The Americans with Disabilities Act (ADA) ensures that people with disabilities, such as severe mental illness, have legal protection against discrimination in the workplace, housing and residential settings (including treatment facilities such as hospitals), public programs, and telecommunications. The ADA’s goal is to give the 54 million Americans with disabilities full and equal opportunities (President Bush’s New Freedom Initiative, 2002).

What are State Protection and Advocacy programs?

Each State, as well as the District of Columbia and the five Territories, has a Protection and Advocacy for Individuals with Mental Illness (PAIMI) program. PAIMI programs safeguard the rights of people with mental illness. Where problems are found, PAIMI programs pursue legal, administrative, and other remedies to ensure protection of rights for people with severe mental illness. People with disabilities who are not eligible for PAIMI services may be eligible for other programs within the Protection and Advocacy (P&A) system, such as the Protection and Advocacy for Individual Rights (PAIR) program or the Client Assistance Program (CAP).

What is an advance directive?

If you frequently seek and use mental health services, you may want to establish an advance directive. There are two general types of advance directives: instructional, such as living wills, and proxy, such as durable power of attorney. Each directive is a legal document that lets you describe what services you want to receive if an illness renders you unable to make decisions about your care. Give a copy of the directive to your usual service provider(s) so that it can become part of your medical record. Laws about advance directives vary from State to State. Work with a lawyer, paralegal, or advocate to write your advance directive.

What is ‘informed consent’?

Informed consent refers to when a patient agrees to undergo or participate in a medical or surgical procedure, treatment, or study after learning what is involved. Informed consent requires that a person know and fully understand the risks and benefits of a certain treatment or procedure.

Can I refuse treatment?

People generally have the right to consent to or refuse treatment. However, under certain conditions-such as when a person is considered a danger to self or others-he or she may be required to seek or receive treatment. This can include involuntary civil commitment, which can be for either outpatient or inpatient treatment, as well as forced medication. Laws about commitment vary by State. If you have questions about the commitment process in your State, contact your State P&A program or consumer or family organization.

What about managed care rights?

Many organizations have developed bills of rights for people with severe mental illnesses who are treated in a managed care setting. The Center for Mental Health Services (CMHS) has developed principles for managed care treatment. CMHS recommends that providers, managed care firms, and consumers consider these principles in their decision-making process. Most managed care firms have a process for grievances and appeals. Participants may appeal a treatment decision, question payment decisions, or file complaints about providers and facilities.

Do I have a right to privacy?

Mental health providers agree to keep your meetings and what you discuss confidential. This means that what you say-as well as your diagnosis and treatment-cannot be disclosed to anyone, including family members, without your written consent.