 There everybody I see that it's just just past 1210 and I'm really excited to get started. So, I'm just going to launch launch the seminar now. So, welcome to the fifth lecture in this year's Dalhousie health law Institute health law and policy seminar series. I'm not online today, but Dalhousie is an I am in McMaggie, the ancient and unceded territory of the magma. We pay respect to the indigenous knowledges held by magma people, and the wisdom of their elders past and present. We pay respect to to the histories, contributions and legacies of African Nova Scotians who've been in this territory for 400 years. I'm the chair of the health law Institute Sheila Wildman. I'm also co chair of an organization called East Coast Prison Justice Society. And I wouldn't typically add that to these introductions but the work of today's guest for broad work over many years surfaces hidden connections between disability and prison justice. Institutionalization and prison abolition, and exposes to the ways that ableism works alongside racism, poverty and other bases of oppression to construct and reinforce systems of institutionalization and incarceration. Our much anticipated speaker today is of course internationally renowned scholar, liit. Professor Ben Moshe. Professor Ben Moshe holds a PhD in sociology from Syracuse University with concentrations in women and gender studies and disability studies. She joins us from the University of Illinois at Chicago, where she is assistant professor of criminology law and justice. She is the author of the 2020 book, The Carcerating Disability, subtitled the institutionalization and prison abolition. I have that book right here but you can also see the wild sort of background behind Leah. She's also co editor of the groundbreaking 2014 collection, disability incarcerated imprisonment and disability in the United States and Canada. And if you do not have those two books, I strongly recommend to you to go out and get them. Do it online while you're listening. We are very lucky to have Professor Ben Moshe with us at a time when advocates and government in Nova Scotia are asking in the context of live human rights litigation, what it might mean to remedy ongoing systemic discrimination against persons with disabilities. Who for decades instead of supports for social inclusion have been subjected to the unacceptable alternatives of institutionalization or social abandonment. Getting that remedy right requires that we be alive to the work of critical intersectional disability scholars like Professor Ben Moshe. With that, Leah, I turn it over to you. One last thing, if along the way, you folks online have questions, things you want to share, there's a button called Q&A at the bottom, and you can type in your question there and we will be fielding those questions at the end of Leah's remarks. Thanks so much. Over to you. Thank you so much. Sheila and thanks for everybody for who invited me. Sheila and Ashley and everybody who is a part of the seminar series. And also thanks for everyone who's doing this kind of work that I'm going to talk about today. I am Liat, and I'm in Chicago, and I put in the chat but Chicago is on the traditional territories of the three fire people, the Ojibwe, Ottawa, and Potawatomi. For people who are on their phone or going to see the recording and for whom it's helpful. A bit of an image description. I'm semi-mil-aged gray hair, very short hair, white femme person wearing makeup and glasses, and you can't really see it, I don't think, but I'm a wheelchair user. I'm wearing an added sweater, and behind me is the background behind me is the image of my book, which is concentric circles that are kind of erupting on the side, which is an abstract image that I think represents some of the things we're going to talk about today. So I'm going to share my screen in just a second to set up. I'm going to talk about today. The main topic is de-institutionalization. I'll describe what it is, some of the factors that led to it, what we can learn from it, and particularly I'm going to focus today on de-institutionalization in the US. I'm going to focus the kind of second part of my talk on particularly litigation efforts, as was mentioned earlier that I hope will connect to some litigation efforts that are happening right now in Nova Scotia. And then I'll end with some pitfalls of this tactic of litigation or class action lawsuits. First, I wanted to mention on the slide, it's an image of my first book, which was an anthology with Chris Chapman and Allison Carey called Disability Incarcerated. And in that book and in all the work that some of us are doing that tries to connect disability to cursorality, what we try to do is to broaden what gets to be defined as incarceration. And in our case today also decarceration, because incarceration happens not just in spaces that we call prison or jails, but it's something that also happens in nursing homes, institutions for people with intellectual developmental disabilities or psychiatric disabilities, nursing homes and so on. So one of the things that's important to understand is that there's several conduits leading to confinement. One of them is of course criminalization and the other one is medicalization. And they both entail surveillance and policing. And this is really important because it helps understand that mental health and disability justice organizing and scholarship are also carceral issues. On the slide is the image of the book I'm going to talk about today, which is called the carcerating disability, the institutionalization and prison abolition. It's really important before I start talking to about this more in depth to understand that when I say that institutionalization in disability institutions for people with intellectual disabilities and psychiatric confinement is carceral or incarceration. I don't mean to say that it's the same as prison. But I do mean that they are literally both carceral. I don't mean that metaphorically. I mean that very, very literally. They are both carceral but this does not mean that they are the same thing. What I'm trying to do through the book through connecting prison abolition and, you know, prison rights litigation, anti-prison activism, critical prison studies, and de-institutionalization, anti-psychiatry, disability studies, disability justice. But trying to connect those things, it's not about to say that they are the same. But it's about saying that we need to understand the connection between various sites of incarceration, not through analogies, not through these kind of oppression Olympics, but to understand that they are connected. And also, if the network of incarceration is connected, then the means for