Protection and Advocacy for Mentally Ill Individuals Act of 1986
PL 99-319 (S.974), enacted 05/23/1986

100 STAT. 478 
PUBLIC LAW 99-319—MAY 23, 1986 
Public Law 99-319 
99th Congress 
An Act 
May 23, 1986 
[S. 974] 
Protection and 
Advocacy for 
Mentally 111 
Individuals Act 
of 1986. 
42 u s e 10801 
note. 
42 u s e 10801. 
State and local 
governments. 
42 u s e 10802. 
To provide for protection and advocacy for mentally ill individuals, and for other 
purposes. 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, That this Act may 
be cited as the "Protection and Advocacy for Mentally 111 Individ-
uals Act of 1986". 
TITLE I—PROTECTION AND ADVOCACY SYSTEMS 
PART A—ESTABUSHMENT OP SYSTEMS 
FINDINGS AND PURPOSE 
SEC. 101. (a) The Congress finds that— 
(1) mentally ill individuals are vulnerable to abuse and seri-
ous injury; 
(2) mentally ill individuals are subject to neglect, including 
lack of treatment, adequate nutrition, clothing, health care, and 
adequate discharge planning; and 
(3) State systems for monitoring compliance with respect to 
the rights of mentally ill individuals vary widely and are fre-
quently inadequate. 
(b) The purposes of this Act are— 
(1) to ensure that the rights of mentally ill individuals are 
protected; and 
(2) to assist States to establish and operate a protection and 
advocacy system for mentally ill individuals which will— 
(A) protect and advocate the rights of such individuals 
through activities to ensure the enforcement of the Con-
stitution and Federal and State statutes; and 
(B) investigate incidents of abuse and neglect of mentally 
ill individuals if the incidents are reported to the system or 
if there is probable cause to believe that the incidents 
occurred. 
DEFINITIONS 
SEC. 102. For purposes of this title: 
(1) The term "abuse" means any act or failure to act by an 
employee of a facility rendering care or treatment which was 
performed, or which was failed to be performed, knowingly, 
recklessly, or intentionally, and which caused, or may have 
caused, injury to a mentally ill individual, and includes acts 
such as— 
(A) the rape or sexual assault of a mentally ill individual; 
(B) the striking of a mentally ill individual; 
(C) the use of excessive force when placing a mentally ill 
individual in bodily restraints; and 
PUBLIC LAW 99-319—MAY 23, 1986 
100 STAT. 479 
(D) the use of bodily or chemical restraints on a mentally 
ill individual which is not in compliance with Federal and 
State laws and regulations. 
(2) The term "eligible system" means the system established 
in a State to protect and advocate the rights of persons with 
developmental disabilities under part C of the Developmental 
Disabilities Assistance and Bill of Rights Act. 
(3) The term "mentally ill individual" means an individual— 
(A) who has a significant mental illness or emotional 
impairment, as determined by a mental health professional 
qualified under the laws and regulations of the State; and 
(B) who is an inpatient or resident in a facility rendering 
care or treatment. 
(4) The term "neglect" means a negligent act or omission by 
any individual responsible for providing services in a facility 
rendering care or treatment which caused or may have caused 
injury to a mentally ill individual or which placed a mentally ill 
individual at risk of injury, and includes an act or omission such 
as the failure to establish or carry out an appropriate individual 
program plan or treatment plan for a mentally ill individual, 
the failure to provide adequate nutrition, clothing, or health 
care to a mentally ill individual, or the failure to provide a safe 
environment for a mentallv ill individual. 
(5) The term "Secretary means the Secretary of Health and 
Human Services. 
(6) The term "State" means each of the several States, the 
District of Columbia, the Commonwealth of Puerto Rico, Guam, 
the Commonwealth of the Northern Mariana Islands, American 
Samoa, the Virgin Islands, and the Trust Territory of the 
Pacific Islands. 
ALLOTMENTS 
SEC. 103. The Secretary shall make allotments under this title to 
eligible systems to establish and administer systems— 
(1) which meet the requirements of section 105; and 
(2) which are designed to— 
(A) protect and advocate the rights of mentally ill individ-
uals; and 
(B) investigate incidents of abuse and neglect of mentally 
ill individuals if the incidents are reported to the system or 
if there is probable cause to believe that the incidents 
occurred. 
