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Background
In May of 1986, President Ronald Reagan signed the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act of 1986 (42 U.S.C. 10801). The PAIMI program was initiated in 1986 in response to congressional findings of widespread abuse, neglect, and exploitation of individuals in state psychiatric institutions. Twenty-two years later, the program is still addressing those issues, along with new problems arising from delivery of mental health services in community-based settings.

The PAIMI program authorizes Protection and Advocacy councils (P & A's) to investigate incidents of abuse and neglect of individuals with mental illness if the incidents are reported to the system or if there is probable cause to believe that the incidents occurred. Also to ensure that the rights of covered individuals through activities are enforced by and Federal and state statutes. Individuals served include persons with a significant mental illness or emotional impairment who allege abuse or neglect or rights violation while inpatient or resident of a facility rendering care and/or treatment or within 90 days post discharge from a facility or being transported to or admitted to a facility or involuntarily confined to a municipal detention facility without a criminal conviction or living in a community setting including their own home.

==Scope of legislation== PAIMI allows for the investigation of incidents of abuse and neglect of individuals with mental illness and disputes should be resolved through non-adversarial processes whenever possible. All administrative remedies must be exhausted in a timely manner where appropriate. The exception is where legal action is needed to prevent or eliminate imminent serious harm.

Access to Facilities

Reasonable unaccompanied access to public and private facilities and programs which render care or treatment is mandated. This includes access in order to conduct investigation of complaint or finding of probably cause, as well as to provide information and referral services and training about individual rights. Monitoring compliance with rights and safety and inspection of all areas used by residents is also directed.

Access to Individual Records

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Conducting an Investigation
Once it has been determined that there is need for an investigation, the attorney general must give the State or municipality at least one (1) weeks notice. Following the notice, the DOJ must contact State or Local government parties and arranges for a tour of the facility or facilities and may ask the parties to produce any number of documents that are deemed relevant to the case.

If, after the investigation, no civil rights violations are uncovered, the DOJ notifies jurisdiction and closes the investigation.

If a pattern of civil violations is uncovered, the Assistant Attorney General sends a "findings letter" that states the alleged violations, explains evidence that was found to support the findings and defines the minimum steps required to correct the violations. The CRD attorneys then meet with State and Local officials to discuss how to rectify violations.

Settlements and Litigation
When Congress enacted CRIPA, they recognized that although it was not an ideal solution, litigation represented "the single most effective method for redressing systematic deprivations of institutionalized persons' Constitutional and Federal statutory rights." Congress was aware of possible tensions relating to federalism with CRIPA, so they built in a window of negotiations that allow States the ability to avoid undue involvement of the federal judicial system. Congress believed that States should have the opportunity to fix conditions through certain processes voluntarily and informally.

As a result, the DOJ must wait 49 days after issuing a findings letter before they can file a suit against an institution. The DOJ, within the 49 day period, must make a good faith effort to work with the facility and ensure that it has had reasonable time to take corrective action. This is to ensure that every effort has been exhausted before filing a complaint. Although Congress' intent was not to wait months or years to file suit, the attorney general has no timetable as to how long they must negotiate with institutions prior to filing suit, other than the 49 day period. Therefore, some investigations and negotiations can last for years.

CRIPA strongly emphasizes negotiation. As a result, a majority of all CRIPA cases are settled in one form or another. Some of these come in the form of informal resolutions, which occur when states are cooperative, take initiative to correct problems voluntarily, and demonstrate that conditions have been improved.

Also, many investigations have resulted in court-endorsed agreements called consent decrees. They are either filed with the court in conjunction with a CRIPA complaint, or they can be filed after a CRIPA complaint has been filed and the case has been through numerous steps of litigation. Before the DOJ can file a CRIPA complaint, it is required that there is reasonable cause to believe the state is actively engaged in a practice of violating civil rights of individuals in an institution and egregious conditions that violate the constitutional rights of individuals residing in an institution. In addition, the attorney general must certify that CRIPA's procedural requirements of notification have been met and that a CRIPA action is in the best interest of the public.

CRIPA allows only for equitable relief as a remedy to any violations. These may include the institutions being given an injunction to stop certain practices, being ordered to upgrade facilities or increasing the size of the staff. The attorney general may seek the minimum necessary to ensure the rights of institutionalized people are guaranteed.