First Circuit: New Hampshire
Verified September 2026.
New Hampshire’s Olmstead settlement is widely cited as a model for federal-state collaboration on integration and successful system reform. Unlike many ongoing settlements, New Hampshire’s case achieved documented completion of its obligations, making it a reference point for effective integration policy and federal enforcement.
New Hampshire: Amanda D. v. Hassan & U.S. v. New Hampshire
Case Name: Amanda D. v. Hassan, 1:12-cv-53 (D.N.H.)
Case Resources:
- Google Scholar Case Law
- PACER Federal Court Records (1:12-cv-53)
- DOJ Settlement Agreement (December 19, 2013)
- Disability Rights Center of New Hampshire
The Issue: State psychiatric hospital reliance and inadequate community mental health services for individuals with serious mental illness. The case alleged unnecessary institutional placement despite capacity to serve individuals in the community.
Federal Court Finding: The federal judge found that New Hampshire violated Olmstead by maintaining unnecessary reliance on institutional (hospital) care.
Settlement Agreement: December 19, 2013 (approved February 12, 2014) – Full Agreement PDF
What Changed: The comprehensive settlement agreement required New Hampshire to:
- Expand community mental health service capacity
- Reduce state psychiatric hospital census
- Build supported housing and community-based treatment infrastructure
- Transition individuals from hospital care to community settings
- Implement supported employment and income support services
Implementation Success: New Hampshire successfully transitioned a significant number of individuals from state psychiatric hospitals to community-based care. Post-settlement data demonstrated sustained integration gains, reduced psychiatric hospitalizations, and stable community placement rates.
Unique Significance: New Hampshire stands as a model case of successful federal Olmstead enforcement with:
- Clear federal-state agreement on integration goals
- Adequate funding for community capacity building
- Documented transition success and sustained compliance
- Peer-reviewed research on post-settlement outcomes
Current Status (2026): Settlement implementation has been completed successfully. New Hampshire continues to maintain community-based services and integrated living arrangements for individuals who were transitioned from psychiatric hospital care. The state’s achievement serves as a reference point for how other states can approach Olmstead compliance when federal oversight and adequate resources are combined.
Research & Evidence: The successful outcomes of New Hampshire’s Olmstead settlement have been documented in peer-reviewed research, providing evidence that federal enforcement can drive measurable, sustained improvements in integration outcomes when backed by appropriate funding and state commitment.
Why New Hampshire Succeeded: Several factors contributed to New Hampshire’s successful completion:
- Adequate Federal Funding: The federal government provided resources to expand community capacity in parallel with institutional downsizing
- Genuine State Commitment: State leadership worked with federal authorities to implement the settlement rather than resist or delay
- Reasonable Timeline: The settlement provided sufficient time (roughly a decade) for systemic change without sudden disruption
- Focused Scope: The settlement targeted one clear system (state mental health) rather than attempting multiple system reforms simultaneously
- Sustained Monitoring: Federal monitoring and accountability mechanisms remained in place throughout implementation
First Circuit Enforcement Pattern
The First Circuit, represented by New Hampshire’s case, demonstrates what successful federal Olmstead enforcement can achieve. The circuit’s case law has supported broad interpretations of the integration mandate and has been willing to impose comprehensive settlement agreements when states have failed to comply voluntarily.
Key Takeaway: First Circuit courts recognize that Olmstead requires not just the absence of institutional care, but the active presence of adequate, high-quality community alternatives. New Hampshire shows that when these conditions are met—adequate funding, genuine state commitment, and federal oversight—states can successfully transition from institutional to community-based systems of care.