Category: Disability Rights

Accessible, Affordable, and AI: How Artificial Intelligence Can Advance Healthcare Access

Between the Constitution of the World Health Organization, the Universal Declaration of Human Rights, and the International Covenant on Economic, Social, and Cultural Rights, the human right to a high standard of physical and mental health has been determinedly codified in international law. Providing this is more difficult. According to the World Health Organization, mostly low and lower-middle income countries will experience a healthcare shortage of 11 million workers within five years, and an estimated 4.5 billion people already lacked access to affordable essential care in 2021. Evidently, the global healthcare system needs a lifeline; with staff shortages and unmet needs, this help cannot come soon enough. Despite my criticisms of Artificial Intelligence’s implementation in healthcare due to data failures and biases, there is real potential for Artificial Intelligence to make the human right to health more accessible, affordable, and efficient. From wearable devices to Telehealth to risk and data analysis, the implementation of AI within healthcare systems can help relieve medical professionals from menial tasks, provide better access to health services for the disadvantaged, and aid in the overall efficiency of often bottlenecked healthcare systems.

REMOTE SERVICES & WEARABLE PRODUCTS

The access to one’s human right to adequate healthcare can be largely determined by geolocation; rural populations suffer significantly worse health outcomes than their urban counterparts, largely due to isolation from hospitals and medical professionals. People living in rural areas may not have the time or financial means to access efficient, affordable health services. Artificial Intelligence can help address this disparity by powering remote services such as Telehealth, aiding individuals in contacting physicians, and even potentially generating diagnoses without patients’ having to sacrifice their time or resources to travel. The primary use of AI within Telehealth aims to alleviate scheduling problems by training algorithms to match patients with the proper providers and ensure the smoothness of scheduling and accessing virtual appointments. This could significantly reduce the delay in access to Telehealth services that rural patients can experience.

A man measures his heart rate on an Apple Watch
Adobe Stock, DenPhoto, #290469935
A man measures his heart rate on an Apple Watch

In addition, wearable products utilizing Artificial Intelligence have shown potential in monitoring chronic conditions, eliminating the need for frequent check-ups, and reducing the burden on healthcare providers. Using data collected by wearable devices, AI algorithms can potentially detect signs of health problems and alert those with chronic conditions if their vitals are amiss. Patients can also receive AI-generated reminders to take medications and health check-ins to ensure proper care on a day-to-day basis.

The use of remote Artificial Intelligence technology to provide healthcare services also has the potential to increase access to mental health resources, especially in rural areas, where psychological help may be expensive, far away, or overly stigmatized. AI-driven personal therapists show potential to improve access to mental health services that traditionally are difficult to schedule and afford. Artificial intelligence has been used to analyze sleep and activity data, assess the likelihood of mental illness, and provide services related to mindfulness, symptom management, mood regulation, and sleep aid. 

ACCESSIBILITY

On top of increased accessibility for rural residents, various employments of Artificial Intelligence in healthcare have the potential to cater to the needs of those with cognitive or physical disabilities. Models can aid in simplifying text, generating text to speech audio, and providing visual aids to assist patients with disabilities as they receive care and monitor their conditions. The ability of Artificial Intelligence to streamline potentially incomprehensible healthcare interfaces and simplify information can also assist elderly patients in accessing health services. Older people can often be intimidated by the complexity of online healthcare’s technological hurdles, preventing them from effectively accessing their doctors, health records, or other important resources; Artificial Intelligence can be harnessed to adapt user personalization on websites and interfaces to best accommodate the problems an elderly or disabled person may experience trying to access online care.

Generative language models, a particular type of Artificial Intelligence that uses training data to generate content based on pattern recognition, has also been employed to overcome language barriers within medical education. The ability of Artificial Intelligence models to effectively translate educational curriculum has contributed to the standardization of medical practices and standards across countries. The digitalization of this process also makes medical educational material more accessible to those without direct access to a wealth of resources, furthering the World Health Organization’s Digital Health Guidelines, which aims to encourage “digitally enabled healthcare education.” The use of AI as a translation tool within healthcare also shows broader potential to be utilized for patient care, eliminating the need for costly translators and ensuring that non-native speakers fully comprehend their diagnoses and treatments. One example of this is the American company “No Barrier AI”, which employs an AI-driven interpreter to provide immediate, accurate, and cost-effective translation for those with little proficiency in English seeking healthcare.

Side view of a focused elderly man sitting before his laptop
Adobe Stock, Viacheslav Yakobchuk, #390382830
Elderly man accesses health portal from his laptop

PATIENT AND DATA ANALYSIS

A whole other blog post could be dedicated entirely to the use of Artificial Intelligence in hospitals and as an aid to medical professionals. Broadly, the integration of Artificial Intelligence into clerical and administrative tasks, health data analysis, and care recommendations has reduced the time and money spent on the slow, bureaucratic processes that weigh down medical professionals. Nearly 25% of healthcare spending in the United States is devoted to administrative tasks, but according to a McKinsey & Company study, the adoption of AI and machine learning could save the American healthcare industry $360 billion, mostly by assisting with clerical and administrative tasks. For instance, AI systems have proved effective in boosting appointment scheduling efficiency, speeding up an infamously difficult process. Because of its ability to detect, analyze, and predict patterns, Artificial Intelligence has also been utilized to track inventory and increase supply chain efficiency, ensuring proper amounts of essential medical supplies and medicines are in stock when they are most needed.

Beyond managerial and administrative duties, Artificial Intelligence has also been integrated into clinical decision-making, data and visual analysis, risk evaluation, and even the development of medicines. Trained models have proven capable of analyzing data from brain scans, X-rays, other tests, and patient records to detect and predict health problems; this ability to detect patterns and predict outcomes has also enabled early detection of diseases and conditions such as sepsis and heart failure. Medical professionals can take the model’s analysis into account while also considering treatment suggestions from Artificial Intelligence as they proceed with patient care. This can reduce the likelihood of clinical mistakes as doctors can compare their findings with those of the AI model. Artificial Intelligence has also been used in telesurgical techniques to improve accuracy and supervise surgeons as they operate. The integration of Artificial Intelligence has also advanced vaccine development, as it aids in identifying antigen targets, helps predict a particular patient’s immune response to specific vaccinations, creates vaccines tailored to an individual’s genetic makeup and medical needs, and increases the efficiency of vaccine storage and distribution.

These are only a few examples of the potential usefulness of Artificial Intelligence within healthcare settings. The examples are countless and increasing every day, and, as I believe, the potential for further advancement is immeasurable.

Two doctors analyze brain scans on a tablet.
Adobe Stock, peopleimages.com, #1599787893
Two doctors analyze a brain scan with suggestions from AI tech

WHAT WE MUST KEEP IN MIND

While these advancements in the accessibility, affordability, and efficiency of healthcare systems show undeniable promise in accessing the human right to health, the development and integration of these Artificial Intelligence technologies must be undertaken with equality at the center of all efforts. As I highlighted in my last post, it is imperative that underlying societal biases be accounted for and curbed within these models to prevent inaccurate results and further harm to individuals from marginalized groups. A survey at the University of Minnesota found that only 44% of hospitals in the United States conducted evaluations on system bias in the Artificial Intelligence models they employed. It is essential to pursue efforts to ensure that Artificial Intelligence promotes not only the human right to health, but also the human right to freedom from discrimination within healthcare practices, especially those aided by systems potentially riddled with bias based on age, race, ethnicity, nationality, and gender.

These technologies are as practical as they are exciting. Still, as the healthcare industry moves forward, Artificial Intelligence developers and healthcare providers alike must maintain the core ideals of the Human Rights framework– equality, freedom, and justice.

Alabama’s “Invisible Disabilities” ID Proposal

Human Rights Perspective on the Proposal to Put “Invisible Disabilities” on Alabama IDs 

Box for ballot papers on desk and young African American man with disability sitting in wheelchair and making his choice.
Box for ballot papers on desk and young African American man with disability sitting in wheelchair and making his choice. By: pressmaster. Source: Adobe Stock. Asset ID#: 580784797

There is buzz around Alabama’s proposal to designate “invisible disabilities” on state ID cards by the end of this fiscal year. This legislative initiative has sparked significant debate and attention. In November 2025, a bill was introduced in Alabama that would allow individuals to add an “invisible disability” designation to their driver’s licenses or state ID cards. Ontario Tillman, the state representative who is introducing this measure, argues that this “protective” measure could help law enforcement and first responders understand and quickly identify persons who may have non-apparent disabilities such as autism, PTSD, or traumatic brain injury. Tillman argues that this would be helpful for law enforcement and other officials to know because people with these and other invisible disabilities may respond to officers in unexpected ways that could cause situations to spiral dangerously. By equipping law enforcement and first responders with the information that the person they are engaging with has an invisible disability, Tillman hopes that there would be more patience and understanding built between responders and the person with the disability.