USE OF ALLOTMENTS 
SEC. 104. (a)(1) An eligible system may use its allotment under this 
title to enter into contracts with State agencies and nonprofit 
organizations which operate throughout the State. In order to be 
eligible for a contract under this paragraph— 
(A) such an agency shall be independent of any agency which 
provides treatment or services (other than advocacy services) to 
mentally ill individuals; and 
(B) such an agency or organization shall have the capacity to 
protect and advocate the rights of mentally ill individuals. 
(2) In carrying out paragraph (1), an eligible system should con-
sider entering into contracts with organizations which, on the date 
of enactment of this Act, provide protection or advocacy services to 
mentally ill individuals. 
42 u s e 6061. 
42 u s e 10803. 
eontracts. 
State and local 
governments. 
42 u s e 10804. 
100 STAT. 480 
PUBLIC LAW 99-319—MAY 23, 1986 
(bXl) If an eligible system is a public entity, the government of the 
State in which the system is located may not require the system to 
obligate more than 5 percent of its allotment under this title in any 
fiscal year for administrative expenses. 
(2) An eligible system may not use more than 5 percent of any 
allotment under this title for any fiscal year for the costs of provid-
ing technical assistance and training to carry out this title. 
SYSTEM REQUIREMENTS 
State and local 
SEC. 105. (a) A system established in a State under section 103 to 
governments. 
protect and advocate the rights of mentally ill individuals shall— 
42 use 10805. 
(1) have the authority to— 
(A) investigate incidents of abuse and neglect of mentally 
ill individuals if the incidents are reported to the system or 
if there is probable cause to believe that the incidents 
occurred; 
(B) pursue administrative, legal, and other appropriate 
remedies to ensure the protection of mentally ill individuals 
who are receiving care or treatment in the State; and 
(C) pursue administrative, legal, and other remedies on 
behalf of an individual who— 
(i) was a mentally ill individual; and 
(ii) is a resident of the State, 
but only with respect to matters which occur within 90 days 
after the date of the discharge of such individual from a 
facility providing care or treatment; 
(2) be independent of any agency in the State which provides 
treatment or services (other than advocacy services) to mentally 
ill individuals; 
(3) have access to facilities in the State providing care or 
treatment; 
(4) in accordance with section 106, have access to all records 
of— 
(A) any individual who is a client of the system if such 
individual, or the legal guardian, conservator, or other legal 
representative of such individual, has authorized the 
system to have such access; and 
(B) any individual— 
(i) who by reason of the mental or physical condition 
of such individual is unable to authorize the system to 
have such access; 
(ii) who does not have a legal guardian, conservator, 
or other legal representative, or for whom the legal 
guardian is the State; and 
(iii) with respect to whom a complaint has been 
received by the system or with respect to whom there is 
probable cause to believe that such individual has been 
subject to abuse or neglect; 
(5) have an arrangement with the Secretary and the agency of 
the State which administers the State plan under title XIX of 
42 use 1396. 
the Social Security Act for the furnishing of the information 
required by subsection (b); 
(6) establish a board— 
(A) which will advise the system on policies and priorities 
to be carried out in protecting and advocating the rights of 
mentally ill individuals; and 
PUBLIC LAW 99-319—MAY 23, 1986 
100 STAT. 481 
(B) which sheill include attorneys, mental health profes-
sionals, individuals from the public who are knowledgeable 
about mental illness, a provider of mental health services, 
individuals who have received or are receiving mental 
health services, and family members of such individuals, 
and at least one-half the membership of which shall be 
comprised of individuals who have received or are receiving 
mental health services or who are family members of such 
individuals; and 
(7) on January 1,1987, and January 1 of each succeeding year, 
prepare and transmit to the Secretary and the head of the State 
mental health agency of the State in which the system is 
located a report describing the activities, accomplishments, and 
expenditures of the system during the most recently completed 
fiscal year. 
(b) The Secretary and the agency of a State which administers its 
State plan under title XIX of the Social Security Act shall provide 
the eligible system of the State with a copy of each annual survey 
report and plan of corrections for cited deficiencies made pursuant 
to titles XVIII and XIX of the Social Security Act with respect to 
any facility rendering care or treatment to mentally ill individuals 
in the State in which such system is located. A report or plan shall 
be made available within 30 days after the completion of the report 
or plan. 