liberation must connect as well. And this is what led me to connect de-institutionalization and disability justice and disability studies, mad studies to prison abolition. And this is because, you know, those of us who are kind of need deep, I should say, into prison abolition probably know this that whenever we kind of talk about this or mention it, one of the things that people often say is, well, you know, critiques of prisons, yes, we totally get it, but surely you don't mean right now. Surely you don't mean in the US and Canada, right? Like you mean in smaller places, like in the Navian countries or something like that. And surely you don't mean in the kind of conditions that we have right now. But one of the things that's really important to understand, and this is what I try to do overall with the book, is that abolition of carceral sites has already happened, both in the US and in Canada. And it has happened in our lifetime. So this is not just a vision for the future. It's not something that just happens in Scandinavian countries. This is something that is happening, has happened both in the US and in Canada. But it has happened not in the prison arena. It has happened in a different carceral arena, in the arena of institutions for people with disabilities. So that's why the institutionalization in mental health and intellectual and developmental disabilities is really important as a precedent. It's something that has already happened. It's a precursor to understanding prison abolition. We can learn a lot from the lessons of the institutionalization. And also, you know, today I'm going to talk about it based on its own merits for people who are trying to push against the confinement of people with disabilities in institutions and close them down. So what I'm trying to do in the book, and more generally, why it's really important, and you know, it's really important for me to say, because some people might find the book kind of, you know, denset parts and so on, and it's also very long. And the reason why is because I'm trying to develop an alternative genealogy to the institutionalization. And that's what I'm going to kind of talk about today. So often we understand the institutionalization as do I is, you know, something that is kind of a big major policy trend, policy change, both in the US and in Canada. I want to, I want to kind of signal I won't get too much into today, but I want to signal that there actually were two kinds of the institutionalization. So I tried to chart in the book the genealogy of both of each one, but there were really two one is in mental health so this is the closure of psychiatric hospitals, and the other one is in the field of intellectual developmental disabilities. It didn't happen in the same time and they didn't exactly happen because of the same reasons, but today I'm kind of going to conflate them both a little bit, but you can find much more specificity in the book and this is why it's also very long because it is very specific. And in general, at least in the US, the institutionalization of people in the mental health field really started to the population in psych hospital really started to decrease in the 19 towards the end of the 1950s. At the beginning of the 60s and so on, but in the field of intellectual disabilities, this was much later 1015 years later that we started to see this kind of large, either a closure or decrease in populations in institutions. So what is the institutionalization. Well, many people understand it as the transition of people with psychiatric and intellectual disabilities or others abilities from state institutions and hospitals into community living, which is really important. It also means the closure of these facilities these institutions these hospitals. But what I add to the definition of the institutionalization is that it's not just a process, but it's a process of kind of Exodus of from institutionalization to the institutionalization. It's a logic, the institutionalization is a logic, it's a framework, it's a movement and it's a logic that counters carceral objects, it's an anti carceral measure. And so I want to focus today particularly on the part of the initialization that was more abolitionary and the kind of tension between reform and abolition. But first I wanted to talk a little bit about how the initialization happened through that tension of reform versus abolition. There were many factors that led to the initialization in the US. One is certainly I should note at the beginning I'm going to do this very, very, very briefly. There's, again, much more details in the book for people who are interested and I'm also very happy to talk about any of this and much more detail in the Q&A. But very briefly in the US, several factors led to the institutionalization. I don't believe that any of these factors is the factor that led to the initialization I think it was all of them. But I also think that, again, there were factions of the initialization that were abolitionary and some that were not. But in general, there were federal programs and policies that just didn't exist. And so once they came into existence, they pushed for the institutionalization or community living for people with disabilities in ways that weren't possible before. So an example in the US is Medicare and Medicaid. Medicare and Medicaid, you know, people sometimes things they've always been here, but, you know, they really started in 1965, and that helped to decrease the reliance on long term institutionalization, particularly the psychiatric arena. But it also created this institutional bias in policy that still continues today. And we can talk about whether or not that exists in Canada as well. But in the US, the institutional bias is particularly, you know, there's Medicaid, what are called like home waivers. But this, because Medicaid is federal, and the way that it's being used is every state in the US can decide how to use kind of the Medicaid money. They don't have to use the waivers, but every state has a budget for institutionalization, basically. So there's institutional bias that actually comes as a legacy of these programming. And so there's a lot of disability advocacy around what is called legislation that's called money follows the person, basically that money would come to the people themselves, the people who have a disability, and then they can direct their care. Because right now the money goes to the institution. So there is this institutional bias, but I did want to mention that without those programs, we wouldn't have this process of the institution. The second thing, which I talk much more about in the book, but particularly in the arena of psychiatric institutionalization, meaning