct but that it’s something they can “deal with”.

“I’ve fought the federal agencies for six years,” said Parson. “I’ll continue to try and figure out what is the right thing to do and what is the wrong thing to do but I don’t have a lot of trust in the opinion of the federal government sometimes.”

The department’s investigation found Missouri fails to provide community-based mental health services for many people with mental health disabilities who need them, including services such as:

  • Assertive Community Treatment;
  • Case management;
  • Supported employment;
  • Mobile crisis response;
  • Crisis stabilization services;
  • Permanent Supportive Housing;
  • Peer support; and
  • Supported Decision-Making.

Instead, the state makes nursing facility services for these people. Missouri can reasonably modify its system to remedy this violation by expanding community-based services and implementing processes to ensure that individuals can receive those services rather than entering nursing facilities.

Additional information about the Civil Rights Division of the Justice Department is available on its website at and

View the findings report here.

View the notice letter here.


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