Advocates for the mentally ill argue that the state should stop relying so heavily on nursing homes to house the mentally ill. Advocates for the mentally ill say that mixing felons, mentally ill people, the elderly and disabled people at nursing homes in Illinois doesn't help serve any of those groups. Recent Chicago Tribune stories also have reported that some residents have been attacked, raped and murdered in nursing homes. As a result, Illinois Gov. Pat Quinn launched a Nursing Home Safety Task Force to expand housing options for the mentally ill.

Besides the Nursing Home Safety Task Force's hosting a series of public hearings to get discussions going, Illinois state senators held a hearing in Chicago to consider ways to improve safety at Illinois nursing homes, where a high number of ex-felons with mental illness have led to reports of assaults, rape and murder.

As for whether one can find reliable, secure, affordable housing for the mentally ill in Illinois, Barry Taylor said, "It's virtually impossible. There is some out there, but a very small percentage of people have that type of community support" and "Illinois knows how to do it, but what they need to do is just provide more funding" to help the mentally ill succeed. Taylor is legal advocacy director for Equip for Equality, which aims to advance the human and civil rights of children and adults with physical and mental disabilities in Illinois.

Advocates for the mentally ill argue that the state should stop relying so heavily on nursing homes to house the mentally ill. They are pushing for changes on how Illinois handles psychiatric patients and contend that the mentally ill could be treated more cheaply and effectively elsewhere.

Nursing Home Safety Task Force Chairman Michael Gelder, who also is senior adviser of health policy, said at the task force's last public hearing that he'll be looking for both short-term and long-term solutions, and he said that, hopefully, some of them will be implemented before the task force turns in a report to the governor by January 31. The task force will examine existing policies and procedures, improve coordination and communication among state agencies, alternatives to institutional placement and work with nursing homes to ensure residents' safety.

Illinois agencies participating on the task force include the following: Department of Public Health, Department of Healthcare and Family Services, Department on Aging, Department of Corrections, Department of Veterans' Affairs, Housing Development Authority, Department of Human Services and the Illinois State Police. The group also is consulting with outside experts, advocates and industry groups.

Illinois depends more than any other state does on nursing homes to house psychiatric patients. "People with disabilities have been historically segregated away from the general public," and that is a form of discrimination, Taylor said.

He said, "Illinois unfortunately has relied upon a more segregated type of approach than most other states and has a system right now of putting people with mental illness either in general nursing homes or in these facilities called IMDs [Institutions for Mental Diseases], which are basically nursing homes where the primary diagnosis is 50 percent or more of the residents have mental illness, and in Illinois it's pretty much 100 percent."

An estimated 5,000 people with psychiatric disabilities live in IMDs in Illinois at an annual cost of more than $160 million, according to Equip for Equality. Although IMDs tend to place restrictions on residents and their activities, Taylor said, "Most states realize that integrating people into the community and providing the support they need is a much better service system." Supportive housing offers the mentally ill services they need as they work and live in their own communities.

Beginning in the late 1960s, the state began releasing thousands of people with mental illnesses from psychiatric institutions, but the state didn't create and develop adequate community housing and services, advocates for the mentally ill say. Then, in the 1970s and 1980s, nursing home operators opened up IMDs, and now people released from psychiatric wards in hospitals often wind up in IMDs.

One problem with IMDs in Illinois is that they are 100 percent state funded and get no federal Medicaid matching funding, Taylor said. However, he said that if the state were to create more community housing options for the mentally ill, they might be able to get federal funding and, therefore, become more fiscally responsible. Equip for Equality estimates that the state could save more than $57 million by transitioning 2,000 residents to the community during the next five years.

A lawsuit challenges Illinois's housing the mentally ill in IMDs. The lawsuit was submitted by Equip for Equality, the American Civil Liberties Union of Illinois, Judge David L. Bazelon Center for Mental Health, Access Living and Kirkland & Ellis, LLP. In the lawsuit, Williams v. Quinn, which previously was Williams v. Blagojevich, four people with mental illnesses, who live in Illinois IMDs, have filed against the state of Illinois a class-action lawsuit on their behalf and on behalf of mentally ill people who live in IMDs and who could live in the community with appropriate support and services. A settlement conference is scheduled for November 24.

