From the U.S. Government Accountability Office, www.gao.gov Transcript for: Mental Health Protection and Advocacy Description: Join us as we discuss a GAO report exploring the federal government's role in overseeing states' mental health protection and advocacy. Related GAO Work: GAO-18-450: Mental Health: Federal Procedures to Oversee Protection and Advocacy Programs Could Be Further Improved Released: May 2018 [ Background Music ] [ Katherine Iritani: ] There was evidence that SAMHSA was appropriately overseeing the state programs. [ Matt Oldham: ] Welcome to GAO's Watchdog Report -- your source for news and information from the U.S. Government Accountability Office. I'm Matt Oldham. Every state has a program for the protection and advocacy for individuals with mental illness. And these programs are overseen at the federal level by the Substance Abuse and Mental Health Services Administration, or SAMHSA, and it falls under the Department of Health and Human Services. I took a phone call with Katherine Iritani, a director on our health care team to talk about a GAO report that took a look at the state of our mental health protection and advocacy problems. Thank you for taking the time to speak with me, Katherine. [ Katherine Iritani: ] Thank you for inviting me, Matt. [ Matt Oldham: ] How are states doing when it comes to mental health protection and advocacy? [ Katherine Iritani: ] So our report looked at the outcomes that were reported by eight state protection and advocacy programs. And we found that they reported a range of positive outcomes from their programs. In 2016, those programs reported resolving about three quarters of the cases that they investigated involving alleged abuse, neglect, or rights violations in the individual's favor. So that was about 1,800 of the 2,400 cases that they undertook. And these are all individuals with serious mental illness. The remaining cases were withdrawn by the individuals or closed due to lack of merit. Or in some cases not resolved in the individual's favor. But the majority of them were. [ Matt Oldham: ] So what role does the federal government play? I know there's oversight involved but what do they do? [ Katherine Iritani: ] HHS with SAMHSA that you mentioned administers a grant program that supports the state program activities. And there's about $36 million in grants that were distributed to these state based programs and about 57 programs. And SAMHSA reviews applications for the funding and oversees the program's compliance with federal, statutory, and regulatory requirements. And these are requirements that for example involve grievance procedures or public engagements and use of funding. [ Matt Oldham: ] You had mentioned that there were more than 2,000 cases the report looked at. How was the federal government done in regard to those cases? [ Katherine Iritani: ] Pretty well. SAMHSA has -- SAMHSA monitors the programs through annual reporting that the programs do in terms of how they are doing with regard to things like their performance, their activities, their accomplishments, the spending, and SAMHSA also does for a smaller number of programs, onsite reviews. So we found that SAMHSA had identified problems with multiple state programs and taken action to correct them. So there was evidence that SAMHSA was appropriately overseeing the state programs. We did find that there were a couple of areas for improvement in relation to SAMHSA's monitoring of changes that states make to their own performance benchmarks. States are allowed to change their goals so we found that many programs were changing their goals but SAMHSA wasn't really monitoring to make sure that those changes weren't reflecting sort of a bigger performance problem. We also found that SAMHSA wasn't always completing their onsite reviews timely and communicating those results to the state programs. [ Background Music ] [ Matt Oldham: ] It sounds like the states' protection and advocacy programs the GAO looked at showed some successes. But SAMHSA could improve some of its oversight functions. So I asked Katherine what her team recommended. [ Katherine Iritani: ] Yes, so we made two recommendations to SAMHSA to take steps to better ensure that they agency is monitoring changes to the goals that the programs may be changing over time and also to ensure that their reviews are completed and communicated in a timely matter to the programs. [ Matt Oldham: ] Katherine, what would you say is the bottom line of your report? [ Katherine Iritani: ] Well these protection and advocacy programs are really important programs from the standpoint of safeguarding the rights of individuals with serious mental illness that may be at risk of abuse and end up neglect. So we feel like it's very important that the federal government monitors these programs to ensure they're complying with federal requirements and are effectively fulfilling their responsibilities. SAMHSA has some good procedures in place to do so but could do more to improve its oversight. So our report hopefully will bring some attention to the role of these programs and up to the SAMHSA role in overseeing them. [ Background Music ] [ Matt Oldham: ] Katherine Iritani is the director in our healthcare team and she led a GAO report on federal oversight of programs for the protection and advocacy for individuals with mental illness. Thank you for your time, Katherine. [ Background Music ] [ Matt Oldham: ] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. [ Background Music ] [ Matt Oldham: ] For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at gao.gov.