Invisible Disability ID Markers Elsewhere

States like Alaska, Maryland, and Colorado have started adding invisible disability indicators to driver’s licenses and ID cards, but they are taking different routes and raising similar debates. Alaska lets residents voluntarily add an invisible disability designation to licenses or IDs through its DMV, framing it as a tool to signal needs in situations like traffic stops or emergencies without revealing a specific diagnosis. Colorado offers a small icon on state IDs for people with invisible disabilities and, in the first year and a half of its implementation, 1,096 people signed up for the marker. In Maryland, “Eric’s Law” created an optional invisible disability notation after disability activist Eric Blessed Carpenter Grantham pushed for the state to offer this accommodation; the Maryland Department of Transportation now treats the marker as one more tool for safety and understanding. Across these states, the basic idea is similar: make it easier for disabled people to get accommodations or de-escalation in high-stress situations by building a quiet signal into ID systems.​

People’s reactions, though, show how complicated it feels to put disability information on something as central as an ID. Supporters, including some disability advocates and families, say these markers can reduce misunderstandings with law enforcement, explain why someone might not respond typically in a crisis, and help folks access assistance in travel, medical, or security settings. Critics worry about privacy, data misuse, and the risk that a symbol meant to protect could expose disabled people to profiling or discrimination, especially if officers or agencies lack proper training. The same design that could make interactions safer may also force people to disclose something deeply personal just to move through public life, which is why most of these programs stress that the markers are voluntary and part of a broader conversation about rights, safety, and trust.​

The Sunflower Movement

The Sunflower Movement takes a different, more global approach by using a simple visual symbol—a yellow sunflower on a green background—to quietly say, “I have a non-visible disability; I may need a little extra time or support.” The Hidden Disabilities Sunflower program started in UK airports and has spread across airlines, transit systems, and public venues in the U.S. and worldwide, with lanyards, pins, or badges that travelers can choose to wear. For people who travel, the appeal is that you don’t have to verbally explain a diagnosis every time you go through security or check in; instead, staff trained on the symbol are supposed to slow down, offer clearer instructions, or provide small accommodations like extra time, seating, or help navigating noisy, crowded spaces.​

Airports from Albany to Boise and Nashville have adopted the sunflower lanyard program as part of disability awareness and inclusion initiatives, often pairing it with staff training and signage so people know what the symbol means. Travelers with autism, chronic pain, anxiety, or other invisible conditions have described feeling more seen and less judged when wearing the lanyard, especially in stressful spaces like TSA lines or boarding gates. At the same time, the sunflower is not legally binding—unlike ADA accommodations—and depends heavily on staff attitudes; if workers aren’t trained or take it as “just a nice idea,” the symbol can lose its power and even feel performative. For many in our generation, the Sunflower Movement sits at the intersection of design and dignity: it’s a low-tech, opt-in signal that can make travel more humane, but it also reminds us that real inclusion still requires policy, training, and accountability behind the symbol.

CRPD and Human Dignity

While there are clearly benefits to implementing such IDs, there are also human rights concerns that we need to be aware of when placing identifying markers on government documents. The Convention on the Rights of Persons with Disabilities emphasizes respect for inherent dignity, autonomy, and privacy, which implicitly warns against measures that increase stigma or surveillance. An ID marker might help in some emergencies, but it can also conflict with the right to privacy and non-discrimination if used coercively or without strong safeguards.​ On one hand, the designation could protect life and security (civil and political rights) in police encounters; on the other, it could undermine equal treatment in employment, housing, or education if IDs are widely requested or copied, thereby harming economic, social, and cultural rights. From a human rights perspective, it is important to consider this bill’s implications for privacy, potential misuse of data, and the risk of profiling. There is the potential for harmful labeling labeling and hidden discrimination practices through this policy, particularly for marginalized communities already facing over-policing.​​

Conclusion

For Alabamians with “invisible” disabilities, this new ID proposal raises immediate questions: Who controls disability disclosure? How do policies intended to “help” sometimes deepen exclusion? And how can we push for alternatives—like better training, crisis-response reform, and universal design—rather than relying on labels that follow disabled people everywhere they go? Creating a human-rights-oriented world requires creativity and innovation, and ID markers and sunflowers are just two methods among many that we could implement to advance this cause. In pursuit of human rights, let’s be sure to consider the pros and cons of every step we take. ​

Eyes on Catatumbo: Colombia’s Silent Humanitarian Crisis

In mid-January 2025, people living among rural hills and rivers of the Catatumbo subregion of Norte de Santander —along Colombia’s border with Venezuela— faced a drastic and sudden surge of violence. Rival armed groups clashed in a territorial battle that forced tens of thousands of men, women, and children to flee their homes in a matter of weeks. According to available estimates, more than 56,000 people were displaced during this outbreak. Entire communities were uprooted almost overnight. Families left behind crops, homes, and schools as they escaped through mountains, carrying little more than what they could hold. Some families traveled for days on foot, crossing rivers and unpaved trails, hoping to reach towns where humanitarian aid might be available. The journey itself was dangerous, exposing them to natural hazards, extreme weather, and the constant threat of encountering armed actors along the way.

The clashes also cut off humanitarian access, collapsing local health services and leaving thousands without food, shelter, or protection. The United Nations Office for the Coordination of Humanitarian Affairs reported that several municipalities, including El Tarra, Tibú, and Teorama, remain difficult to access even for aid convoys due to the presence of landmines and ongoing combat. These obstacles reveal not only the magnitude of the emergency but also the absence of a unified response strategy capable of addressing overlapping humanitarian, political, and security challenges. Medical teams attempting to bring vaccinations and essential medicines often have to reroute through alternative paths, delaying assistance to families in urgent need. Aid organizations have emphasized that the lack of reliable roads, combined with intermittent communications, hampers coordination and prevents the full scale of needs from being properly assessed.

Colombian army patrolling the streets, military forces on urban patrol in Colombia, soldiers securing the streets in Colombia, army troops conducting street patrol, Colombian military presence
Photo 1: Colombian army patrolling the streets. Source: Adobe Express. By: Alejandro. Asset ID# 1249540839.

A Conflict That Refuses to End

For many in Catatumbo, this is not a new story. The region has long been a zone of contestation, where fertile land, strategic routes, and a history of coca cultivation have drawn armed actors for decades. Despite multiple peace efforts, the Colombian government and the National Liberation Army (ELN) have failed to reach a lasting agreement, even after several rounds of talks in 2024 and early 2025. These breakdowns in dialogue have left a dangerous power vacuum, allowing the ELN and the dissident Revolutionary Armed Forces of Colombia (FARC) fronts to consolidate control in certain areas and tighten their grip on communities. Negotiations, often mediated by international actors, faltered due to persistent mistrust, accusations of non-compliance, and ongoing attacks during ceasefire periods.

Without a credible peace accord or strong state presence, civilians remain trapped between armed factions. Extortion, forced recruitment, and targeted assassinations continue to define daily life. In municipalities like Tibú, local residents report that shops must pay protection fees to avoid being attacked, while teachers and health workers face direct threats if they refuse to comply with armed groups’ demands or resist recruitment campaigns targeting young people. The persistence of conflict is also tied to the strategic importance of Catatumbo’s geography; its dense forests, mountainous terrain, and border with Venezuela make it a natural corridor for smuggling, illegal mining, and drug trafficking. Both the ELN and FARC dissidents use this border to move arms and coca paste, while Venezuelan armed groups exploit the instability to expand their influence.

For local residents, peace talks that never materialize mean that promises of safety remain words on paper, while violence continues to dominate daily life. As one community leader told the newspaper El Espectador in February 2025, “We are living between two wars—the one that happens in the mountains and the one that happens in silence when no one comes to help us.” This sentiment is echoed across Catatumbo, reflecting the frustration and fear that residents endure as cycles of displacement and insecurity continue year after year.

When the Crisis Fades from View

Despite the urgency and scale of this crisis, national and international coverage faded quickly after the first wave of reports in January and February 2025. That silence matters. When forced displacement disappears from headlines, so do the people living it. This invisibility normalizes neglect, delays humanitarian responses, and weakens accountability.

Based on the most recent protection analysis report, by April more than 62,000 people had been displaced and an additional 27,000 confined in their homes, unable to move because of landmines or threats from armed groups. Yet beyond a few humanitarian updates, public attention dwindled. One reason lies in the geography and access issues of Catatumbo. Journalists and medical staff face severe restrictions: entering many rural zones requires permission from the military or local armed actors. Donor fatigue also plays a role: international organizations have limited budgets and often prioritize higher-visibility crises. As a result, funding for Colombia’s internal displacement response in regions like Catatumbo has lagged.

The invisibility of the crisis is not just informational, it is political.

A view of indigenous children from the Embera people, displaced by armed conflict.
Photo 2: A view of indigenous children from the Embera people, displaced by armed conflict. Source: UN Photo; by Mark Garten; Unique Identifier: UN7715269.

The Stakes: Life, Dignity, and the Fabric of Communities

When a family flees their home at night carrying only what they can, they are not just moving, they are losing a way of life. Land, livelihood, and community ties are abruptly severed. Among those displaced in Catatumbo, families are separated, elders lose access to medication, and children miss months of school. Young people face a heightened risk of recruitment or exploitation. Humanitarian workers warn that amid the chaos, gender-based violence, human trafficking, and child recruitment are on the rise. These are not isolated incidents; they are part of a broader pattern of rights violations that undermine communities’ social fabric.

This is not only a crisis of numbers—it is a crisis of rights and belonging. When the state cannot or will not guarantee protection, internal borders form. These lines are not drawn on maps, but rather through abandonment, neglect, and fear. Those living within these invisible borders are often left to face violence alone. The humanitarian system’s focus on immediate relief, without long-term strategies for restitution or reintegration, risks perpetuating these cycles of vulnerability.

Cúcuta: The Border City Bearing the Weight

The humanitarian fallout has spilled into Cúcuta, one of the largest cities in Norte de Santander and a key crossing point to Venezuela. As displaced families arrive seeking refuge, schools, shelters, and hospitals are overwhelmed. Local authorities struggle to register new arrivals and provide basic assistance. Many displaced people sleep in overcrowded houses or informal settlements near the border, where conditions are precarious. Limited job opportunities push most into informal labor or survival economies. Meanwhile, the influx of people has intensified pressure on already fragile public services, deepening social inequality and tensions in host communities.

