U.S. Department of Health and Human Services
         Substance Abuse and Mental Health Services Administration
                     Center for Mental Health Services
     _________________________________________________________________

    PROTECTION AND ADVOCACY PROGRAM FOR INDIVIDUALS WITH MENTAL ILLNESS
     _________________________________________________________________

    THE PEOPLE WE SERVE

   An elderly female State hospital resident had a long history of mental
   illness. She also had a history of assaultive and aggressive behavior.
   After multiple psychiatric hospitalizations, she contacted her State
   Protection and Advocacy (P&A) agency. She complained about the care
   she was receiving and requested assistance in returning home. Prior to
   her hospitalization, she lived in a rural community as a ward of the
   public guardian. P&A contacted the guardian and explained the woman's
   needs and wishes.

   A case manager was assigned, and a discharge plan was formulated with
   the participation of the woman, her guardian, and appropriate
   community services providers. Although she was granted a trial visit
   to a transitional community residential facility in her home
   community, the woman was denied placement because of the number of
   stairs she would have to climb. P&A intervened again and insisted on
   reasonable accommodations in her community. As a result, the woman was
   given a room on the ground floor.

     * Congress has found that people with mental illnesses are
       vulnerable to abuse and neglect, including lack of treatment,
       appropriate nutrition, clothing, health care, and discharge
       planning. Congress also has found that State systems which monitor
       compliance with an individual's rights vary and often are
       inadequate.
     * Congress established the P&A Program to protect the rights of
       people with mental illnesses in, or recently discharged from,
       residential facilities and to investigate alleged incidents of
       abuse or neglect. P&A programs do not provide mental health care;
       they are required to be independent of any organization providing
       care, treatment, or services in the State.
     * P&A programs are authorized to provide services to individuals who
       have a severe mental illness or emotional impairment, as
       determined by a mental health professional, and who are inpatients
       or residents in public or private residential facilities that
       provide care or treatment for people with mental illnesses.
     * People who have been discharged from such facilities in the past
       90 days are eligible for P&A services. Residential facilities that
       discharge people without ensuring appropriate housing, followup
       treatment, or support services may be subject to P&A actions.

    MANDATE

     * Public Law 99-319, the Protection and Advocacy for Individuals
       with Mental Illness (PAIMI) Act (42 U.S.C. 10801 et seq.),
       authorizes formula grants to be awarded annually to P&A systems
       designated by the Governor of each State.

    FUNDING

   FY 1995
   $ 21,957,000

    STATUS

     * P&As engage in administrative, legal (individual and class
       action), systemic, and legislative activities. Each P&A system
       sets its own policies and priorities for the services it provides.
       These priorities are subject to annual public review.
     * There are 56 P&A systems, one in each of the 50 States and the
       District of Columbia, the Virgin Islands, Puerto Rico, Guam,
       American Samoa, and the Commonwealth of the Northern Mariana
       Islands. A total of 43 are private, non-profit organizations, and
       the rest are State government agencies or special departments.
     * During FY 1995, PAIMI programs served almost 17,000 clients to
       address nearly 25,000 complaints of abuse, neglect, and rights
       violations. Seventy percent of the clients served by the PAIMI
       program were between age 21 and 59 years old; 17 percent were
       younger than age 21; and 7 percent were older than 60 years.
       Fifty-eight percent of the clients were male, while 40 percent
       were female.
     * In addition to their direct involvement in resolving complaints
       for individuals, PAIMI programs represented nearly 122,000 persons
       in class action suits; acted on behalf of 332 groups (e.g.,
       hospital wards and consumer organizations) representing nearly
       526,000 persons; responded to 44,219 requests for information; and
       conducted education and training for 320,550 mental health
       administrators, legislators, P&A staff, clients of the mental
       health system, their family members, and other community
       organizations.
     * PAIMI programs work cooperatively with public and private mental
       health providers and administrators; legal, judicial, and law
       enforcement personnel; State legislative bodies; mental health
       consumer/ex-patient, family, and other mental health advocacy
       organizations; and State housing, health care, transportation,
       education, welfare, and other social services providers.
     * How To Find Your State P&A System: The P&A System telephone number
       should be available from the information operator. If you have
       difficulty locating the telephone number, call the CMHS PAIMI
       Program at (301) 443-3667 or the National Association of
       Protection and Advocacy Systems at (202) 408-9514.

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