On July 26, 1990, the Americans with Disabilities Act (ADA) 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 based on race, color, religion, sex, or national origin… the ADA is an “equal opportunity” law for people with disability”.1
The Substance Abuse and Mental Health Services Administration (SAMHSA) has long recognized the importance of enhancing opportunities for full community participation for individuals experiencing mental health and substance use conditions. SAMHSA’s numerous programs and initiatives promote the protection of rights and address disparities in access to health services and behavioral supports. A key resource is SAMHSA’s Advocacy & Support Program for Individuals with Mental Illness (PAIMI).
Since the passing of the PAIMI Act of 1986,2 State Protection and Advocacy (P & A) systems have: 1) protect and support the rights of those with serious mental illness/severe emotional disturbance residing in public and private facilities and community settings who are at risk of abuse, neglect and rights violations using “ administrative, legal, systemic, or other appropriate remedies on their behalf”; 2) investigate reports of abuse, including the inappropriate use of solitary confinement and restraint; and 3) ensure enforcement of the U.S. Constitution, federal laws and regulations, as well as state statutes. SAMHSA PAIMI beneficiaries serve all 50 states, the District of Columbia and five US territories. In 2000, the Children’s Health Act established 57u P & A System for the Native American/American Indian Consortium.3 From 2017 to 2021 alone, the PAMI program helped nearly 50,000 adults with serious mental illness and children with severe emotional disorders access needed behavioral health services.4
One of the most important results of the ADA was the Olmsted Decision of the Supreme Court. In 1999, the US Supreme Court found that in its case Olmstead v. LC, unreasonably segregating individuals with disabilities constitutes 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 enable individuals to live in the most integrated environment that suits them. The State of Georgia’s PAIMI program was instrumental in bringing the case to Court, which involved two lead plaintiffs who had been committed to psychiatric hospitals despite being determined to be able to live in the community.5 Since that decision, enforcement of that decision has been an area of particular focus for PAIMI beneficiaries.6 As a result of their advocacy, many individuals previously confined to institutions are now living in their own homes and receiving community-based services of their choice. Many more have been diverted from entering higher, more limited levels of care. Instead, they can access services and supports that are critical to their continued integration into the community.
Despite the tireless efforts of PAIMI grantees, many federal agencies, community partners, consumers, and family members to protect the rights of those with mental health and substance use conditions, much remains to be done. There remain people with behavioral health problems who reside in nursing facilities, hospitals, and other institutions because of a lack of community-based services. There are those in prisons, jails and other criminal justice facilities with inadequate access to behavioral health treatments and rehabilitation support. And there are those who experience early severe mental illness for whom the evidence-based treatment critical to staying in their homes and communities is not available. In this 32n.d anniversary of the ADA, SAMHSA remains committed to ensuring that all Americans are afforded opportunities to fully participate and contribute to their communities.
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1Civil Rights Division of the United States Department of Justice. Introduction to ODA. Retrieved from: https://www.ada.gov/ada_intro.htm.
2 42 US Code 10801 et seq.
3 US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2020). The Protection and Safeguarding of Individuals with Mental Illness (PAIMI) Program Activities Report for fiscal years 2017 and 2018. Retrieved from:
4 WEBBGAS Protection and Advocacy for People with Mental Illness Grants. PAIMI Data Tables, 2017-2019 and 2020-2021. Retrieved from: https://bgas.samhsa.gov/.
5Office for Civil Rights of the United States Department of Health and Human Services. 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).
6US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2011). Evaluation of the Protection and Advocacy Program for Individuals with Mental Illness (PAIMI) Phase III: Evaluation Report. Retrieved from:
