Center For Mental Health Services
Protection and Advocacy Program

(Dollars in thousands)

Authorizing Legislation - Section 102 of the PAIMI Act

2005 Authorization Expired

Purpose and Method of Operation
The Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program provides formula grant awards to support protection and advocacy (P&A) systems designated by the governor of each State and the territories, and the Mayor of the District of Columbia. State P&A systems monitor facility compliance with respect to the rights of individuals through activities that ensure the enforcement of the Constitution and Federal and State laws. State P&A systems monitor public and private residential care and treatment facilities and non-medical community-based facilities for children and youth. The program primarily supports SAMHSA's Capacity goal by expanding the availability of protection and advocacy services. The program directly supports the Mental Health System Transformation priority area and the Seclusion and Restraint priority area.

Accomplishment

State P&A systems:

• Increased the number of clients served since the program's inception
• Used media to increase public awareness, greatly increasing the number of individuals reached
• Increased the number of favorable resolutions for violations involving abuse, neglect, or rights

The Protection and Advocacy Program has a data reporting system and program measures in place that were developed collaboratively with other involved Federal agencies. Consequently, trend data are available beginning in FY 1997. The data system and measures were reviewed in 2002, with a plan to refine the measures to increase the ability to assess the effectiveness of the P&A system programs' performance. The measures expired in November 2003. Revised measures will be included at a future date.

The number of persons served increased from FY 2001 to FY 2002. Expanded capacity to address substantiated reports of incidents of abuse, neglect, or rights violations met or exceeded the projected 77% performance levels in FY 2002; 77% or 2,921 incidents of abuse; 82% or 3,405 incidents of neglect and 88% or 5,480 incidents of civil rights violations were favorably resolved for clients.

In 2001, 31 State P&A systems reported 1250 deaths, of which 410 were investigated. In 2002, 27 State P&A systems reported 1,777 deaths, of which 972 were investigated. P&A systems efforts to investigate these incidents were affected by such factors as challenges by public and private facilities to P&A access to clients, facilities, and records, which had to be resolved by the court; inadequate information from the reporting facility; and lag time between the fatality and the notice to the P&A systems. Investigations conducted by State P&A systems included highly publicized deaths, often brought to their attention by the media (many States had no mandatory death reporting requirements to cover residential care and treatment facilities in effect). Findings substantiated that residential facility staff either used excessive physical restraint or provided inadequate medical care.

Funding levels for the past five fiscal years were as follows:

Funding FTEs

2000.... $24,903,000 ---
2001.... 30,000,000 ---
2002.... 32,500,000 ---
2003.... 33,779,000 ---
2004.... 34,620,000 ---

Rationale for the Budget Request
The FY 2005 budget proposes $34.6 million, the same as the FY 2004 final conference level. These funds will serve an estimated 20,000 persons, the same as in FY 2004. Existing funding will support awards to the 57 P&A systems. Funding will also support investigation and community expansion provisions for individuals with mental illness.

Although the proposed funding is the same as FY 2004, the allotments to individual States differ because source data for the formula (State population and per capita estimates) were different in the two fiscal years.