the closure of psychiatric hospitals, a lot of people assume that because of the advent of psychotropic medication like Thorazine, for example, that's what led to the ability to really release psychiatric patients close down some psychiatric hospitals, decrease the reliance psychiatric hospitalization that it was basically drugs that did that. And without the advent of these drugs without kind of discovering these drugs, we wouldn't have been able to do that. That story is very problematic and simplistic and most of what I just said is also not true. Like it literally didn't happen like that. And so just as an example, for example, is the story of Thorazine, which is a drug that really was used very, very substantially in psychiatric hospitals, but also institutions for people with intellectual disabilities. And we don't hear, you know, the reason why this is so fascinating to me is because, and this is why I call it an alternative genealogy of the institutionalization is because we don't hear the same claims. Oh, why did so many institutions for people with intellectual disabilities closed down. Oh, it's because of Thorazine. That's not what usually people say. But in fact, at least in the US it was used very, very widely in these kind of institutions. But it's not really part of the origin story of the institutionalization in intellectual disability. In the same way that it is in psychiatric hospitalization. And why is that one of the reasons why I think that is, is because the story of, you know, of the discovery of Thorazine, which wasn't really discovered at that time it was just used at that time in psychiatric hospitals. And it was actually used quite frankly to more effectively institutionalize people, not de institutionalize people. But the reason why I think it really took up is this kind of origin story of the institutionalization in psychiatric hospitals, why we were able to decrease the reliance on psychiatric hospitalization is because this is the time that Thorazine is one of the kind of origin stories of bio psychiatry would become bio psychiatry. And, you know, psychiatry wasn't always only biological. So, we have here the convergence of and psychiatric different mental difference as a psychiatric disorder. And that happened really with drugs like Thorazine, for example, and then later on other drugs as well Prozac and so on. And so people kind of look at these stories as these narratives to say, Oh, of course, it's cured of some way decreased mental illness. This is why we're able to people were able to be released from psychiatric hospitals. But of course, it didn't kind of cure that. And it's really important, I think for a lot of us were disability activists and scholars to say that disability and the whole category of mental illness, intellectual disability and so on, are socially constructed. They're not inherent in peoples in bodies, they change over time, they change over cultures and so on. And this is a moment that really connected bio psychiatry and really kind of made mental illness as the epitome of what psychiatry does. And so this is just long form to say the story of psychopharmaceuticals kind of releasing patients because they were cured and all that is a really simplistic version of the kind of coercion that would some psychiatric people call chemical incarceration, and the whole that it has on people to this day. Some of the other factors leading to the institutionalization. And you'll note kind of a spoiler alert that I'm telling you the factors and critiquing them at the same time. As I said, it's really important to understand the simplification, the, that has been made of these reasons for the institutionalization for reasons that I'll discuss in a little bit. So another factor leading to the institutionalization the US is of course, what we come to call neoliberalism, which really started around this time, particularly in the arena of intellectual disability this time meaning early 70s, at least in the US when neoliberalism was kind of important from the UK from Thatcher was important in the US by Reagan. So at least in the US we started to see it. Certainly, it was more pronounced in the 80s. It was kind of imported in the 70s. And so we're starting to see these austerity measures and cutback in human welfare. That's in social services, while at the same time and this is really important to say the spending was increased on corrections and punishment, meaning that this idea of, oh we don't have enough in our budget is, is really about priorities it's not accurate in terms of economic terms. It's not in the budget because it's not a priority, but the money is still there it still went to things like the military industrial complex still started to go more towards corrections and punishment. And so we're starting to see, you know, if you have kind of a graph we're starting to see this uphill in terms of spending on corrections and downhill in terms of spending on actual human needs. Things like housing, for example, education, and actual, you know welfare, and so on. And in addition, we're starting to seeing that the miniscule amounts that are now are spending about around mental health are mostly, and today only for what we come to call bio psychiatry. There was to be a lot of investment in community mental health in peer support that has never come to fruition in the US. But the really interesting you know thing about this, I mean of course, this led to the institutionalization. And that's not the major component that led to the institutionalization, because I'm one of the things that I'm trying to push is this idea that the institutionalization was also a change in how we think about disability and how we think about difference, and so on. And certainly these austerity measures weren't a part of that. You know, to say it very bluntly, you know when Reagan as governor of California said that he's going to close down all the psychiatric hospitals, which he ended up not closing all but he closed many of them. And then later he did the same of course as president. He didn't do it because he cared that people were incarcerated in these places. He didn't do it because he was going to put money into community mental health which he never did. He didn't do it because honestly he cared about people with disabilities. He did it because of this neoliberal policies that he was developing and ushering, and because of this kind of cost profit measure. But, you know, that still led to the closure of psychiatric hospitals but I want to be very careful by saying that this is not the kind of the initialization that I was talking about earlier. So I want to now focus a little bit about the fourth kind of measure