Organizations like the International Rescue Committee (IRC) and Pastoral Social have set up temporary aid centers offering hygiene kits, psychosocial support, and legal counseling. However, these efforts often operate with minimal funding and no long-term sustainability. Teachers in Cúcuta’s public schools have reported overcrowded classrooms, with some hosting up to 50 students, many of them recently displaced or migrants from Venezuela. Children often struggle to keep up academically, while parents face pressure to find income quickly, forcing many into informal work that provides little security.

Human rights observers, including the ACT Alliance, the Norwegian Refugee Council, and UNHCR, have warned that unless there is sustained national support, Cúcuta and the surrounding municipalities could soon become the epicenter of a prolonged displacement emergency.The city’s local government has called for international coordination, urging Bogotá, UN agencies, and the Venezuelan authorities to establish a humanitarian corridor. However, bureaucratic obstacles and diplomatic tensions between the two countries have stalled progress. Even when aid is allowed, delays and limited resources prevent sustained coverage for both immediate relief and long-term recovery.

 

A view of a migrant tent
Photo 3: Migrant tent. Source: Adobe Express. By Andrea Izzotti. Asset ID# 128345640.

Documentation and the Demand for Accountability

In the midst of this crisis, documentation plays a crucial and often lifesaving role. Human rights groups, journalists, and even the survivors themselves aren’t simply keeping track of events; they are building a record that can shape humanitarian responses, inform policy, and hold perpetrators accountable in the future. Organizations like Human Rights Watch, the Norwegian Refugee Council (NRC), and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) rely heavily on reports from the field to see what’s really happening, identify urgent needs, and spot patterns of abuse. They collect this information through interviews with displaced families, surveys in affected communities, and photographic or video evidence of destroyed homes, schools, and infrastructure. Each record isn’t just a statistic—it’s a voice, a story, and a testimony from people whose experiences are too often ignored or silenced.

For families, documentation gives words to experiences that are otherwise invisible. It allows survivors to describe what happened, who was affected, and who is responsible. Lists of victims, personal testimonies, and photographs are far more than records, they’re tools for protection, reparations, and accountability. Imagine a parent reporting that their teenage child has been forcibly recruited by an armed group; that report isn’t just a number in a database. It can trigger emergency protection measures, alert authorities to ongoing recruitment campaigns, and eventually inform broader policy changes. Photographs of destroyed homes, abandoned fields, or burned schools can serve as concrete evidence in legal and advocacy processes, ensuring that destruction and loss don’t go unnoticed.

But documentation on its own isn’t enough. In Catatumbo, the state is often absent, and political will is inconsistent at best. Armed groups operate with near impunity, while local authorities may lack the capacity, or the security, to act on reports of abuse. Without a platform to turn these records into action, documentation risks becoming a snapshot of suffering rather than a catalyst for change. This is why media attention, advocacy, and international solidarity are so essential. Without them, even the most thorough documentation can sit in databases without effecting any real-world impact.

The Colombian Truth Commission (CEV) has stressed that remembering is key to preventing repetition. Its final report highlights how collective memory plays a central role in breaking cycles of violence. But if testimonies simply sit in a database without leading to policy reforms or justice initiatives, then impunity continues, and survivors remain vulnerable. In other words, documentation must have a purpose: it must feed into action, whether through legal avenues, public policy, or protective measures.

Local communities have also taken matters into their own hands. Community radio stations like Voces del Catatumbo act as informal archives of survival. They broadcast updates, report abuses, and provide essential information about displacement, health, and security. These stations give residents a platform to be heard in real time and foster a sense of connection in a region where isolation is a constant threat. They are also a reminder that documentation isn’t just a bureaucratic process—it’s lived, community-driven work that can save lives.

A passenger truck travels on the road between Riohacha and Uribia on La Guajira peninsula, Colombia.
Photo 4: A passenger truck travels on the road between Riohacha and Uribia on La Guajira peninsula, Colombia. Source: UN Photo; by Gill Fickling; Unique Identifier: UN7386312.

What We Can Do as Readers, Citizens, and Advocates

Keeping eyes on Catatumbo is both a moral and political act. Sharing verified information, reading humanitarian updates, and amplifying local voices helps keep the crisis visible. International partners can support local organizations with funding and technical assistance, while citizens can call for greater accountability from their governments and international institutions.

We must hold two truths together: the urgency of humanitarian needs today, and the necessity of long-term justice and inclusion. Attention, when sustained and informed, can make a difference.

If we listen to the people of Catatumbo—and now those arriving in Cúcuta—we learn that rebuilding is not only about returning to what once was. It is about imagining what could be: a community whose safety, dignity, and memory are protected, not merely by the absence of conflict, but by the presence of justice.

 

The Treatment of People with Disabilities in Institutional Care Settings in Brazil

 

A flag of Brazil flowing in the wind
Image 1: Flag of Brazil. Source: Yahoo! Images

Overview of the Issue 

In Brazil, thousands of children and adults with disabilities are confined to institutions for people with disabilities, facing widespread neglect, abuse, and isolation. Designed ostensibly to provide care, many of these institutions have instead devolved into detention centers where individuals are deprived of their autonomy and dignity. Reports from Human Rights Watch reveal the harrowing conditions experienced by people with disabilities in these facilities, underscoring the urgent need for systemic reform to safeguard their basic rights.  

One relevant case is that of Leonardo, a 25-year-old man with muscular dystrophy who has lived in a residential institution since he was 15. His mother, unable to care for him due to a lack of adequate support, was left with little to no choice. Like many others, Leonardo shares cramped quarters with multiple residents, with minimal privacy or control over his daily life. There are very few meaningful activities available for him to partake in, and he has seemingly no apparent opportunity to participate in society as an autonomous individual, mirroring the experiences of countless other residents across Brazil’s institutions.  

Causes of Institutionalization  of the Care for People with Disabilities 

The institutionalization of the care for individuals with disabilities in Brazil is shown through several interrelated systemic issues. First, the lack of adequate support for families plays a significant role. The government offers limited resources, and financial assistance programs, such as the Benefício de Prestação Continuada (BPC), often fail to fully meet the comprehensive needs of individuals with disabilities, which include therapy, assistive devices, and accessible housing. Without meaningful support systems, families may feel they have no alternative but to rely on institutional care.  

Brazil’s legal and systemic framework also plays a crucial role. Guardianship laws that remove legal capacity from individuals with disabilities mean that many residents in institutions cannot consent to their placement. This lack of autonomy, combined with the stigma of ableism, creates an environment where people with disabilities are treated as passive recipients of care rather than individuals who should have rights and preferences. Public perception remains rooted in ableist attitudes, which continue to limit access to inclusive services and resources.   

The COVID-19 pandemic exacerbated these disparities, intensifying existing challenges for people with disabilities in Brazil’s institutional care settings. This revealed vulnerabilities in both healthcare access and living conditions. Individuals with disabilities were disproportionately affected by the virus due to several factors, including pre-existing health conditions, limited access to adequate healthcare, and cramped, unsanitary living environments within institutions. These conditions not only increased infection rates but also made it difficult to implement preventive measures, such as social distancing and proper sanitation.   

Hospital Beds. Source: Yahoo! Images
Image 2: Hospital Beds. Source: Yahoo! Images

Problems Within Institutions for People with Disabilities 

The institutional care setting for People with Disabilities in Brazil fails to meet even the most basic standards of dignity and human rights. Living conditions in many of these institutions are deplorable. Reports from Human Rights Watch describe facilities that resemble prisons more than care centers. Physical restraints, such as tying residents to beds or sedating them, are surprisingly common. Such practices not only prevent individuals from engaging in any form of meaningful activity, but also contribute to a host of physical and psychological traumas.  

Isolation is another significant, impactful issue. Many residents are confined to their beds or rooms for extended periods, with little to no engagement in social interaction or personal development. Children, specifically, suffer due to the lack of educational and recreational activities, which then stunts their intellectual and emotional growth. This isolation leads to further stigmatization and marginalization, unfortunately reinforcing the perception that people with disabilities are separate from society and should be hidden from view, whether intentionally or not.  

The lack of oversight and enforcement of existing laws allows for egregious human rights abuses to go unchecked. In many cases, individuals are institutionalized unlawfully, deprived of family connections, and subjected to a lifetime of neglect. Children who enter these institutions often lose contact with their families permanently, which can lead to long-term emotional trauma and a deep sense of abandonment.  

Access to healthcare for people with disabilities in Brazil also remains alarmingly inadequate. Despite the legal frameworks designed to protect their rights, physical and financial barriers to healthcare still exist, compounded by a lack of training among healthcare providers to address the specific needs of people with disabilities. These gaps contribute to a high incidence of preventable health complications and reduced life expectancy.   

Efforts Toward Reform  

While Brazil has established a strong legal framework for the rights of people with disabilities, including the ratification of the Convention on the Rights of Persons with Disabilities (CRPD) and the enactment of the 2016 Law on Inclusion, the enforcement and practical implementation of these laws remain lacking in change. Legal rights exist on paper, but without mechanisms to enforce them, individuals with disabilities continue to suffer abuse, neglect, and loss of their freedoms.  

