Provisions in HR 3717 that improve Protection and Advocacy for Individuals with Mental Illness (PAIMI)  program


PAIMII was enacted by Congress for the noble purpose of protecting the civil rights of and preventing abuse of individuals with “serious” mental illness living in institutions, It was later expanded to include individuals with “serious” mental illness living in the community. SAMHSA distributes PAIMI (formerly Protection and Advocacy, P&A)  funds to advocacy organizations in each state that have been designated by the state to receive the funds. The National Disability Rights Network (NDRN) is the congressionally mandated trade association for the state recipients and receives $2 million directly which is supposed to be used to provide technical assistance to the state programs consistent with PAIMI’s legislative mission.

PAIMI has provided valuable services that protect the rights of persons with serious mental illness.

Problems with PAIMI Programs

While PAIMI has provided valuable services that protect the rights of persons with serious mental illness, those efforts have now become the exception, not the rule. Almost all the evidence shows that neither NDRN, nor the state PAIMI organizations are serving the needs of the most seriously ill anymore. Almost all their activities are focused on improving the mental health of all others. It is important to note, that were that all that were wrong with PAIMI, (it no longer meets its mission and doesn’t focus on seriously mentally ill), many would not call for reform.

The far more significant problem with PAIMI, that does need reform, is that the organizations are using their funds to fight  programs that do help the most seriously ill. It is PAIMIs efforts at systemic reform that comprise their biggest impact on the mental health system, and these are to prevent, not facilitate treatment.  This is what HR 3717 attempts to scale back and what must be scaled back.

PAIMIs own statistics show they helped 10,838 individuals with individual problems but performed systemic advocacy for 24,145,211 individuals. Many of the individual acts of advocacy and most of the ‘systemic advocacy’ was to prevent states from implementing treatments that help the most seriously mentally ill. PAIMI attempts to defend what they do by publishing heart wrenching stories of worthy personal assistance they provide. HR 3717 allows most of  that work to continue. It is the anti-treatment systemic advocacy that it tries to reign in.

How PAIMI and NDRN fight programs that help treat the most seriously mentally ill

PAIMI and NDRN have an ideology that says being psychotic is an exercise of free will and persons with serious mental illness should never be treated over objection no matter how psychotic they are. If they don’t like a program, they merely claim (without ever bringing cases in support) that the program raises ‘civil liberties’ concerns or in their mind, is ‘abuse’. They then use their own pronouncement as justification to fight the programs they don’t like.

Ex. All court cases have shown Assisted Outpatient Treatment is an appropriate use of the states police powers and parens patraie powers. It is constitutional. It does not violate civil rights. It helps consumers engage in a meaningful exercise of free will.  See Uncivil Liberties. PAIMI uses federal funds to prevent states from implementing AOT, merely by pronouncing that they raise civil liberties concerns.

Ex. Courts have ruled that ‘need for treatment’ and ‘gravely disabled’ civil commitment standards are constitutional and don’t compromise civil rights. They help people who are not yet dangerous avoid becoming so and thereby avoid incarceration. PAIMIs and NDRN use federal funds to prevent states from using these standards merely by making their own determination that they raise civil rights concerns.

Ex. State Psychiatric Hospitals are constitutional. There is no civil rights issue of making hospitals available to those who need them. PAIMIs and NDRN use federal funds to lobby to close hospitals

Ex.PAIMIs and NDRN are using federal funds to lobby against  HR 3717, the “Helping Families in Mental Health Crisis Act”  which would improve care for the most seriously ill. The bill is a good bill, but even if were not, PAIMI is not supposed to use funds to lobby.

Ex. PAIMIs and NRDN are using federal funds to lobby for passage of Convention on the Rights of Persons with Disabilities. Through complicated legal mumbo-jumbo, PAIMI and NDRN want Congress to interpret the bill as preventing seriously mentally ill from being treated until after they are danger to self or others. That’s ludicrous. Laws (like seat belt laws) are often passed to prevent danger, not require it. But again, whether the bill is righteous or not, PAIMI is not supposed to spend federal funds to lobby.

Ex.Willy Bruce, a young man with schizophrenia was in a state hospital thanks to work by his loving parents to get him treatment. PAIMI decided treatment violated Williams rights and PAIMI ‘freed’ him. William went home and killed his mother.

PAIMIs do some good work on individual cases. But their biggest impact has been their lobbying for systemic change. By focusing on systemic change-often to prevent people with serious mental illness from being treated- they have successfully prevented thousands from being treated. Many end up incarcerated. And then, displaying the ultimate hubris, PAIMI bemoan the treatment in jail, without recognizing that it was their own policies that put patients there.

Proof of problems at PAIMI

SAMHSA investigated PAIMI and found multiple problems with PAIMI.
Oregon Law Review published  a major article that documented the extensive prohibited lobbying by PAIMI

HOW HR 3717 attempts to improve  PAIMI and scale back their activities to prevent persons with serious mental illnes from receiving treatment.

Subtitle E of HR 3717 proscribes NDRDN and PAIMI from engaging in three limited practices.

‘(A)  lobbying  or  retaining  a  lobbyist  for  the purpose of influencing a Federal, State, or local governmental entity or officer.”

‘‘(B) using such funding to engage in systemic lawsuits, or to investigate and seek legal remedies  cases  other  than  individual  cases  of abuse or neglect” This is to ensure the funds are used as intended and the funds are not diverted to preventing treatment.

‘‘(C) counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.’’.  This tries to prevent local PAIMis from superceding the role of families that are providing care for loved ones.

It also eliminates the funding that was used to engage in those practices and continues the funding for permitted activities.

The limitations on PAIMI programs included in HR 3717 are measured and important. Obviously, any organization that has its funding cut, or its mission-creep subjected to mission control will object and NDRN and PAIMIs are objecting. But that is to be expected.