or factor that led to the initialization in the US. And this is institutional reform litigation. And so which I'll focus for most the rest of my talk. So institutional reform litigation is any legal actions in the form of lawsuits that sought to reform or improve conditions of public facilities or to desegregate them, especially on the basis of race or disability. So this comes from a history of desegregation institutional reform litigation. It started in the US with Brown v Board of Education so it started with really racial desegregation class action lawsuits. And then moved into other arenas, especially the disability arena. It was the most pervasive in the mid 60s and 1970s in the US, which was the era of disability rights following civil rights. It was an era of enter psychiatry, what is called the principle of normalization in intellectual and developmental disability principle of normalization meaning that to put it very simplistically that people should live as much live grow up be educated with reside with with their peers as much as possible. And basically that's what it means. And this was a new kind of formulation that came from particularly education scholars in the field of intellectual disabilities. So these class action lawsuits or legal actions. The next for the rest of our time is where these class action lawsuits affective and for whom for what. And were they affective with an a right like what did they do also in terms of illicit emotions in people illicit actions in people. What did they do to the plaintiffs to incarcerated people. What did they do to the rationale of confinement, and what did they do to the net of incarceration. And I'll try to answer these questions. So some of the famous ones, at least in the US, in terms of class action lawsuits were Wyatt, the Wyatt lawsuit, which was really about the right to treatment. And this was a very famous case in which the judge said the words without habilitation. The hospital is transformed into a penitentiary, meaning people with disabilities who are confined to institutions at the very least should have the right to habilitation the right to treatment. So this lawsuit created kind of a ruffling effect in which afterwards a lot of lawsuits were made with the precedents and policy was made through the precedent of that lawsuit. The second one, which was very famous and had a lot of kind of resonant effect was the Wallabrow case. The work was an institution for people with intellectual disabilities. At some point it was one of the biggest institutions in the world. One of the things that happened through that case is that the judge said that people don't have the right to habilitation, they only have a right to protection from harm. They basically have the same rights as prisoners, the right to protection from harm. The way that the lawyers in the Wallabrow case litigated it was really interesting because these were all kind of activist lawyers in all this institutional reform litigation and these were kind of taken by firms or people that were activist lawyers. And what they did is that in the series of lawsuits Wyatt, Willowbrook and so on, is that they mandated institutions to increase their quality of care. And the idea was to make the institutions more expensive. I mean they knew or hoped that they won't be able to maintain the institution with that level of care. But they wanted to show that in fact the only quality care that people with disabilities could obtain is outside the institution, it's in the community. It was the beginning of what I call abolitionary litigation. So what they really wanted to do is close down these institutions in some ways. Because many of the institutions were already pretty dilapidated at the time that these lawsuits came on, what they wanted to again gain is that this would be too costly to maintain and in fact would be closed down. A very interesting strategy. But it was really not until the Pennhurst lawsuit that we see not just a lawsuit about the conditions of confinement, but really a lawsuit against an institution for being an institution. So in Pennhurst, the really the carceral logic or the institutional logic itself was placed on trial. It was really a case against the merits, not just the conditions of disability based confinement. They brought in a lot of experts to talk about how people become worse in an institution to talk about how people with disabilities, regardless of severity of disability can live in the community. They showed cases where people do live in the community and the gains of that, particularly people with intellectual disabilities, which is what Pennhurst mostly incarcerated people with intellectual disability. And so the whole issue of why do people with disabilities need to be institutionalized at all really was placed on trial. And it really was kind of the perfect storm, if you will, of lawsuit, like it happened in a perfect timing. The lawyers who litigated it, so on and so on. So this is really what we might call a abolition type of litigation. It wasn't about reforming the institution. It was about how can we use a class action lawsuit to really shut down this institution and in essence all institutions like it to really use it as a precedent to do that. But let's see what happened. So this was, I just want to say all these lawsuits I forgot to put. I'm so sorry forgot to put years on them. This wasn't the heyday of institutional reform litigation so these lawsuits were mostly 60s 70s, and so on when they started to be litigated, mostly in the 70s. A little bit in the early 80s. But we, after the passage of the Americans with Disabilities Act, which passed in 1990, we're starting to see a surge of new kind of institutional reform litigation. The institutional reform litigation didn't kind of die in the in the 70s it just kind of transformed. And the way that it transformed David Furleger, who is one of the kind of prominent activist lawyers that was very involved in the Pennhurst lawsuit, for example. He says that legal efforts for the mentally disabled first emphasized commitment procedures, how you get in. And literally it emphasized the right to treatment. What happens once you are in. And the newest inquiry he says is whether there is justification for institutionalization, whether anyone should be in at all, which is what Pennhurst kind of was. In the passage of the ADA, what we're starting to see is an anti-discrimination argument that's added. So it's not just challenging loss of liberty and needing to justify confinement, but it becomes an anti-discrimination argument, and people are discriminated people with disabilities are discriminated against because they are confined while other people who