United Nations Committee on the Rights of Persons with Disabilities and many advocacy organizations have called on the Brazilian government to transition from institutional care to community-based services that prioritize individual autonomy and family support. These efforts encourage the development of small, inclusive residences and group homes to reduce the dependence on large-scale institutions. Although some of these programs have been started up, they fall short of ensuring true independence and often lack the necessary resources to fully support residents in their transition to independent living.  

Efforts to improve healthcare access are underway, focusing on providing disability-specific training to healthcare providers and addressing financial and physical accessibility challenges. These interventions are essential to improving the health outcomes of individuals with disabilities and to fostering an inclusive healthcare environment that treats people with disabilities as valued members of society.  

Looking Ahead  

The treatment of people with disabilities in institutional care settings in Brazil reveals a profound humanitarian crisis that requires focused attention. The combination of insufficient support systems, societal stigma, and legal challenges results in an environment where individuals with disabilities are denied their rights, autonomy, and dignity. While Brazil has made some strides toward recognizing and enshrining the rights of individuals with disabilities, significant gaps remain in the enforcement of these rights and in the availability of community-based alternatives to institutionalization.  

Addressing these issues calls for a multifaceted approach, including policy reform, enhanced support for families, and the development of inclusive, community-based care. By prioritizing the rights and voices of individuals with disabilities, Brazil can move toward a more just and humane society where all individuals are treated with respect, dignity, and equal opportunity.  

 

American Psychiatric Abuses: Residential Treatment Facilities

Content warning: this blog will include mentions of child abuse, child self-harm, child suicide, and child sexual abuse.

Psychiatric Residential Treatment Facilities (PRTFs) are in-patient institutions that provide inpatient psychiatric care to people under the age of 21. They are a common form of short-term psychiatric care for young people. Children do not choose to be committed to these facilities, and they do not want to be. Two children said they were being treated like animals. Many said, “I don’t feel safe.”

Physical Abuse 

Children in PRTFs are extremely vulnerable due to both psychiatric issues and the nature of living in institutionalized care. Facilities are often understaffed, leading to minimal supervision and increased opportunities for abuse – by staff and other children.

 

A former child group home resident and his mother.
Image 1: A former child group home resident and his mother. Source: Yahoo Images

Staff members at PRTFs have frequent opportunities to abuse their charges. A staff member at Cumberland Hospital in Virginia “poured scalding water on a non-verbal 16-year-old.” An 11-year-old boy from Arkansas was pushed down, had his hair pulled, and had a staff member place her foot in his back. A staff member at Devereaux Brandywine in Pennsylvania was found guilty of assault after she “punched and kicked a 14-year-old in the head, face, and body until the child was unconscious.” In December 2023, a staff member at a facility in Arkansas told a police officer, “I went in there, and I basically twisted his ear real hard in order to get him off the bed, which we’re not supposed to touch them.” A staffer at a facility in South Carolina “hit the child twice, including punching the child in the head.” At a Devereux facility in Viera, Florida, a staff member hit a boy on his neck, leaving marks. It is sad that state governments pay pay thousands of dollars daily for children to be abused by their caretakers.

Further, due to apathy and unawareness from staff, children are also able to abuse other children in PRTFs. At Riverside Hospital in Virginia, a child was “repeatedly stabbed by another child.” At North Star Behavioral Health in Alaska, after two children were accidentally placed in seclusion together, one child gave the other a bloody nose. At the same Alaska facility, a child was “punched, slapped in the eye, and kicked by other children.”

None of these instances of abuse were reported to the children’s guardians in a timely manner. Some parents were never notified.

Sexual Abuse 

A caregiver at Lighthouse Care Center of Augusta, in Augusta, Georgia, was arrested and convicted of child molestation. An employee at a facility in Alabama was sentenced after sexually abusing a 13-year-old boy she should have been caring for. A man working at a facility in Chicago was charged with three counts after sexually assaulting minors in his care. A Utah man pled guilty to sexually abusing three male students at a residential school he worked at.

Staff members also allow sexual abuse to occur between children. At Devereux Brandywine in Pennsylvania, a 13-year-old boy asked not to be placed in a room with an older boy he was afraid of. They were placed as roommates, and “the older boy forced the younger child to perform oral sex on him on three successive nights in a walk-in closet.” This is one of many equally disturbing instances of staff enabling sexual abuse at facilities. One facility in New Mexico closed partially due to “the unchecked spread of HIV among patients” – something that brings to mind the hepatitis experiments of the 1950s, 1960s, and 1970s at Willowbrook State School, an infamous institution in New York.

A postcard from Willowbrook State School.
Image 2: A postcard from Willowbrook State School. Source: Yahoo Images

Neglect and Unsafe Environments 

Staff at PRTFs are often unable or unwilling to prevent children from harming themselves. Disability Rights Arkansas, the Protection & Advocacy Agency for Arkansas, reported that one girl “still had access to items to cut her arms. There were numerous new scars over her old scars.” The staff did not care. Another child at the same facility said that she had “used the second stall [with cracked and sharp shower tiles] to self-harm.” The staff did not care. If they had, the children in their care would be safe. A child at Palmetto Pines Behavioral Health in South Carolina “barricaded themselves inside of his suicide watch room…[and] used the plastics piece to cut his neck in an attempt to kill himself, but it was not sharp enough.” The staff did not care. A child at Provo Canyon School in Utah “caused personal injury during self-harm, with wounds that were one and two inches in length… through the fatty tissue.” At Oak Plains Academy in Tennessee, two 15-year-olds overdosed on Benadryl. The mother of one of them said, “I’ll never see her again; I just want justice for her; I just want her story told. And I want – I never want this to happen again to anyone.”

A box of Benadryl.
Image 3: A box of Benadryl. Source: Yahoo Images

Minority Children 

Children who are also members of minoritized groups, especially children of color and LGBTQIA+ children, have even greater difficulties in PRTFs.

According to a Senate report, “[T]he longer an RTF stay, the longer a child is at risk of exposure to harms, including the use of restraints and seclusion, physical and sexual abuse, insufficient education, and substandard living conditions. This risk is heightened for children of color, LGBTQIA+ youth, and children with I/DD (intellectual/developmental disabilities) who are most likely to live in these settings.” Black children are 35% more likely than white children to be placed in institutionalized care facilities.

Cornelius Frederick, a 16-year-old Black boy from Michigan, was killed at a facility in Kalamazoo, Michigan, in April 2020. Seven male staff members restrained Frederick for 12 minutes. The medical examiner ruled his death a homicide – asphyxiation.

In 2018, a gay 16-year-old was attacked while residing at St. John’s Academy, a Sequel facility in Florida. His attacker told him that he “didn’t want a fa***t in the pod.” Disability Rights Washington reported that two “crisis plans” for children residing at PRTFs used incorrect gendered pronouns when referring to the child. In 2020, two transgender girls resided at Sequel Courtland in Courtland, Alabama – a boys’ facility. One girl was being stalked by other residents. She did not feel safe.

Further Information 

For further reading about the kinds of abuses that go on in these facilities, consider reading a blog I wrote in April about group homes. You can also reach out to local representatives about ending or reducing out-of-state institutionalizations, which are harder to investigate than in-state institutions.

Group Homes for People with Disabilities are Harbors for Abuse

By James DeLano

“I don’t feel safe here.” 

That statement was uttered repeatedly in interviews performed by the Alabama Disabilities Advocacy Program (ADAP) with residents of Sequel Courtland, a psychiatric group home for boys in Courtland, AL. The residents of the home reported consistent patterns of abuse. One boy “reported witnessing a staff member lifting another resident up by the throat and slamming him to the floor.” Multiple boys reported being slammed into the ground and not being allowed to receive medical attention.

Three people standing outside the door of a group home
Group homes often house only a few people. Source: Yahoo Images

Sequel Courtland is a facility for boys. At the time the letter was sent in July 2020, there were “at least two transgender girls inappropriately placed at Courtland,” one of whom reported that she “is constantly touched, smacked on the butt” and that “they [other residents] try to watch me dress.” 

At a Sequel facility in Owens Cross Roads that was part of the same investigation, “male staff repeatedly enter girls’ bedrooms and put them in violent containments.” At the same facility, residents were frequently ordered to sleep in common areas rather than in their bedrooms as a punishment. Staff also failed to report or make any attempt to prevent suicide attempts. 

Sequel Montgomery practiced “Group Ignorance” as a punishment. Group Ignorance, or GI, involved staff and other residents completely ignoring the person being punished. The isolated person was unable to interact with peers in any way; just being within ten feet of another resident would be considered a violation. The facility’s then-current guidelines read that “They can participate with peers only during direct billable services—BLS and therapist-led group therapy.” One resident reported attempting suicide specifically because of the stress of being isolated under GI. 

Sequel Tuskegee utilized a “time-out room” for up to days at a time as a means of controlling residents. There was no mattress present in the room; boys were required to move the mat from their bedroom into the confinement area. It also lacked a toilet or sink. Because of that, residents were forced to either try – and often fail – to gain staff’s attention to use the restroom or, failing that, “urinate in the corner of the room and clean it up later.” 

A Sequel group home in Ohio was also investigated by that state’s protection & advocacy (P&A) agency,  Disability Rights Ohio. They reported that one of the children living at that home told them he was “Put in a hold so strong that it almost broke my arm; they kept holding me tighter and tighter; my hands and arms were tingling and going numb.” Another said, “I don’t feel safe.” 

Abusive group homes are not exclusive to Sequel. Group homes are often abusive, no matter what company owns them. 

