Psychology, Department of


First Advisor

William D. Spaulding

Second Advisor

Rich Wiener

Third Advisor

Mario Scalora

Date of this Version


Document Type



Avila, A. (2018). Creating a "good" Olmstead plan for people with serious mental illness: An empirical evaluation of the legal frameworks (PhD dissertation; University of Nebraska).


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor William D. Spaulding. Lincoln, Nebraska: August, 2019

Copyright 2019 Andrea Avila


Olmstead v. L.C. ex rel Zimring (1999) was a landmark US Supreme Court decision holding that unjustified segregation of people with disabilities is impermissible discrimination; specifically, if the clinician and client believe community integration to be appropriate, the state must have reasonable accommodations in place for the client to be in the community. Enforcement of the Olmstead decision for people with serious mental illness has taken many shapes, from the DOJ’s settlement agreements requiring substantive development of community mental health services and aggressive community integration protocols, to the Third Circuit approach which requires only lower census numbers in the state psychiatric hospital (SPH). This dissertation, through legal research, identified five distinct Olmstead response types (DOJ, Third Circuit, Ninth Circuit, Minnesota, Florida) created by litigation in ten states. Using growth curve models, the present study explored connections between those five response types and fifteen dependent variables: SPH census; state budgets for SPH, community treatment, police, judiciary, and corrections; incarceration rates; suicide rates; employment rates; disability benefits applications, approvals, and recipients; community treatment rates; readmissions to inpatient care within 30 days; and data collection trends.

All states decreased SPH census numbers, but only Minnesota showed an increase in community treatment rates; however, both changes were happening primarily before Olmstead litigation. The Ninth Circuit states had lower rates of people on disability benefits, while the Third Circuit had a significant increase in filings for disability benefits immediately after litigation. Suicide rates were much lower in Florida but showed alarming increases in the DOJ state of New Hampshire. Minnesota had greater increases in employment rates after litigation, and all states had slower incarceration rates after litigation. States managed their budgets in different ways after litigation, but overall, there was not an increase in funding for community mental health treatment after litigation outside of DOJ states. DOJ states, the Third Circuit, and Florida had the highest rates of missing data across all variables, while Minnesota had the lowest rate of missing data. Implications, limitations, and future directions are discussed, as well as ideological and ethical considerations for applying Olmstead’s requirements with a recovery orientation.

Advisor: William D. Spaulding