are not disabled are not. So if litigation from the 60s to the 80s or early 90s words about improving living conditions. In the case of closing down particular facilities, the strategies after ADA and especially after the Olmsted decision in 1999, the strategy is to increase community based living. So the fight right now is not so much about the institution and its conditions, although there's a lot of litigation about that as well for sure. So let's talk about what comes after what comes instead of the institution. So let's take stock of this. Remember I asked you at the beginning so was this effective with an E was it effective with an a. What was the role of these lawsuits that really acted as kind of expose is for people. Especially the early ones. But but even contemporary lawsuits, a lot of the kind of big ones really act as a shock and awe campaigns. What they have done is that they really have this cumulative, cumulative effects, meaning that it really brought to the public imagination the horrific conditions of institutions. What I mean by this is that, you know, most people don't necessarily know what's going on into inside of psychiatric hospitals institutions for people with intellectual disabilities. Nursing homes, prisons. And this is because we can't know because we can't go into these places because we're not supposed to know. But lawsuits act as exposés in the way that they kind of bring that attention outside of these spaces of carcerality and confinement. And they really politicize people both people on the outside that were really horrified by these early lawsuits and exposés. And the fact that institutionalization still persists. So people are horrified. It politicizes people on the outside. It also politicizes people on the inside. So, in terms of the Pennhurst case, the Willoughborough case, they became kind of groups of people. It really brought people together, especially in terms of self advocacy. So the seeds of self advocacy in intellectual disability movement came through processes like these lawsuits, whether or not they were successful. But that's how a lot of people kind of came together. So one of the other things that it did or the main thing that it did is that it brought through reforms that really resulted in changes in these facilities. More buildings, more staff, more funding. Unfortunately, it brought in more buildings, more staff and more funding, meaning these institutions lingered on because of these lawsuits that some of these lawsuits sought to close them down. They did in some degree the opposite, unfortunately. So Willoughborough closed down, Pennhurst closed down, but they closed down 30 years, 40 years after the initial lawsuit was brought on. This is decades later, decades. By that point, there was hardly anybody in there. And this is not to say that the people that remained there should have stayed or something like that. But this is to say, what has often happened is that it was litigated for decades, resulted in really watered down consent decrees that were not adhered to, went back to the court, went back to the court, went back to the court and so on. This is what prison abolitionist activist Rachel Herzig calls tweaking Armageddon. This is this kind of reform. Let's do a little bit more of this. Let's do a little bit more of that. But in essence, you're really tweaking catastrophe. What this reform did is that it critiqued conditions of confinement, but not really the rationale of confinement, questioning how service, you know, whether or not services are effective doesn't necessarily lead to eroding the legitimacy of caging people. And the other thing that's really important is that some of these, even if they ended up in the closure of particular facility, it wasn't necessarily abolitionary, because some people end up in a different facility. So closure or facility, even though it's incredibly important, it's necessary, but it's not a sufficient action on the road to abolition. So I want to, you know, kind of move towards the analysis that would lead us to the conclusion here. And this is the difference between kind of reform and abolition or the pendulum, not really a difference because they're very connected, but the pendulum between reform and abolition. And this is from the Politics of Abolition, a 1974 book by Thomas Mathiasen, M-A-T-H-I-E-S-E-N. And he followed Andre Gorsuch's G-O-R-F-Z definition between reformist and non-reformist reforms. Reformist and non-reformist reforms that were later popularized, you might have heard it from activists and scholars like Ruthie Wilson Gilmore. Reformist reforms are situated in the status quo, meaning that the changes are made within an existing system or framework. Non-reformist reforms really imagine a different horizon. They're not really limited to what is possible at present. So it's not about, oh, let's bring more staff, let's bring more budget. It's about imagining community living through something like litigation, for example. So that's the difference between reformist and non-reformist reforms. And we can ask ourselves whether or not litigation was reformist or non-reformist. In some cases, it's both. So what are some of the lessons now, you know, kind of bringing us to more conclusion. So what then led to the institutionalization as abolition? I talked about psychiatric medication. I talked about austerity measures or neoliberalism, basically, you know, cutting budgets and closing down things without putting anything in their place. I talked about Medicare and other policies that arose. I talked about litigation. What then led to the institutionalization as abolition? Well, in addition to everything that I mentioned at the beginning, including litigation, one, what I think really led to the institutionalization as abolition was none of those things I mentioned earlier or only a little bit of those things I mentioned earlier. That really helped in the closure of the facilities. But closure is not enough. What we really need is a change in social attitudes towards disability and mental health. We have to see that in the litigation aspect as well. Once kind of experts, including disabled people were put on this stand to talk about why nobody should be in an institution because of their disability or otherwise. We're seeing the influence of inter-psychiatry movement, of consumer-survivor expatient movement, of self-advocacy movement, which by the way, at least in the US, and it's not just in the US, it's also in Canada, actually. And Melanie Panitch talks about it in her work, Panitch, P-A-N-I-T-C-H. The self-advocacy movement, the movement of people with intellectual and developmental disability, they called for closing down all residential