Whether Missouri has violated the American with Disabilities Act by using skilled nursing facilities to house individuals with mental illnesses is a question the Department of Justice will try to answer with an investigation it announced this week.

The DOJ wants to ensure the state is making all other alternatives available to those with mental health issues before moving them into nursing homes. The department said it will try to determine if the state “unnecessarily institutionalizes adults with serious mental illness” by placing them in nursing facilities, a practice often referred to as warehousing.

The investigation will include reviews of other options, including supported housing, assertive community treatment, crisis response services and peer support services. The investigation will include the state’s use of guardianship as a contributor to unnecessary facility placement. Guardians are court-appointed to make decisions about where a  person lives.

“People with disabilities have too often been unlawfully isolated in institutions and stripped of their autonomy,” Assistant Attorney General Kristen Clarke said in a press release.

The DOJ opened a similar investigation in South Carolina last January, and in 2018 reached a settlement with the Louisiana Department of Health that required the state to “assess all nursing facility residents with mental illness all new referrals for admission to determine whether they can be served appropriately in the community.”

The review is part of the federal government’s increased enforcement efforts over the last decade to uphold the 1999 Supreme Court decision in Olmstead v. L.C, which found that the Americans with Disabilities Act requires states to house people with disabilities in the most integrated setting possible, eliminating unnecessary segregation.