At a residential facility called Canyon Hills Treatment Facility in North Carolina, “at least one-third of residents lost weight after they were admitted for treatment.” Canyon Hills’ residents were children who should still have been growing. When residents asked for more food, their portions were cut even further. At another facility in North Carolina called Anderson Health Services, “Ten staffers at this facility have been charged with child abuse since 2017.”

At a group home in California, a woman with severe autism often went out on rides in the home’s van. She occasionally tried to stand up, after which “the staff member driving would slam on the brakes and, like, brake check her.” That practice caused bruises. The same woman, who had harmed herself in the past, was frequently left alone and unsupervised, during which time she banged her head into the wall, leaving large holes in the process. 

Neglect in Group Homes 

Many group homes are chronically understaffed. That, along with low pay and a lack of care from and proper training for staff, collectively leads to preventable injuries and death. 

A woman choked to death at a New Jersey group home in 2017. She was unable to swallow large pieces of food; everything needed to be in small pieces, and she required supervision while eating. Two years prior, she had been taken to the hospital after choking on a bagel – an incident her family was never told about. 

As a result of poor staffing, a resident of an Oklahoma group home named Terry Brown was strangled by his roommate. There was only one staff member on duty; when she intervened, she was attacked as well and “watched Terry’s body turn purple, go limp and fall lifeless.” At a group home owned by the same company, a resident drowned in 2011 on an outing. He was supposed to be wearing a life jacket. When he died, there was no life jacket for him to wear. 

One Texas caregiver worked for almost 70 hours straight while caring for two disabled women; her only breaks were a short nap and a trip to run errands. She is the only caregiver for two women who require constant care and supervision. She was clocked in from 8:16 Tuesday morning to 10:08 Friday morning, and only four hours after clocking out she returned for another 19-hour shift. She said that, “I’m always here. The only thing I do for fun — besides sleep — is go to church, read my Bible, hang out with my family.” The only occasional help she has comes from equally understaffed and exhausted workers at other group homes. For her work – providing constant, necessary care to two people – she makes $9 per hour, which is a wage that is not uncommonly low and serves as one of many reasons group homes are so often neglectful.

At the previously mentioned Sequel group home in Courtland, Alabama, ADAP investigators found blood and feces on windows and floors. The same investigation had residents report insufficient and inadequate food and water, nonexistent education and medical treatment, and that “there’s mold in the showers, and rats and roaches in our bedrooms and the hallway.” 

Physical and Chemical Restraint 

Mental healthcare professionals generally agree that restraining someone who is in crisis only makes things worse. Many group homes do it anyway.

As part of the previously mentioned investigation into Sequel facilities in Alabama, numerous instances of inappropriate restraint were reported. A report compiling the results of several investigations by various state Protection & Advocacy Agencies (P&As) reads about an Alabama group home, “One boy described his head being caught on a nail in the wall during a restraint; another said he was picked up and slammed on his stomach onto the concrete. A boy who had visible gashes to his head said that facility staff had slammed him against a wall the previous night.” 

In 2020, a 16-year-old boy was physically restrained by several staff members at a Sequel facility in Kalamazoo, Michigan, for twelve minutes. They used their body weight to restrain his torso and legs. He died two days later due to being asphyxiated while he was restrained. His name was Cornelius Frederick. In the 18 months preceding his death, emergency services visited the facility 237 times. 

A group home in Carlton Palms, Florida has yet another pattern of restraints being used. Those restraints include cuffs, residents being strapped to chairs or being tied down, and straitjackets. These restraints directly cause physical harm – broken bones, bruises, and broken teeth, to name a few. 

A box of Seroquel in front of a laptop.
A box of Seroquel in front of a laptop. Source: Wikimedia Commons

Seroquel is an antipsychotic drug that is approved by the FDA to treat some severe mental illnesses. Seroquel does not have an immediate effect. It is not approved as a form of chemical restraint or as a treatment for insomnia or anger management, among other off-label uses, but that is what it has been marketed and used for. Disability Rights Tennessee, the P&A agency in Tennessee, reported that “In one facility, staff increased a child’s Seroquel dosage from 50 mg to 300 mg as an emergency intervention.” The same problems occurred in North Carolina; “staff had administered Seroquel numerous times to a child who did not have any diagnoses that would indicate use of antipsychotics.”

What Is Being Done? 

Several of the group homes mentioned above have shut down since investigations into them concluded, including some Sequel group homes. Sequel changed its homes’ names to Brighter Path due to the negative press. In other cases, states have stopped sending children to abusive group homes or, rarely, revoked their licenses. Other group homes, while not yet shut down, are no longer receiving new residents or are being downsized. 

Mental Illness in U.S. Prisons and Jails

by James DeLano 

“I run the biggest mental hospital in the country.”

That was Los Angeles County Sheriff Lee Baca in 2005. He was referring to the fact that, in 2005, over 2,000 people in the county jail had been diagnosed with a mental illness. That has not changed. Nationwide, between 16% and 24% of incarcerated people have a severe mental illness. In the general population, 4% of people have these illnesses. Prisons are serving as replacements for psychiatric hospitals, but they are not changing to accommodate that.

In the 1840s, people with mental illnesses were generally imprisoned. That was due to the criminalization of many symptoms and a lack of societal acceptance. Although mental disability has not been a legitimate excuse for imprisonment, mental health problems are still significant in today’s prisons.

National Problems 

Nationally, estimates for the percentage of inmates with a severe mental illness range from 15% to 20%. As previously mentioned, the Los Angeles County Jail was described by its sheriff in 2005 as the largest mental hospital in the country. At the Cook County Jail in Illinois, about 1/3 of the incarcerated population has a mental illness. According to the mental healthcare supervisor at the Gwinett County Detention Center in Georgia, the closure of a nearby psychiatric hospital caused the number of mentally ill inmates to skyrocket. In Polk County, Florida, the jail has a mental health unit based on psychiatric hospitals and “immediately put[s] them back on medication because the vast majority of them – the overwhelming majority of them — have decompensated.” In the U.S. Virgin Islands, individuals who were found not guilty of a crime by reason of insanity – that is, who committed a crime but were determined not to be culpable due to a mental illness – are kept in the general prison population rather than being hospitalized. For that reason, the U.S. Virgin Islands has been involved in a class-action lawsuit, Carty v. Mapp, since 1994, one which shows no signs of being resolved.

These situations are exacerbated by the criminalization of symptoms and coping mechanisms of people with mental illnesses. Some people use illegal substances as a means of self-medication. Others steal food or break into buildings to find a place to sleep. Rather than investigating the reasons behind these crimes, people are incarcerated, sometimes medicated, and only occasionally given true mental health treatment. They are then released with no outside support or ways to continue accessing medications.

That is still entirely ignoring that prisons can cause mental health issues on their own. Solitary confinement, something that is widely used in American prisons, can cause or worsen symptoms of mental illness. Incarcerated people kept in solitary confinement are almost seven times as likely to harm themselves and more than six times as likely to “commit acts of potentially fatal self-harm” when compared to the general prison population.

Failures in the South

In 2017, a federal district court found that the Alabama Department of Corrections (ADOC) was providing “significantly inadequate care.” This decision came after years of litigation. The case, Braggs v. Dunn, is still ongoing almost ten years after it was first filed in 2014. Since then, little has changed in ADOC’s prisons.

An opinion given in the case mentioned Jamie Wallace and his testimony 36 times over 300 pages. Wallace was incarcerated in 2014 for the murder of his mother. He had been diagnosed with bipolar disorder and schizophrenia. He testified in December of 2016. He died of suicide ten days later while in a unit dedicated to severely mentally ill inmates. Five days prior to his suicide, a healthcare worker at the prison wrote that he was “using crisis cell/threats to get what he wants.”

Wallace was mentally ill. For that, he was punished by prison guards. He was disciplined twelve times for harming himself, six of which involved being subjected to solitary confinement. Solitary confinement is regularly criticized for being inhumane, and it is especially so for those with preexisting mental health issues. According to Solitary Watch, a non-profit dedicated to ending the overuse of solitary confinement, citing a 2014 study on the topic, “individuals placed in solitary confinement were 6.9 times more likely to commit acts of self-harm and 6.3 times more likely to commit acts of potentially fatal self-harm than people in the general population.” Adding that people with mental illnesses are more likely to harm themselves than people without paints a grim picture of what happens inside these walls.

After Wallace’s suicide, the court ordered an emergency plan to be made to prevent future suicides. That plan was too late for James David Johnson, who hung himself only a few days after Wallace.

The court also accused correctional workers of being ambivalent or actively encouraging suicide. “ADOC officers essentially called a prisoner’s bluff, and then that person attempted suicide.” During his testimony, Wallace said that a correctional officer handed him a razor blade and told him, “You want to kill yourself? Here you go. Use this.” The two parties in the case had previously settled over the issue of razor blades’ presence in crisis cells – the same kind of cell Wallace was able to hang himself in. This lack of awareness on the part of ADOC was only exacerbated by the chronic understaffing of mental health workers. In January of 2023, ADOC stopped reporting the number of deaths – both homicides and suicides – that occurred in its prisons.

In 2021, Disability Rights Mississippi, Mississippi’s federally mandated watchdog agency (protection & advocacy agency), filed suit against the Mississippi Department of Corrections due to severe mistreatment of numerous disabled inmates. One individual, who was described as having ADHD, OCD, and bipolar disorder, was refused access to his medications and, according to DRMS’s investigative report, “during suicide watch, recalls being told by a passing officer to go ahead and kill himself.” Another person with PTSD and bipolar disorder “needs… mood stabilizers. MDOC has yet to treat this offender.” The lawsuit itself, Wallace v. Mississippi Department of Corrections, reads, “DRMS has encountered many offenders who have attempted self-harm, which was ignored by MDOC staff. In some cases, the self-harm was encouraged by MDOC staff.”