institutions for people with disabilities, which they called very earlier on as a form of incarceration. So once the self-advocacy movement really began to take hold, they were very clear and very early, kind of early on clear that it's not just this institution or that institutions, but they talked about how, in their words, we need to get our friends out. We need to close down those despicable places and so on. And so they talked about it, again, they didn't use the word abolition, but basically that's what they demanded very early on, the abolition of these spaces. So that is de-institutionalization, is abolition, it came from social movements. This is why de-institutionalization, it's not only abolitionary, and it's not only about social movements, but this is the aspect that nobody almost ever talks about in relation to de-institutionalization. And this is why. It's radical, it's considered kind of dangerous, right? And it's, we tend to talk more about like the austerity measures, dorsing, you know, all of these kind of notions of why de-institutionalization happened, because we say that it failed. At least in the US, a lot of people blame de-institutionalization for the rise of incarceration, for the rise in homelessness, all kinds of things like that. But de-institutionalization didn't, a lot of things in it we can do better about for sure, but it wasn't a failure. It was a success, and this is because it happened, and it's something that a lot of people for many decades, people with disabilities advocated for it to happen. And so to say that it failed is in essence to kind of blame these movements for things that were much broader, like neoliberalism, blaming disability for neoliberalism. I mean, it's like, but this is the dangerous, this is the danger of this simplistic narrative of the genealogy of de-institutionalization. If we think de-institutionalization only happened because of thorazine and Reagan and, you know, all these kind of stuff, then we really don't have an understanding of disability history, of the resistance of disabled people to their own confinement, of everything that we were able to achieve. And that's kind of thrown into our faces as something that led to the rise of imprisonment, homelessness, you know, and things of that nature, when in essence it was really the socio-economic political changes that led to those two things at the same time. And so one of the things I also wanted to mention, you know, there was also a parents movement and so on. I don't have really time to kind of go into all of this, but one of the lessons that I want us to kind of remember from de-institutionalization is just like people in the self-advocacy movement have been saying since pretty much early 80s. Is anybody should and can be decarcerated. So this is why de-institutionalization is abolition is so so so important, because we have to break down these kind of hierarchies between who can quote unquote live on the outside and who can or should not live on the outside. And in fact, one of the most successful cases of de-institutionalization were not Willowbrook and Pennhurst, you know, and those things that took 40 years to close down an institution, but it was cases in which people started from the margins. People started de-institutionalization with, what do we do with the quote unquote most kind of severe cases or severe disabilities or in the prison abolition world, the opposite of non-violent, the opposite of non-sexual offenders and so on. So what do we do when we start with the violence, the sexual offenders that I'm putting it all in air quotes, if you can see the quote unquote severe cases. If we think about people with the most complex needs first, it's much easier than to release people with less complex needs. This is true in terms of emotional needs, medical needs, all of those things. And so that is one of the lessons of de-institutionalization as abolition. Anybody can live on the outside with the right support. The second lesson is that institutional institution and de-institutionalization is a logic. It's not a place. So closing down an institution is really, really, really important. But it's really just step one because otherwise people will be put in a different institution or a different kind of institution. So the abolitionary framework or de-institutionalization as abolition, again, the way self-advocacy talks about it, no more institutions ever for anybody is really, really, really important because it's logic. It changes how we think about people. It becomes nonsensical for us to cage people for being disabled or for anything. Once that kind of shift happens, then we can really start talking about, okay, what is the best thing for each individual people? And then we start to have a conversation more about community reinvestment. What do we do with all this money? Because it is very costly. Institutionalization is very costly. So can we use that to actually invest in people, in community? And so, you know, one of the things to really remember also that one of the things that happened in the U.S. at least in terms of de-institutionalization. And I know this has happened in Canada too, because this is mostly a kind of women's labor. I do want to kind of point that this is a feminist issue. By women's labor, I mean that post de-institutionalization, a lot of people with particularly intellectual disabilities no longer live in institutions, which is wonderful. But that means that if they live in the community, it's usually with a family member, and that family member is usually a mother or a sibling. And it's really important to kind of develop or think about communities that take up this approach of the abolitionist mindset, but also to do it in a way that is feminist. Lastly, I just wanted to say, what if we don't? What if we understand de-institutionalization as the closure of facilities, but not really as an abolitionist measure? Well, if we only understand it as a measure of kind of closing down things, then we will get into what I call carceral ableism or carceral sanism. Sanism for people who don't know, by the way, just to pause, sanism is the oppression based on particular impetuses to be rational, to be sane. It's mostly the oppression of people that we call psychiatrically disabled, but really it's the oppression of all of us with this impetus to be sane or to perform sanity. So, going back, carceral ableism or carceral sanism is what I define as the praxis and believe that people with disabilities need special or extra protections. But it happens in a way that often expands their further marginalization and incarceration. What do I mean by all this? If we understand de-institutionalization only as