A program that monitors public and private psychiatric institutions, hospitals and nursing facilities for abuse, punishment, or seclusion of patients with mental illness could see a drastic reduction in its national budget next year.
In just one state, Indiana, the Protection and Advocacy for Individuals with Mental Illness program investigated a hundred alleged rights violations, 29 cases of neglect, and nine cases of abuse in 2023 alone. It conducted a six-year investigation of 22 facilities across the state serving youth, which led to two facilities being closed for non-compliance. And already this year, the program has kept a person living in an assisted living facility from being wrongfully discharged.
But soon this work may be unsustainable.
The budget cuts are part of a wave of potential federal funding drawdowns in President Donald Trump’s 2026 budget proposal.
The budget proposal calls for cutting PAIMI’s national budget from $40 million in 2024 to about $14 million next year. The program is funded independently of the states through federal dollars, to ensure there isn’t a conflict of interest when reporting on state-run mental health facilities.
In Indiana, it would shrink the program’s budget to less than half. Iowa, Kansas, and Nebraska would all see cuts of more than $300,000 — a drop of more than 60%. Ohio and Illinois would see even larger cuts, dropping from budgets of more than $1 million to just under $400,000.
This comes as the program is already bracing for the ripple effects from Medicaid and health care funding cuts through Trump’s “One Big Beautiful Bill”, which Congress passed July 4.
Melissa Keyes, the executive director for Indiana Disability Rights, said funding may decrease but the need for PAIMI’s services will only increase.
IDR is Indiana’s designated PAIMI organization. The proposed budget gives IDR just a little over $230 thousand next year. Keyes said this will not be enough to investigate alleged instances of abuse or bring about systemic changes through class action lawsuits and other mechanisms.
“We just won't — given all that we are tasked with doing — we would not be able to make the budget work for that program,” Keyes said.
The cuts will likely lead IDR to reduce staff, Keyes said.
The funding cuts hit an already limited budget
Federal funds for PAIMI are part of a larger pot of money the group receives for managing a handful of other programs, including the Developmental Disabilities program and the Traumatic Brain Injury program.
Work in each program is spread across some thirty staff, but Keyes said some of the other programs managed by their office are also slated for cuts. In total, the new Trump budget could cut IDR's budget from $3.5 million to $1.9 million.
“On top of the other cuts that are being proposed to mental health services in general, mental health programming, Medicaid, our ability to respond to issues is going to decrease at the same time that the need for our services is going to increase,” she said. “And that is a recipe for disaster.”
Other experts have raised similar concerns about a reduction in PAIMI funding, but add that the accountability mechanism was already underfunded.
Morgan Shields, an assistant professor in the School of Public Health at Washington University in St. Louis, said that while PAIMI should be able to monitor all kinds of mental health facilities or hospital units across states, they often have a narrower focus because of limited resources.
“They tend to be quite focused on these state-owned facilities, long-term patients, including maybe forensic patients,” said Shields, who studies accountability in behavioral health care.
Another issue, according to Shields, is that PAIMI reports findings from its investigations back to state oversight agencies, but doesn’t have the ability to revoke state licenses or institute punishments of its own.
PAIMI can sue, but rarely does, according to Shields, because of resource constraints.
“PAIMI wants to be able to resolve these issues through education, through informal advocacy, and not through suing the state,” she said.
But the federal cuts, to Shields, will only make matters worse and weaken PAIMI’s already limited abilities.
“It would be great if they actually had greater capacity and boots on the ground to be able to provide that sort of protection and be a watchdog for everyone who ends up inside a psych facility,” she said. “It would be really unfortunate if the funding went away.”
Trump’s budget proposal will ultimately require congressional approval.
Contact Health Reporter Benjamin Thorp at bthorp@wfyi.org.
Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.