Florence Supermax 

A short time after Braggs v. Dunn, another lawsuit was filed for similar reasons – this time against the supermax prison in Florence, Colorado, also called the ADX. Rodney Jones, who assisted in the early stages of the lawsuit and who was previously held in the ADX, told the New York Times in 2015 that a staff psychiatrist stopped the medication he took for his bipolar disorder because “We don’t give out feel-good drugs here.”

One of the plaintiffs in that lawsuit is Jack Powers. Powers was sent to the ADX after an escape attempt preempted by threats from members of the Aryan Brotherhood, some of whom he had testified against after witnessing the murder of a friend. All three men he testified against were being held at ADX Florence when Powers was transferred there. While incarcerated there, Powers “lost his mind.” He mutilated himself numerous times, including by removing his earlobes, chewing off one of his fingers, removing one of his testicles, and tattooing himself with a razor and black carbon paper dust.

A slightly elevated shot of Florence Supermax prison, a red brick building surrounded by short grass and hills.
Florence ADX Prison. Source: Yahoo Images

David Shelby was incarcerated for threatening President Bill Clinton after he “became convinced that God wanted him to free Charles Manson from prison.” While incarcerated, Shelby sliced off part of his finger and ate it. Herbert Perkins, another prisoner, attempted to cut his throat with a razor. After being treated, he was ordered to mop up the blood left in his cell – it had not been cleaned since he was taken to the hospital.

Conclusions 

American prisons often have inhumane conditions. Those issues are compounded even further when the inmates in question have a mental illness. Prisons are unprepared to serve as psychiatric institutions, nor have they, overall, attempted to change to do so. Even so, that is what they are doing. Between the lack of adequate treatment, the negative psychological effects being incarcerated can cause, and the lack of assistance from correctional workers, it should be no surprise that rates of self-harm, suicide, and mental illness in prisons are so high.

Courts take time to process cases. This is demonstrated by many of the cases mentioned; Carty v. Mapp has been ongoing for 30 years, Wyatt v. Stickney ended in 2003, 33 years after it was first filed, and Braggs v. Dunn, one of the more recent lawsuits mentioned, is over a decade old. This is by design. A longer trial gives more opportunity for both parties to adequately present cases and, in the cases of these lawsuits, make changes. Despite that necessity, something needs to change. Mentally ill people are suffering and dying in jails and in prisons. The correctional system will not change on its own; it takes outside pressure to change things, and lawsuits, the most effective means of creating this change, take decades to be resolved. Systemic changes need to be made to how these prisons function and the societal role they play.

 

How American Disability Rights Are Not Enforced

by James Delano

What Disability Rights Laws Exist? 

The Americans with Disabilities Act (ADA) is the primary law safeguarding the rights of disabled Americans. It was passed on July 26th, 1990, with updates later passed in 2008. The ADA was the largest law related to rights for people with disabilities in the United States when it was passed and remains so today. 

The ADA recognizes three major areas it applies to, covered in Titles I, II, and III. 

Title I was written about employment. It ensures equal access to employment for people with disabilities. It forbids discrimination towards employees with disabilities based on their disability and requires reasonable accommodations be made for them. Title II covers public services and buildings, such as libraries, public colleges and universities, courthouses, and benefits programs. Title II creates stricter standards for publicly funded agencies and programs than Title III does for private organizations. Both Title II and Title III require reasonable accommodations be made for the disabled individual requesting the accommodation without the infliction of undue hardship. 

Title III covers private corporations and “public accommodations,” which include hotels, restaurants, stores, private schools or daycares, parks, and others. 

Prior to the passage of the ADA, legislation designed to improve the rights of people with disabilities was sparse. The first major piece of legislation passed was Section 504 of the Rehabilitation Act of 1973. Section 504 was signed in 1977, years after the original Rehabilitation Act, due to the 504 sit-ins occurring at the time. The first version of IDEA, which protects children with disabilities, became law in 1975. The Fair Housing Act was only expanded to people with disabilities in 1988.

Dozens of protestors celebrate in San Francisco after Section 504 was passed. Source: Yahoo Images
Dozens of protestors celebrate in San Francisco after Section 504 was passed. Source: Yahoo Images

The ADA is primarily enforced by complaint. A person with a disability is required to submit a formal complaint to the Office of Civil Rights or to the Department of Justice. They are then required to go through the process of creating a mediation agreement to ensure future access for the complainant and for future people with disabilities. People with disabilities are discriminated against in almost all parts of life: employment, marriage, and voting. 

For example, in 2016, Jefferson County was forced to alter its polling locations due to violations of the ADA in numerous polling stations. Until 2010, UAB was under a similar resolution about buildings on campus; many buildings built and renovated after 1992, when architectural requirements began being enforced, were non-compliant with the ADA. Both complaints were filed by people with disabilities after their rights were violated. 

People with disabilities also largely lack marriage equality in the United States. Married individuals almost always lose their benefits after marriage, including Social Security payments, healthcare, and other necessities. Often, people with disabilities would be forced to give up the things that make them able to survive – health insurance, home healthcare, and other benefits – in order to gain the legal protection and social benefits of marriage.  

The ADA is the main legal source for most rights for people with disabilities in the United States. If the ADA goes unenforced, people with disabilities are left behind. That is why its enforcement is so important: without the ADA, most people with disability lack the ability to utilize their rights, and without that ability, those rights may as well not exist.

American Disability Rights in Modern Institutions for People with Disabilities 

Olmstead v. L.C. (1999) was a Supreme Court decision decided based on the text of the ADA. It created requirements in many cases for community-based services over widespread institutionalization. The goal of the decision was to reduce the number of people with disabilities who lived in institutions.

In 1967, 400,000 Americans resided in these institutions, amounting to about 0.2% of the total U.S. population. By 2012, that number had risen to about 1,900,000 Americans with disabilities living in institutions, or just over 0.6% of the total U.S. population. Is this an example of deinstitutionalization?

A middle-aged man stands inside a room at a group home in front of a bed. Source: Yahoo Images
A middle-aged man stands inside a room at a group home in front of a bed. Source: Yahoo Images

The ADA applies to group homes and smaller forms of institutions, but abuse is still rampant in those locations. In 2021 in a group home in Eight Mile, a resident was severely beaten, allegedly by an employee of the group home he was living at. A year later, at a group home in Chickasaw, two group home employees were arrested for pouring boiling water on a resident of the home who had physical and intellectual disabilities. In 2022 a man with an alleged history of domestic abuse was employed at a group home in Mobile County, where video footage shows him using a belt to assault a resident with severe disabilities. These cases of abuse in institutions happen regularly, despite Alabama’s rate of institutionalization of people with disabilities being lower than the national average and us being a smaller state than many others.

Larger states and the country as a whole are not immune to this problem. A study conducted in 2000 found that “Children with disabilities are 3.4 times more likely to be maltreated than nondisabled peers.” Between 2004 and 2010, over 6% of the deaths of people with developmental disabilities were caused by neglect and abuse. At the state level, numerous New Jersey group homes were forced to close in 2022 due to unreported abuse. 

American Disability Rights in Outside Institutions for People with Disabilities 

Discrimination against people with disabilities is not exclusive to group homes and locations specific to people with disabilities. In Alabama alone, since 2013, the Department of Education Office of Civil Rights (DOEOCR) recorded 74 resolved civil rights complaints in Alabama. The DOEOCR covers all areas under the Department of Education (DOE), including universities, K-12 schools, public libraries, and other groups funded by the DOE, and has recorded 74 resolved ADA-related complaints in Alabama since 2013. Those complaints have been filed against institutions including community colleges, four-year universities, including UAB, and K-12 school districts, including Birmingham City Schools twice, the Jefferson County school district once, and multiple other Jefferson County school districts. 

Outside of areas of education, the Department of Justice has filed 114 cases related to the ADA and other disability legislation since 2021. Two of those cases occurred in Alabama. One agreement involved Medicaid discrimination; the other was based on employment discrimination by the Alabama Department of Transportation. Prior to 2021, the Department of Justice filed numerous other cases regarding the ADA. Many cases involved people with HIV/AIDS, who are classified as disabled under the ADA. Others were over Olmstead. As I discussed above, Olmstead was intended to aid in the national deinstitutionalization effort. To that effect, the Department of Justice has filed many cases since Olmstead was decided regarding its enforcement. 

Medicaid is not immune to these problems either. Medicaid provides health insurance to low-income individuals and people with disabilities, many of the latter also being low-income. Last year, the Alabama Disability Advocacy Program (ADAP) filed a complaint against the Alabama Department of Senior Services (ADSS) alleging that there are barriers to accessing services provided by programs under the Alabama Medicaid Agency. According to ADAP, in the time they took to process the complaint in question, two individuals on the Medicaid programs in question died due to these failures. These Home & Community Based Services (HCBS) spent $132,000,000 in the 2021 fiscal year, and Alabama Medicaid as a whole received $5.6 billion in federal funding the same year, about $4700 in federal funds for each Alabamian who was eligible for Medicaid at the time. 

What is Changing? 

