Template | Protection & Advocacy for Individuals with Mental Illness

Dear [Representative/Senator/Committee],

Individuals living with serious mental illness (SMI) and/or co-occurring psychiatric and substance use disorders represent one of the most vulnerable populations in the United States. They face disproportionately high rates of unemployment, homelessness, poverty and premature death. Population-adjusted rates of incarceration among this group are among the highest of any protected class, often stemming from low-level infractions such as shoplifting or vagrancy. Alarmingly, many of the nation's largest providers of mental health services are now jails and prisons—especially in urban areas—highlighting profound systemic failure.

Legal advocacy and support for these individuals are severely limited. At the same time, new or repurposed institutions—including jails, psychiatric units, forensic programs, Institutions for Mental Disease (IMDs), supervised residential facilities, and large group homes—often replicate the neglect, abuse, and fraud that plagued the state hospitals of the last century.

Against this troubling backdrop, we write to express our deep concern about mental health and substance use-related cuts proposed in the White House’s pre-decisional budget for the Department of Health and Human Services (HHS). In particular, we wish to draw attention to three critical issues:

The Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program PAIMI is a vital source of legal representation and protection for individuals with mental illness, particularly those experiencing abuse or discrimination in institutional and community settings. It supports Protection & Advocacy (P&A) organizations in every state, which play a dual role in both legal support and systemic oversight—monitoring institutions for abuse, neglect, and fraud. Unlike most lawyers, advocates, and other organizations advocating for individuals with mental illnesses, PAIMI provides P&As with federally mandated access authority to enter facilities, residential settings, and community providers where people with mental health disabilities live or receive services. This provides P&As with the unique ability to see the true conditions of mental health facilities and understand the full continuum of mental health service systems.

P&As ensure that vulnerable individuals with mental illness are not abused and neglected. Recent P&A advocacy efforts include Disability Rights Michigan investigating medical professionals justifying involuntary treatment at multiple psychiatric hospitals based on falsified documentation, Indiana Disability Rights’s multiyear effort to help a psychiatric hospital patient who underwent a bilateral frontal lobotomy at fifteen years old obtain a community placement 41 years after their initial hospital admission, and a complaint filed by Disability Law Center of Utah concerning the state’s long term care facility oversight. This complaint described an earlier public report by the Utah P&A investigating the inhumane facility conditions and lack of psychiatric care that led to a resident death as well as advocacy efforts concerning a psychiatric hospital with such rampant sexual abuse that facility staff described it as “The Rape Hospital.” Without P&As, these horrifying abuses could continue without public knowledge. In Arkansas, Disability Rights Arkansas  created a publicly available youth psychiatric facility database aggregating licensing agreements, incident reports, and additional oversight documents for facilities throughout the state to ensure provider accountability and that children and parents can make informed decisions about their care options.  And Disability Rights Maryland’s recent lawsuit has alleged that state officials are allowing criminal defendants who are deemed incompetent to stand trial to languish in carceral settings for indeterminate periods without receiving the mental health services and supports they would need to regain competency.

Cutting P&A services will leave more persons with mental health disabilities vulnerable to more expensive emergency care and institutionalization. In January, Disability Rights of West Virginia filed a lawsuit regarding misconduct and abuse by state facility workers. Describing the lawsuit, the P&A explained that one state psychiatric hospital spent more than $45 million on just contract staff workers in the most recent fiscal year. That is more money than the entire PAIMI budget nationwide for FY 2025.Cuts to Community-Based Mental Health ServicesWhile proposed cuts to PAIMI alone would be devastating, they are compounded by the simultaneous targeting of critical community-based programs – precisely those programs that keep individuals with mental health challenges out of institutions.  

Termination of SAMHSA’s Certified Community Behavioral Health Clinics (CCBHCs) expansion grants, offer broad services for people with psychiatric disabilities and substance use conditions; Housing First programs, which provide immediate, unconditional housing with voluntary voluntary support—resulting in greater housing stability, reduced hospitalizations, and improved well-bein 

• Reductions to training and technical support for peer-led services that build trust, promote self-determination, and improve engagement and recovery outcomes. 

• Serious threats to Medicaid-funded Home and Community-Based Services (HCBS) like New York’s Adult Behavioral Health HCBS program, which includes supported employment and psychosocial rehabilitation, keep people stable in their communities.

• Termination of critical voluntary wraparound services like SAMHSA’s Healthy Transitions program, which aims to provide strong and proactive supports as youth with significant psychiatric disabilities transition to adult systems of care;

• Multifaceted risk to core supports, like SSI/SSDI, SNAP, and supported housing, that ensure sustained recovery and community integration.

Along with other threatened reductions to Medicaid, these cuts would further destabilize this already at-risk population, increasing the likelihood of costly and traumatic hospitalizations or incarceration, and exposure to abuse and misconduct in hospitals and institutions.

Return to Coercive and Institutional ApproachesIn the midst of these proposed cuts, recent statements from President Trump and other officials have explicitly promoted re-institutionalization and expanded use of involuntary commitment and other coercive interventions.   This is despite decades of research demonstrating that the most effective and cost-efficient solutions are voluntary, community-based systems of care supported by robust, means-tested benefits. Dismantling the protections of the PAIMI program while increasing coercive treatment and undermining community-based care would reverse decades of progress and put vulnerable Americans at great risk.

We respectfully urge Congress to:

1. Fully fund the SAMHSA PAIMI program at $40 million;

2. Preserve and expand funding for SAMHSA and CMS programs that support individuals with SMI and co-occurring disorders in the community, including CCBHCs, Healthy Transitions, and Medicaid HCBS and 1115 waiver programs;

3. Oppose calls for increased institutionalization and coercion, and instead invest in the voluntary, person-centered care system long envisioned by the community mental health movement.

We thank you for your attention to these critical issues and stand ready to support your efforts to ensure that all Americans with mental health and substance use needs receive compassionate, effective, and recovery-oriented care.