Summary of Discussion on PAIMI Act Implementation at the 2001 CEO Meeting
The following is a summary of a discussion by a large number of P&A Executive Directors regarding the new authority and resources under the PAIMI Act, which took place at the CEO meeting in March 2001. The discussion here and options offered complement the analysis contained in main paper on this issue (attached).
The general concern identified by the CEOs relates to how P&As should allocate the new PAIMI Act resources in a way that:
- fits the agency’s mission,
- meets Congress’ and CMHS’ standards and expectations (e.g., regarding follow up on restraint and seclusion abuses),
- is reasonably consistent with the agency’s past advocacy role re people with mental illness or emotional impairment (e.g., PAIR work in housing/employment discrimination), and
- begins to respond to the existing unmet advocacy needs of people with mental illness or an emotional impairment
The following related issues were discussed, with pros and cons raised.
PAIMI Eligibility Determinations
In addition to being considerably less burdensome to implement, the option of serving under PAIMI all people with a mental illness or emotional impairment could be justified by the fact that the appropriations level for the PAIMI Act is much higher than that for the PAIR Program. Moreover, this approach would be easier to explain to the public.
A major concern with this approach, however, is the possibility that consumers and others will have unrealistically high expectations about what the P&A will be able to do with the new funding under the PAIMI Act. These people may be disappointed or angry when they see what P&As actually do.
If instead, P&As were to serve under the PAIR program some subset of people with mental impairments who live in the community, it may allow services under that Program for individuals whose issues fall within the Program’s priorities.
Other Eligibility Issues
What are the options for eligibility for an individual with a severe physical disability and a significant mental illness? All of the following may be considered as options:
1. Always PAIR eligible
2. Always PAIMI eligible
3. Could be PAIR- or PAIMI-eligible, based on P&A discretion (e.g., which disability is emphasized at intake)
4. Depends on the advocacy issue – which aspect of the person’s disability is in the forefront (e.g., physical access)
Also, a question was raised as to whether P&As should serve some (or all) kids with SED under PAIMI – versus the past practice of serving many under the DD Act.
Concerns related to New Authority and Resources
Related to the new resources and authority available under the PAIMI Act generally, there are a number of potential concerns that should be carefully considered :
- A lack of staff expertise to investigate/monitor, given the expanded abuse and neglect mandates/expectations;
- Consumer dissatisfaction that an issue/problem is not being addressed;
- Inability to satisfy potential consumer expectation that we will serve all people in the community;
- Too much emphasis on community issues versus institutional issues;
- Negative public relations with consumers relating to priorities;
Strategy Options that P&As Can Use to Apply New Authority and Resources
P&As should strongly consider the following options:
Expand Existing Services
- Serve more kids with SED (including kids living with their families)
- Provide more short-term assistance overall
- Spill over effect on PAIR (that is, there will be new opportunities to expand advocacy under the PAIR Program now that formerly eligible clients are served instead under the PAIMI Program)
- Enhance investigation capacity (especially re R/S and abuse and neglect)
- Continue strong role in residential facilities (especially where P&A is only player)
- Maintain some continuity re past PAIR work
- Strengthen R/S advocacy role (including chemical restraints)
Break New Ground
- Serve previously unserved mental health consumers
- Expand abuse and neglect investigations into nursing homes
- Provide assistance on employment and housing discrimination under PAIMI
- Serve more people in nursing homes, RTCs, correctional facilities, including juvenile facilities (focus on right to mental health services)
- Apply new resources to developing expertise in seclusion and restraint, conducting proactive education and reactive investigations
- Attempt to influence public policy re practices used with kids, e.g., restraint and seclusion, drugging and future planning
- Move to program-wide priorities
- Strengthen relations with community health system
- Olmstead types cases
- Advance directives
- Initiative focused on managed care
- Elderly people with mental illness
- EPSDT for kids with SED
- Involuntary commitment
- Representing people in family court system
- Outpatient programs in the community
- Ensure services for children living at home
- Development of community MH services
- Serve people at risk of institutionalization
- Create new investigations or monitoring unit
Change Organizational Structure/Operations
- Move all PAIMI-eligible cases out of PAIR
- Use new statutory authority – leverage to get more money
- Change mix of attorneys and non-attorneys
- More outreach and investigation
- Clarify internal eligibility/billing procedures
Long-Range Planing
- Revisit priorities for MH advocacy
- Gradually widening of the door (that is, take some types of new cases in the first year, then broaden to other cases in succeeding years).
- Strategically deploy system and individual case advocacy
- Develop interim strategy for FY 2001, but start long-range planning process now (e.g., board retreat, focus groups with consumers and advisory council)