There are currently changes being made to many of the systems I discussed in this post. The aforementioned ADAP complaint regarding Medicaid is currently unresolved, and the Colby Act, which my colleague Lexie Woolums discussed at length in a recent blog post, was recently passed into law. Just a few months ago, the Department of Health and Human Services proposed changes to regulations around the Americans with Disabilities Act to clarify those that already exist. Those changes include clearer standards for health insurance coverage of medical equipment and clarify childcare requirements, both of which are things that many Americans have difficulty affording.

Shackling and Psychosocial Disabilities

by Blue Teague

An empty room with three windows, all with long, sheer curtains. The two ceiling lights are off. Nothing but light can be seen outside the windows.
An empty room with three windows, all with long, sheer curtains. The two ceiling lights are off. Nothing but light can be seen outside the windows. Photo by Hans Eiskonen on Unsplash.

Mental Health, Autonomy, and Psychosocial Disability

In 1887, Elizabeth Seaman—better known as Nellie Bly—published Ten Days in a Mad-House, a collection of articles she had previously written for Joseph Pulitzer’s New York World. Along with cementing her status as a World journalist, her raw, unfiltered reporting offered thousands of readers a rare glimpse into a mysterious frontier: American mental asylums.

A Pennsylvania native, Bly’s anonymous newspaper pieces championing women’s rights soon evolved into a career based on investigative journalism. However, complaints from her subjects resulted in newspaper executives assigning her to less controversial topics. After years of rejection and gender discrimination, Bly made a last-ditch attempt to save her career by approaching Pulitzer directly and weaseling her way into a novel undercover assignment. Critics had called her insane her entire life for her risky stories, and now she had to play the part.

Bly’s articles quickly garnered attention for numerous reasons. For one, the story itself was sensational. After successfully feigning insanity with odd mannerisms and facial expressions, Bly found herself in New York City’s Women’s Lunatic Asylum after a medical professional declared her clinically insane. There she remained for ten days despite immediately dropping the act. During this period, staff allegedly attributed her every move, including normal behavior, to her supposed mental illness. This would have perpetually prevented her release had outside contacts not stepped into vouch for her sanity. By this time, Bly had risen to minor celebrity as New York questioned where this “pretty crazy girl” had even come from.

However, it was Bly’s description of the institution’s conditions that quickly spread through the masses. Her multi-page articles detailed the physical abuse, gross negligence, and psychological harm patients endured.

Sanitation was poor. Disease was rampant. Food and potable water were scarce, and the staff frequently resorted to physical and verbal beatings when dealing with those under their care. Upon her exit, Bly stated that she believed many women there were as sane as herself. If anything, the asylum’s treatment of already vulnerable women caused insanity.

Eventually, a grand jury launched its own investigation into Blackwell Island’s institution, the parent of the Women’s Lunatic Asylum. Despite immense budget increases, the institution shut down a few years later in 1894.

 

A dilapidated wooden shed with some white paint on the door and bottom boards. It has two windows with broken glass and rusty frames. Behind it its dense woods.
A dilapidated wooden shed with some white paint on the door and bottom boards. It has two windows with broken glass and rusty frames. Behind it its dense woods. Photo by Lilartsy on Unsplash.

Life in Mental and Physical Shackles

Despite Bly’s work sparking outrage over a century ago, inhumane treatment of those with mental health disorders—or psychosocial disabilities—continues today. According to the World Health Organization, 1 in 8 people live with mental health issues. Without adequate support and resources, these conditions can quickly become disabling. Psychosocial disabilities share strong correlations with higher poverty rates, increased medical discrimination, occupational inequity, and other factors contributing to a generally lower quality of life.

In 2020, Human Rights Watch released 56-page document reporting rights violations of the mentally ill. “Shackling,” a recurring theme, was found in 60 countries across six continents.

Shackling is an involuntary type of hyper-restrictive housing. Although it does not include shackles specifically, restraints such as ropes, chains, and wires are commonplace methods in keeping the victim in extremely close quarters. These areas can be sheds, closets, or even caves. Similar to the asylums in Bly’s era, sanitation is a luxury. The detained person often eats, drinks, and defecates in the same space with little ability to prevent contamination.

The motives and background around shackling is a complex cultural issue. Some offenders tend to be family members who, despite loving the person, lack the resources and/or education to deal with mental health crises. Keeping the person confined can appear to be the safest option when confronted with the possibility of them hurting themselves or others.

Additionally, social stigma can create even more danger for the family as a whole as well as the mentally ill individual. Instead of risking exile or ostracization from the community, families may seek alternative healing methods at home, such as herbal remedies, that lack significant medical backing. This, in turn, can intensify psychosocial disability, leaving the family overwhelmed and confused with few options.

A photograph of a medical IV stand holding and empty IV bag on a dark background.
A photograph of a medical IV stand holding and empty IV bag on a dark background. Photo by Marcelo Leal on Unsplash.

Abuse at the Systemic Level

However, abuse does not just occur at the familial level. Mistreatment and abuse flourish in large institutions. The institutions go by many names: asylums, mental hospitals, psychiatric healing centers, etc. These are establishments, often state-funded, purposefully keeping those with psychosocial disabilities away from the general population. Although the institutions usually operate under the pretext of healing and protecting the mentally ill, many criticize the asylum system for blatant human rights offenses.

The abuse is systemic when many perpetrators organize and hide the mistreatment of victims. One such man, “Paul,” shared his experience with reporter Kriti Sharma from HRW’s Disability Rights Division. Paul had lived for five years in a religious healing center in Kenya. He said, “It makes me sad…It’s not how a human being is supposed to be. A human being should be free.”

Paul and his companions walked in chains—literal shackles—and were not allowed clothing. His restroom was a bucket.

In the USA, a wave of deinstitutionalization in the 1970s shuttered many mental asylums, and psychiatric facilities still operating do so with varying levels of success. New York City’s mayor Eric Adams recently announced an expansion of a law allowing months-long involuntary commitment to hospitals for those who, due to mental illness, failed to acquire “basic needs” such as shelter and food. Hospitalization would, in theory, provide the psychosocially disabled with the time and education to recover and start anew.

Opponents quickly pointed out flaws in this process.

As with shackling, involuntary hospitalization represents a loss of autonomy. In a 2022 article in The Guardian, Ruth Sangree reflects on the USA’s changing legislation by connecting it to her own experiences. She describes the monotonous isolation, undercurrent of fear, confusion resulting by the sudden loss of control over her own life. As a nineteen-year-old with no idea of when she would be “set free,” Sangree focused on appearing normal in fear of indefinite hospitalization, regardless of the effectiveness of treatments.

There stands the argument of many critics of institutions: the system is ineffective at best and traumatic at worst. Still, rebuttals exist. In one Times piece, retired employees from a California asylum vouch for the happiness of their patients, stating they “blossomed” when provided with regimen and shelter. This view forms the defense for New York’s law revision, which frames involuntary hospitalization as a compassionate action for the patient’s own well-being.

Objectively, both sides claim to want the same thing: a better quality of life for those with psychosocial disabilities. It has always been the how that stirs debate.

Eight people of varying skin and sleeve colors standing in a circle with one hand each stacked on top of each other's.
Eight people of varying skin and sleeve colors standing in a circle with one hand each stacked on top of each other’s. Photo by Hannah Busing on Unsplash.

The Future of Mental Health Care

One factor in the corruption of institutional systems lies in language. Terms like “healing center” and “asylum” have historically protected potential perpetrators from legal action. Nellie Bly’s work helped lift the veil around mental health and disability, peeling away the euphemisms to reveal the abuse of a vulnerable population.

Today, watch groups exist for this reason. Organizations such as the Alabama Disability Advocacy Program (ADAP) examine the care of people with disabilities in facilities like hospitals, nursing homes, and schools, where caregivers can easily take advantage of those under their care. If rights violations are found, they can work with the facility to improve conditions or take legal action. These organizations exist on a state and national level in the USA.

Individuals can make a difference by simply learning about mental health and advocating for equal treatment of those with mental health conditions. #BreakTheChains is a movement led by Human Rights Watch with goals of educating communities to prevent the chaining of men, women, and children with psychosocial disabilities.

Additionally, awareness is key—October is recognized as mental health awareness month, and invisible disabilities week is in late October. Psychosocial disability month specifically takes place in July.

A Brief History of Disability Advocacy in America & How the Colby Act is a Step Forward

by Lexie Woolums

“It will help me live a full life — to vote, to marry, and to go to church. It will help people with disabilities to live their own lives and speak for themselves.” – Colby Spangler.

How the Colby Act Began

The Colby Act is named after Colby Spangler, a Shelby County resident who was born with cerebral palsy.

Kim Spangler, Colby’s mom, remembers when she and Colby attended the Spring concert for Colby’s high school band. Colby had been in the school’s band for a year as a freshman. At this concert, the seniors stood up and declared where they would be attending college.

This prompted Colby to ask his mom where he would be going to college, which is something she had yet to consider.

Throughout Colby’s high school career, they began researching colleges that he could attend. Through this research, they learned that Colby’s individualized education plan (IEP) had to reach a certain degree for him to qualify to attend college. They also learned that most college programs preferred or even required that the student was their own guardian rather than being under guardianship by someone else, which was important to note since guardianship is a common occurrence as young people with disabilities become legal adults in Alabama at the age of nineteen. Some critics have called this the “school to guardianship pipeline.”

According to Kim, many people do not realize how many rights people sign away with guardianship, such as the right to vote, marry, and even where you can live.

