On July 26, 1990, the Americans with Disabilities Act (ADA) was signed into law. Considered one of the most sweeping and comprehensive pieces of civil rights legislation ever passed, it “prohibits discrimination and guarantees that people with disabilities have the same opportunities as everyone else to participate in the mainstream of American life…. Modeled after the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, religion, sex, or national origin… the ADA is an ‘equal opportunity’ law for people with disabilities.”1
The Substance Abuse and Mental Health Services Administration (SAMHSA) has long recognized the importance of enhancing opportunities for full community participation for people experiencing mental health and substance use conditions. Numerous SAMHSA programs and initiatives foster rights protection and address disparities in access to behavioral health services and supports. One key resource is SAMHSA’s Protection & Advocacy for Individuals with Mental Illness (PAIMI) Program.
Since the passing of the PAIMI Act of 1986,2 state Protection and Advocacy (P & A) systems have: 1) protected and advocated for the rights of those with serious mental illness/serious emotional disturbance residing in public and private facilities and community settings who are at risk for abuse, neglect, and rights violations by using “administrative, legal, systemic, or other appropriate remedies on their behalf”; 2) investigated reports of abuse, including the inappropriate use of seclusion and restraint; and 3) ensured enforcement of the U.S. Constitution, federal laws, and regulations, as well as state statutes. SAMHSA PAIMI grantees serve all 50 states, the District of Columbia, and five U.S. territories. In 2000, the Children’s Health Act established a 57th P & A system for the Native Americans/American Indian Consortium.3 From 2017 – 2021, alone, the PAMI program assisted nearly 50,000 adults with serious mental illness and children with serious emotional disturbance to access needed behavioral health services.4
One of the most significant outcomes of the ADA has been the Olmstead Supreme Court decision. In 1999, the U.S. Supreme Court found that in the case of Olmstead v. L.C., unjustified segregation of individuals with disabilities is discrimination in violation of Title II of the ADA. They found that the ADA’s “integration mandate” required states to provide community-based services that enabled individuals to live in the most integrated setting appropriate to them. The State of Georgia’s PAIMI program was instrumental in bringing the case to the Court, which involved two primary plaintiffs who had been institutionalized in psychiatric hospitals despite their having been determined to be able to live in the community.5 Since that ruling, enforcement of this decision has been an area of particular focus for PAIMI grantees.6 As a result of their advocacy, many individuals previously confined to institutional settings now live in their own homes and receive community-based services of their choice. Many more have been diverted from ever entering higher, more restricted levels of care. They are instead able to access services and supports critical to their continued community integration.
Despite the tireless efforts of PAIMI grantees, many federal agencies, community partners, consumers, and family members to safeguard the rights of those with mental health and substance use conditions, there is much more to be done. There remain individuals with behavioral health conditions who reside in nursing facilities, hospitals, and other institutional settings due to a lack of community-based services. There are those in jails, prisons, and other criminal justice facilities with inadequate access to behavioral health treatment and recovery supports. And there are those experiencing early serious mental illness for whom the evidence-based treatment critical to their remaining in their homes and communities is unavailable. On this 32nd anniversary of the ADA, SAMHSA remains committed to ensuring that all Americans are afforded opportunities to fully participate and contribute to their communities.
1United States Department of Justice Civil Rights Division. Introduction to the ADA. Retrieved from: https://www.ada.gov/ada_intro.htm.
3 U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2020). The Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program Activities Report for Fiscal Years 2017 And 2018. Retrieved from: https://www.samhsa.gov/sites/default/files/paimi-activities-report-fy-17-18.pdf.
4 WEBBGAS Protection and Advocacy for Individuals with Mental Illness Grants. PAIMI Data Tables, 2017-2019 and 2020-2021. Retrieved from: https://bgas.samhsa.gov/.
5United States Department of Health and Human Services Office of Civil Rights. Serving People with Disabilities in the Most Integrated Setting: Community Living and Olmstead. Retrieved from: https://www.hhs.gov/civil-rights/for-individuals/special-topics/community-living-and-olmstead/index.html#:~:text=The%20U.S.%20Supreme%20Court's%201999,with%20Disabilities%20Act%20(ADA).
6U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2011). Evaluation of the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program Phase III: Evaluation Report. Retrieved from: https://store.samhsa.gov/sites/default/files/d7/priv/pep12-evalpaimi.pdf