The lawsuit states that the IMDs violate the Americans with Disabilities Act and discriminate against the mentally ill by not providing "services in the most integrated setting appropriate to their needs." They contend that IMDs "are designed to warehouse - often for private profit - large numbers of people with mental illness in a segregated setting." The lawsuit calls for the state to promptly provide eligible people with "appropriate services sufficient to allow them to live in the most integrated setting appropriate to their needs."

In addition, the lawsuit states that "IMDs do not prepare residents to live independently and deny residents privacy and control over their lives." It also states that IMDs "provide little or no rehabilitative treatment designed to promote recovery, independence and integration into the community."

The mentally ill need more individualized service and should not be forced to live via a one-size-fits-all "cookie-cutter model" for everyone, Taylor said. Providing individualized service also would be more fiscally responsible, he said.

Although Illinois relies more heavily on nursing homes to house the mentally ill than other states do, it isn't the only one challenged with finding reliable housing for them.

"New York has these large, what they call adult homes that are similar to our IMDs, and they have a similar lawsuit that just got resolved in their favor - in favor of people with disabilities," and calls for the state to provide community service housing programs for the mentally ill, Taylor said. Taylor said he hopes that the New York ruling will encourage Illinois to do the same thing and rule in favor of the mentally ill.

New York Gov. David A. Paterson announced that the State of New York has submitted a plan that would offer supported housing to people with mental illness who currently live in certain adult homes in New York City.

In the New York lawsuit, the judge decided that people with mental illness who live in adult homes are not sufficiently integrated into the community and that that violates the Americans with Disabilities Act as interpreted by the Supreme Court's 1999 Olmstead v. L.C. decision, which stated that that unjustified institutionalization and isolation stigmatizes people with disabilities. Also, the judge stated that an integrated setting is a setting that enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible, and the judge ordered the state to submit a remedy.

Back in Illinois, Barbara McGoldrick, who talked at the last task force hearing, is the mother of a 47-year-old son who has suffered from mental illness. After being unable to find appropriate housing for her son several years ago in Chicago, she moved him to Minnesota. Although her son eventually came back home to Illinois to live in a home with three other men who used to live in nursing homes, McGoldrick said that successfully transitioning from a nursing home to an apartment is difficult for the mentally ill. She said that one housing opportunity, though, is to get a voucher to live in an apartment via the Permanent Supportive Housing program, which provides funding for the production of affordable rental housing with accompanying supportive services.

"Illinois has fallen short in providing community-based housing to those people who were moved out of psychiatric institutions," McGoldrick said. "This failure to keep pace with the need, combined with the continual lack of funding year after year thereafter, has left our mentally ill circling between hospitals, nursing homes, homeless shelters, or worse, wandering the streets or trapped in our jails. Nursing homes have become dumping grounds for the state to warehouse young and middle-aged persons with mental illness."

Meanwhile, McGoldrick said, "People who are ex-felons with psychiatric problems are now being admitted to nursing homes. We are hearing over and over of deplorable conditions, terrifying incidents, shameful cover-ups, shocking security breaches and negligence and false reporting on background checks."

Illinois Sen. Heather Steans (D-Chicago) represents a North Side district in Chicago with a high concentration of mentally ill nursing home residents. Talking about the residents, Steans said, "I am concerned that they are not always receiving quality care. We are placing patients with mental illnesses into nursing homes in large numbers unlike anywhere else in the country. Many - not all - of the patients could be and would prefer to be treated in community-based settings."

When state senators met in a recent hearing, they said they would try to introduce reform legislation by February to end mixing ex-felons with the elderly, disabled and mentally ill. Suggestions included having more home-based and community-based service options for the mentally ill.

Sources for funding to house the mentally ill should be shifted, Steans said. "Currently nearly 60 percent of resources for people with severe mental illness in Illinois are spent on institutional care," she said. "We need to move resources that care for these patients to community-based treatment options. This must be done with planning to ensure patients have high quality places to go."

In the immediate time, though, Steans said, "I am encouraged by the task force the governor has convened under the leadership of Michael Gelder. I trust the task force will provide recommendation on how to better serve folks with mental illnesses and keep our nursing homes safe."