Through this knowledge, combined with Kim’s advocacy as Colby went through high school, the Colby Act was born. Kim introduced the act in 2022, sponsored by Senator Arthur Orr (R-Decatur) and Cynthia Almond (R-Tuscaloosa). After being unanimously passed on April 20, 2023, the bill was signed into law by Governor Ivey and later went into effect on August 1, 2023. I will discuss this in further detail later, but the Colby Act proposes a legal alternative to guardianship known as supported decision-making. This is an important improvement for disabled people and elderly people since it will preserve their autonomy.

 

Colby wearing a shirt that says "The Colby Act, vote yes!" next to Representative Cynthia Almond of Tuscaloosa.
Figure 2:Source-Kim Spangler; Colby & Representative Cynthia Almond,
who co-sponsored The Colby Act with Senator Arthur Orr. 

 

History of Disability Advocacy in America

In the United States, people with disabilities have historically had their rights ignored or entirely removed. While I will not go into explicit detail here, my colleague, James DeLano, recently wrote an article about the atrocities of institutions for disabled people. Though institutions in the context of James’s discussion are far from the only instances where disabled people face being stripped of their rights, I found the brief history to be exceedingly informative as I wrote this article.

Legally and socially, disability rights have not always been viewed as civil rights but through a lens of charity, especially in the case of developmental and intellectual disabilities. Beyond that, legal action to protect disabled Americans came exceptionally slowly.

In 1977, President Carter’s new HEW (Housing, Education, and Welfare) Secretary, Joseph Califano, formed a review board to consider an act that would protect disabled people under federal law. Unfortunately, the board did not include anyone from the disabled community, so many people were concerned that the law would have critical aspects of it removed before being passed. The American Coalition of Citizens with Disabilities (ACCD) pushed for the signing of the regulations as they were, with nothing removed by the review board. They stated that if the piece was not signed by April 5, they would respond.

As the date passed with no action, protests began. In April of 1977, around 150 disability advocates staged a sit in a federal building in San Francisco. They remained there for 25 days, refusing to leave until the Carter Administration signed the law that promised to protect people with disabilities. Similar protests broke out across the United States, but most only lasted a few days, making San Francisco one the most impactful.

 

a black and white photo featuring disability rights advocates. In the center, a person in a wheelchair has a sign that reads "I can't even get to the back of the bus."
Figure 3:Source- Yahoo Images; Disability protesters

 

These are known today as the Section 504 protests. They were a significant turning point because disabled people publicly rejected the pity and charity sentiments and held the Carter Administration accountable for giving them the same protections as every other American.

“Through the sit-in, we turned ourselves from being oppressed individuals into being empowered people. We demonstrated to the entire nation that disabled people could take control over our own lives and take leadership in the struggle for equality,” said activist Judith Heumann.

Through the protests and meetings with the Carter Administration, Section 504 was passed. Beyond that, Section 504 of the Rehabilitation Act of 1973 laid the groundwork for the Americans with Disability Act (ADA), which prevented any institution receiving federal funds from discriminating based on ability.

Black and white image of a person holding a protest sign that reads "504 is law now make it reality."
Figure 4:Source-Yahoo Images; Protest sign mentioning Section 504

Considering the history of disability advocacy in the US, we have come a long way. Despite that, there is still a lot of work to be done, especially for people with intellectual disabilities.

 

Distinction of Conservatorship and Guardianship in Alabama

Before diving into what the Colby Act does for Alabamians today, I want to address the elephant in the room and make an important distinction.

Over the past couple of years, there have been a few cases where conservatorships have come under fire, most notably with US pop star Britney Spears. Her father, Jamie Spears, became the conservator of her financial estate and personal life in 2008. One of the more significant outcries from this was when Britney Spears commented that she could not get married and have kids due to her conservatorship. More specifically, she claimed that they would not allow her to have her birth control removed. Many aspects of this conservatorship were considered abusive by much of the general public, sparking the Free Britney movement in 2021. I bring this up to clarify an essential distinction in discussing conservatorships.

Other stories like this have been brought to the public’s attention recently, bringing awareness to conservatorship abuse. With that being said, not all of them represent how conservatorships function in Alabama. In California, where the Spears conservatorship was established, conservators have jurisdiction over the ward’s financial estate and personal life decisions, which would not be the case in Alabama. In Alabama, a conservator has jurisdiction over the person’s estate. In contrast, a guardian would have jurisdiction over a person’s decisions, including the ability to get married or have children.

To put it simply, a guardian makes decisions for a person’s everyday life, and a conservator makes decisions for their financial estate. So, in the state of Alabama, for a person to have the control that Jamie Spears had, they would have to obtain two distinct approvals from a Probate Court: one for a conservatorship of the person’s estate and the other for a guardianship of the person’s decisions in their personal life. With that distinction in mind, we will look at how guardianships impact people with disabilities.

 

Colby standing and smiling for the photo in between James Tucker and Nancy Anderson of ADAP at an event.
Figure 5:Source-Kim Spangler; James Tucker & Nancy Anderson of ADAP
with Colby at a Partners in Policy for Alabama Event

Guardianships for Disabled People in Alabama

In Alabama, the primary way for parents of people with disabilities to help protect their children and young adults as they transition into adulthood at the age of nineteen is by getting guardianship over them.

Guardianship is used when a court proceeding finds a person to be incapacitated. According to the Alabama Disability Advocacy Program (ADAP), Alabama law defines an incapacitated person as “any person who has one or more of the following impairments: mental illness, mental deficiency, physical illness or disability, physical or mental infirmities accompanying advanced age, chronic use of drugs, chronic intoxication, or other cause (except minority), and lacks the ability to make or communicate responsible decisions.”

In essence, guardianship allows another person to make decisions if a court determines someone is incapacitated. Similarly, conservatorship enables another person to make decisions about a person’s estate if a court determines that someone is incapacitated.

The important thing I want to note here is that to be legally declared incapacitated, the person must have one of the listed impairments and lack the ability to make responsible decisions. The person petitioning for guardianship or conservatorship must prove to a judge that the person is incapacitated based on these criteria.

Many people have guardians for a variety of reasons. For example, many older adults struggle to make responsible decisions and keep themselves and others safe as they grow older, so guardianship is sometimes needed so that family members can help with medical appointments and make decisions about other fundamental aspects of the person’s life.

While guardianships are necessary for some people who are disabled, they have been used as a one-size-fits-all solution, which fails to account for the varying abilities and needs of different people with disabilities.

Guardianship also proves problematic if a guardian decides they no longer want to have the responsibilities of being a guardian. More commonly, the guardian dies, which can result in a delay in decision-making for the ward (the person for whom the guardianship is for).

Often, it takes time for a new guardian to be set up. In many cases, the ward will become a ward of the state, which means that a judge, or, in some cases, even a sheriff, can become the ward’s guardian. State wards are often overworked and underfunded. Beyond that, they have little personal connection to the ward, which increases the risk of the person’s quality of life declining significantly.

 

Section one of the 14th Amendment, which states "All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."
Figure 6:Source-Yahoo Images; 14th Amendment, which includes the equal protection clause that formed the basis of the argument for disability inclusion and signing of Section 504

 

Autonomy vs. Protection

One concern for people who have disabilities, especially intellectually disabled people, is the fear of people taking advantage of them. Commonly, guardianships have been established to protect the person from harm, even though they don’t always give parents the protection they seek for the adult.

For example, suppose a young adult has a past of being a victim of domestic abuse. In that case, guardianship may not necessarily protect them from that. Still, it is often viewed as a sort of legal footstep for the guardian to step in if things go wrong. Unfortunately, this is not always effective and is still extremely limited in its ability to prevent harm.

While some disabled people may require guardians, the one-size-fits-all approach of guardianship has been seen as the only option for far too long.

 

What The Colby Act Does for Alabamians Today

The Colby Act introduces the concept of supported decision-making for adults with disabilities in Alabama, making it the 19th state with supported decision-making (SDM) laws.

The Colby Act defines supported decision-making as “The process of supporting and accommodating an adult in the decision-making process without impeding the self-determination of the adult. This term includes assistance in making, communicating, and effectuating life decisions.” More specifically, the act states the following: “In lieu of a guardianship, an adult may enter into a supported decision-making agreement with supporters who may assist and advise the adult with making certain decisions without impeding the adult’s self-determination.”

This is a critical option for a disabled person who may need assistance making decisions but is not incapacitated as defined by the state, in which case a guardianship would unnecessarily strip them of their autonomy. This can also be a helpful option for aging adults since setting up an SDM agreement can prevent the need for guardians or conservators as they become elders.

The Colby Act defines a supporter as “An individual at least 18 years of age who has voluntarily entered into a supported decision-making agreement with an adult and is designated as such in a supported decision-making agreement.” It also establishes criteria for supporters and limitations on them, such as not obtaining information about the person for purposes beyond their role as a supporter.

Another significant piece of the act is the subject can revoke the SDM agreement at any time by notifying each supporter in writing. This is important because it preserves the adult’s agency and autonomy, allowing them to change the agreement or revoke it if it does not facilitate their ability to live a full life as anyone else would.

 

Colby stands in a black graduation cap and gown. He stands in front of a wall of red and white balloons, with a sign above that reads "where legends are made."
Figure 7:Source-Kim Spangler; Colby celebrating graduation from the College of Education’s
CCOS program at the University of Alabama.

 

The Colby Act is a big deal because it provides a law for something that has been happening informally for a long time. Due to the passing of the Colby Act, people who create supported decision-making agreements will now have additional protections behind the law. Though supported decision-making may not be an effective alternative for every instance where a family is considering guardianship, it is a substantial step in providing an alternative for disabled people who could benefit from a less invasive approach.