Statement of Objectives and Priorities

Protection and Advocacy for Individuals with Mental Illness

Statement of Goals and Objectives

Approved by the PAIMI Advisory Council on December 1, 2021

Approved by the Board of Directors on February 6, 2023

 

Missouri Protection and Advocacy Services (Mo P&A) will conduct activities in the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program according to the goals and objectives as established in this document. These goals govern both individual cases and systemic issues.

The goals for the PAIMI program reflect our best understanding of the overall needs expressed by consumers, their families, mental health professionals, others in Missouri’s mental health community, and our PAIMI Advisory Council.

The role of Mo P&A is necessarily limited by its resources. Funding for the PAIMI program is derived from a formula established in federal law. The objectives, case acceptance criteria, and outcome measures listed in each goal define what the Missouri Protection and Advocacy Services’ Board of Directors believe can reasonably be achieved with the funding provided.

Advocacy cases are opened to assist consumers with problems falling within the PAIMI goals. The problem must be directly related to the consumer’s disability. Services will be provided to resolve problems at the lowest possible level of intervention. Litigation in a court of law will be pursued only after all administrative remedies have been exhausted.

Individual Assistance & Legal Representation Limitations

Mo P&A does not accept cases where the allegation involves client-to-client abuse. Mo P&A has a conflict of interest in these situations. When a conflict of interest for Mo P&A exists, a referral to the appropriate authority will be made and a review will be conducted of how the matter was handled.

Mo P&A does not duplicate advocacy or legal services, where legal or advocacy services are already being provided to current clients or applicants of this agency, by other attorneys, or private individuals.

Attorneys for Mo P&A do not represent PAIMI-eligible individuals in criminal cases or divorce proceedings. Individuals accused of a crime have a right to representation in a court of law. Therefore, if an individual cannot afford an attorney, the court will appoint a public defender or private attorney (pro bono) to represent them.

Goal #1 - Imminent Danger, Abuse/Neglect & Death Investigations

PAIMI-eligible individuals will not be subject to abuse or neglect which may cause injury or death.

Objective: Imminent Danger, Abuse/Neglect & Death Investigations

Mo P&A will conduct an investigation for every report of abuse and/or neglect of a PAIMI-eligible individual where there is a loss of life or allegation of serious physical or psychological harm.

Key Outcome Measures - Mo P&A will:

  1. Imminent Danger Investigations: Conduct an Imminent Danger Investigation for every report of abuse and/or neglect of a PAIMI-eligible individual, where there is an immediate potential for loss of life or serious physical or psychological harm. Mo P&A will provide advocacy (and legal representation when necessary) in order to seek remedies from administrative agencies, prosecuting agencies, and courts for substantiated allegations.

  2. Abuse/Neglect Investigations: Conduct an investigation for selected reports of abuse and/or neglect of a PAIMI-eligible individual where there is an allegation of serious physical or psychological harm. Mo P&A will provide advocacy (and legal representation when necessary) in order to seek remedies from administrative agencies, prosecuting agencies, and courts of substantiated allegations.

  3. Death Investigations: Review notifications of all unexpected deaths among Department of Mental Health PAIMI-eligible individuals. Conduct primary/secondary death investigations in each case where probable cause of abuse or neglect exists.

  4. Restraint/Seclusion Deaths: Conduct a primary death investigation for each PAIMI-eligible individual identified by the Centers for Medicare and Medicaid Services (CMS) who died while in restraints or seclusion.

Potential Interventions in Individual Representation

Mo P&A will conduct a secondary investigation in cases where a primary investigation is being conducted by another agency.

Mo P&A will review all previous investigations that have been conducted for a reported incident or death. Mo P&A will determine if further investigation or intervention is needed to make a determination or seek a remedy.

Goal #2 - Abuse/Neglect & Violation of Rights

PAIMI-eligible individuals will be free from abuse, neglect, and receive appropriate treatment, care, respect, and services, which upholds their rights, in the least-restrictive environment.

Objective: Abuse/Neglect and Violation of Rights

PAIMI-eligible individuals will not be subject to abuse or neglect or violations of rights.

Key Outcome Measures

  1. Abuse/Neglect Allegations: Mo P&A will provide advocacy services for allegations of non-imminent danger abuse and/or neglect. This includes ongoing monitoring of state tracking systems for allegations of abuse and neglect, and ensuring that state-run facilities have appropriate policies and procedures in place to prevent unnecessary/abusive restraint and seclusion.

  2. Violation of Rights Allegations: Mo P&A will provide advocacy services for allegations where probable cause exists to believe that disability-related rights have been violated. Focus areas will include inappropriate placements in a more restrictive environment and violations of a ward’s rights by a guardian.

Acceptance for Individual Representation Criteria

Mo P&A will accept cases where there is a probable cause to believe that the client’s right to a safe environment is being violated. Mo P&A will assist clients with complaints that raise probable cause to believe that involuntary treatment and restrictions are being illegally imposed or that significant rights are being improperly restricted.

Mo P&A will accept cases when the client is inappropriately placed in a facility. Mo P&A will represent PAIMI-eligible individuals whose right to reside in the least-restrictive environment is endangered by decisions made by treatment teams, guardians, or courts which unduly restrict the rights and environment in which the client resides. Mo P&A will not represent clients at hearings for which competent court-appointed representation is provided.

Goal #3 - Outreach, Access, and Information & Referral

Every effort should be made to facilitate access to Mo P&A services, help foster communication, and give clients the opportunity to register complaints about treatment, care, and rights violations.

Objective: Services

PAIMI-eligible individuals residing in 24-hour care and treatment facilities and in the community need a range of advocacy-related services. Every effort should be made to facilitate access to Mo P&A and provide clients the opportunity to register complaints about their treatment and care.

Key Outcome Measures - Mo P&A Will:

  1. Toll-Free Number: Maintain a toll-free information line available to all PAIMI-eligible individuals, to enable them to access our services and information about their rights. Mo P&A will work to ensure that this phone number remains posted at all 24-hour care and treatment facilities.

  2. Information & Referral: Provide PAIMI-related information and referral services to callers and applicants for services.

Priority #4 - Significant Impact

PAIMI-eligible individuals may need advocacy or legal services when a disability-related issue(s) not addressed in the current PAIMI goals may have a significant negative or detrimental impact on their life.

Objective #1: Serious Harm

Provide advocacy or legal representation (where necessary) to PAIMI-eligible individuals to ensure that they are not seriously harmed by disability-related issues that may have a significant negative impact on their life.

Objective #2: Disaster Relief & Services

Address the unique needs of PAIMI-eligible individuals during disasters in our State, including but not limited to: pandemics, floods, tornadoes, earthquakes, wildfires, and civil unrest. Assistance may be provided to ensure that individuals are receiving appropriate services for both physical and emotional distress.

Acceptance for Individual Representation Criteria

  1. Mo P&A will accept a limited number of disability-related cases (as funding allows) in which a PAIMI-eligible person is confronting an issue that places them at risk of serious harm in their life.

  2. Mo P&A will accept a limited number of disability-related cases in which a PAIMI-eligible person has been denied disaster relief or services.

  3. The Executive Director shall make the decision to provide services under this goal.

Potential Interventions in Individual Representation

Mo P&A will accept a limited number of cases for advocacy or legal representation.