something with limits, meaning only for some people, but surely people with severe, quote unquote, disabilities always will need to be incarcerated, right? Surely people, not everybody can live in the community, right? Surely, you know, and so on and so on. Then that would lead to the marginalization and incarceration of people because what happens is that it legitimates incarceration. This is not good for these people, but surely for other people it's fine to have an institution. De-institutionalization as abolition says not fine for anybody, it makes no sense. It's carceral. And so if we think about that, the kind of what people now call alternatives to incarceration, which are so infuriating, we can start addressing really as carceral sanism or carceral ableism. What are some examples? Community treatment orders, right? So people, sure, they don't need to be in an institution, but they absolutely still need to mandatory take their drugs and people need to see that they're taking their drugs. And so we have these community treatment orders. We have what is called chemical incarceration, you know, this enforcement of psychiatric drug taking and so on. And all of these things people say are alternatives to incarceration, but actually are just incarceration in a different form. Here is just a link that I will put in the chat about kind of how to tell the difference between abolition and reform or reform and non-reformist reforms. I'm happy to put that in the chat. But really what I want us to kind of think through together is the pendulum again between reform and abolition and looking at the institutionalization as abolition. Thank you. Thank you very much, Leah. One thing that I really wish is that we sort of, we were in a room where everybody was here able to speak and share. But what I'm going to do is go through a couple of questions that are in the Q&A. And I just want to set it up very, very briefly. I mentioned this earlier. I also referred to it, but just to situate your remarks in the context of Nova Scotia and where it's sitting in in relation to deinstitutionalization litigation. So I want to just sort of frame that. And for people in the audience as well, that an important human rights complaint was successful in establishing before our Court of Appeal, Nova Scotia Court of Appeal in 2019 that Nova Scotia had systematically discriminated against people with disabilities needing social assistance, really in three primary ways. So by forcing folks to live in institutions in order to receive some form of support, second forcing people to move far from their home communities in order to receive that support. And third, kind of the converse of institutionalization, just leaving people languishing on wait lists and getting no support at all. So those things sort of tied together were recognized as systemic discrimination against people with disabilities in Nova Scotia. So where we're sitting right now and I'm saying this to frame the first question that I see here on the list. We're in a process as a province of considering what remedies would answer would would speak to those harms. And so that's where your talk has in in many ways led me to, you know, think in light of the precedents that you've that you've so helpfully put forward some of the pitfalls there but also the incremental kind of the progress and the new strategies and new unpacking of logics and so on. So, a big question that you've put on the table for us is what it might mean to responsively in a responsive to the kind of anti carceral logics, let's say, that you've identified is at the heart of the most potent litigation how how might a remedy look. So here's the first question that I see. It's from Vince Calderhead who's one of the lawyers that worked on the disability rights coalition case he worked for the individual complainants. And the question is what happened to the ADA Americans with Disabilities Act discrimination litigation approach so you sort of built up to that one that was challenging the logic of institutionalizing the legislation itself as discriminatory he says under that paradigm anti discrimination, how can or could institutions continue as you have suggested they have. Yeah, thanks. Thank you Vince for the question and thank you for your work really really really. You know she'll kind of filled me in very very important lawsuit. I'm assuming this is a rhetorical question because. Yes, how. But more substantially, I kind of glossed over it but really the big one in the US was almost dead, you know and almost dead was filed in 1999. And it's a lawsuit that was brought by to through, I should say to plaintiffs. One, the reason why I'm mentioning it because one of the plaintiffs lowest Curtis. She died, I think last month, or two months ago and you know her death is very very mess she was very big in stability rights, and especially self advocacy in the US so I just want to kind of take a moment to you know thank her. We really wouldn't have almost dead you know without her and without the people who brought on that lawsuit. And so what that lawsuit did is on behalf of of lowest and another plaintiff. They reasoned that on the basis of enter discrimination that both of those plaintiffs didn't need to be in an institution because they were already. medically right even the doctor said they don't need to be an institution, but there was no community placements for them to be. And so that was all instead. And so today in the US. I don't want to give a numerical answer because I'm not sure, but I want to venture to say that in almost any, maybe not all but in almost all states in the US there's some kind of an all lawsuit happening like right now, which is based on the same premise meaning with the precedent of all said, and they're literally called all said lawsuits, meaning that people are in institutions because they because they don't live in the communities because of this institutional bias that I mentioned the beginning of my talk, the money doesn't go towards that money from the government goes towards institutionalizing people. And so the lawsuit is based on that is that people even that medically, people say don't need to be in an institution or place there and that's where it entered discrimination kind of comes comes through. And we're asking why it's not working. You know, it's because the US is a capitalist settler. Petriarchal ableist institution and he doesn't really care about these things. But secondly, which I think is related to the other question here. Particularly nursing homes and those kind of institutions in the US, they're almost all always for profit. And so, you know the profit impetus here is like it's huge. So in addition to the to the bias in the actual policy which is Medicare and Medicaid the way allocation is disability assistance right allocation of money. The way that assistance is done in addition to that, there's of course the bias of what Martha Russell called handicapitalism, you know how disability is spun into gold. And this is through institutionalization. A lot of the time so this is a major major like industry at least in the US. And again I really encourage people to pick up your book where you develop this idea of you know the sort of corporate and profit seeking element of perpetuation of of institutionalization in different forms, as well as you know other, other factors perpetuating it so that's that's a neat start on that so that there is another question I see from Allison which I think you've started your your answer was speaking to in part. You're bringing out some cost arguments, which kind of goes back to your, your neoliberal point and the point that sometimes you can find, let's call it strange bedfellows in arguing for the institutionalization, based on economic arguments of incarceration in Nova Scotia provincial jail was 14.8 times higher and says below 2021 numbers and what would have been provided to an eligible income assistance recipient with a disability. So 950 bucks a month for income assistance 14,100 per month to incarcerate an adult. So I haven't gone and checked precisely those numbers but Allison let's take. This is absolutely such such a key point, the investment is so high when the person is in that prison space or in this case jail space. He says, do you believe litigation against the province for their lack of support to folks with disability could be successful. And here, Allison I take your question to go beyond the de institutionalization work of shutting institutions and shifting to community it's kind of the sort of what does that mean in terms of social assistance being in some sense. Yeah, adequate. I would reflect on that in light of your, the precedent sure familiar with, in terms of litigation since that was the question, or, you know, anything broader around social movements as well. Yeah, I think I'm not sure that like litigation would be the way to to kind of counter the economic aspect of this to be quite honest. I, but there is a lot of disability rights activism, you know, around it, mostly through kind of legislation and shifting policy, because this comes from policy, right. So the numbers that you've given are at least in, you know, Illinois, for example where I'm at. If you were to kind of insert those numbers, not just for prisons and jails but large institutions large meaning 15 or I'm sorry 16. I don't know why 16 or over in the US is large. So it's the same thing, meaning exponentially more costs more to incarcerate somebody in an institution. And then it is to provide somebody with finances to hire home health aid or personal assistance and basically support somebody for independent living at home. It's exponentially more cost to incarcerate. So, you know, the question of why again has a lot to do with the, what we come to call the prison industrial complex, the institution industrial complex and so on. And it's not really something that necessarily litigation I think it's going to, to help because I'm not sure it was clear maybe I tried to bury it, but abolition, at least prison abolition is an anti capitalist and anti racist and anti colonial framework. So you, it's not just like a pro disability thing it's really we have to change everything. And this is, you know, with the Wilson Gilmore who's a prominent prison abolitionist. She has a book coming out it's literally called Change Everything, because people often ask her, Well, what do we need to change in order to, you know, abolish prisons and literally it's everything. You know, anti capitalist, you know, anti racist, anti colonial framework. And so it can't be built on top of the world, or the systems that we have now. It's imagining a world in which we relate differently to each other, and which we don't put profit over people in which we care about you know the land and environment and you know all of those things and those things are connected also within our struggles. Leah and folks in the audience I, I really wish that we could go on and have a much longer conversation. It's now 20 after which is the time when we have on our poster that we end I'm just going to take a moment more to say, just a couple of things and one one response to what I see is Ellison adding to that question. So I would, I would have loved in fact I'd love to have a whole other section with you, Leah, speaking more about remedies and what it would mean to achieve transformative remedies, reaching to the kinds of structural constraints that you just mentioned. And that is the struggle for many of those, not just here but everywhere involved in trying to articulate what the different what a different system would look like and so you had mentioned first and directed funding or money follows the person not the institution so I listen it's back to your, your questions about how the money could be redistributed. And that is one of the, the burning questions I think for us is how one can operationalize and structure such a system without falling prey to the neoliberal, you know, kinds of cost savings, logics, which include downloading administration to individuals, you know, the drying up of supports and so on. So I just wanted to say that as another follow up to this really important question of, you know, where the money is going institutions or something else. I'm going to close it up with. First of all just our gratitude liette to you for coming and sharing this wonderful work and thinking on dismantling sort of a conventional thinking about the institutionalization and its possibilities with us. And I do encourage I'll say it again everybody who's here to engage really closely with liette's work over the last decade and more on this really live this live and bringing issue for us in Nova Scotia both in the prison context and thank you for your questions and I'm sorry to others who we weren't able to get to and in the disability institutionalization context. I want to just say that next up in the health law seminar series is Joanna Erdman, who is McBain chair in health law and policy here at the DAL Friday, February the 10th, same time, but this will be in person as well as online webinar. Her seminar will be abortion rights after the fall of row V wait, and I encourage you so strongly to come out to that one as well. And for me, at least in theory, I can hear the applause in some version of the world in thanking liette once again. So, thank you, liette. Thanks for having me.