ACCESS TO RECORDS 
SEC. 106. (a) An eligible system which, pursuant to section 
105(a)(4), has access to records which, under Federal or State law, 
are required to be maintained in a confidential manner by a pro-
vider of mental health services, shall, except as provided in subsec-
tion (b), maintain the confidentiality of such records to the same 
extent as is required of the provider of such services. 
(b)(1) Except as provided in paragraph (2), an eligible system 
which has access to records pursuant to section 105(a)(4) may not 
disclose information from such records to the individual who is the 
subject of the information if the mental health professional respon-
sible for supervising the provision of mental health services to such 
individual has provided the system with a written determination 
that disclosure of such information to such individual would be 
detrimental to such individual's health. 
(2)(A) If disclosure of information has been denied under para-
graph (1) to an individual— 
(i) such individual; 
(ii) the legal guardian, conservator, or other legal representa-
tive of such individual; or 
(iii) an eligible system, acting on behalf of an individual 
described in subparagraph (B), 
may select another mental health professional to review such 
information and to determine if disclosure of such information 
would be detrimental to such individual's health. If such mental 
health professional determines, based on professional judgment, 
that disclosure of such information would not be detrimental to the 
health of such individual, the system may disclose such information 
to such individual. 
(B) An eligible system may select a mental health professional 
under subparagraph (A)(iii) on behalf of— 
(i) an individual whose legal guardian is the State; or 
Reports. 
42 u s e 1396. 
42 u s e 1395. 
Reports. 
State and local 
governments. 
Classified 
information. 
42 u s e 10806. 
71-194 0 - 89 - 18 : QL 3 Parti 
100 STAT. 482 
PUBLIC LAW 99-319—MAY 23, 1986 
State and local 
governments. 
Contracts. 
42 use 10807. 
(ii) an individual who has a legal guardian, conservator, or 
other legal representative other than the State if such guardian, 
conservator, or representative does not, within a reasonable 
time after such individual is denied access to information under 
paragraph (1), select a mental health professional under 
subparagraph (A) to review such information. 
(C) If the laws of a State prohibit an eligible system from obtain-
ing access to the records of mentally ill individuals in accordemce 
with section 105(aX4) and this section, section 105(a)(4) and this 
section shall not apply to such S3rstem before— 
(i) the date such system is no longer subject to such a prohibi-
tion; or 
(ii) the expiration of the 2-year period beginning on the date 
of the enactment of this Act, 
whichever occurs first. 
LEGAL ACTIONS 
SEC. 107. (a) Prior to instituting any legal action in a Federal or 
State court on behalf of a mentally ill individual, an eligible system, 
or a State agency or nonprofit organization which entered into a 
contract with an eligible system under section 104(a), shall exhaust 
in a timely manner all administrative remedies where appropriate. 
If, in pursuing administrative remedies, the system, agency, or 
organization determines that any matter with respect to such 
individual will not be resolved within a reasonable time, the system, 
agency, or organization may pursue alternative remedies, including 
the initiation of a legal action. 
(b) Subsection (a) does not apply to any legal action instituted to 
prevent or eliminate imminent serious harm to a mentally ill 
individual. 
PART B—ADMINISTRATIVE PROVISIONS 
42 u s e 10821. 
State and local 
governments. 
State and local 
governments. 
Contracts. 
APPUCATIONS 
SEC. 111. NO allotment may be made under this title to an eligible 
system unless an application therefor is submitted to the Secretary. 
Each such application shall contain— 
(1) assurances that amounts paid to such system from an 
allotment under this title will be used to supplement and not to 
supplant the level of non-Federal funds available in the State in 
which such system is established to protect and advocate the 
rights of mentally ill individuals; 
(2) assurances that such system will have a staff which is 
trained or being trained to provide advocacy services to men-
tally ill individuals; 
(3) assurances that such system, and any State agency or 
nonprofit organization with which such system may enter into a 
contract under section 104(a), will not, in the case of any 
individual who has a legal guardian, conservator, or representa-
tive other than the State, take actions which are duplicative of 
actions taken on behalf of such individual by such guardian, 
conservator, or representative unless such guardian, conserva-
tor, or representative requests the assistance of such system; 
and 
(4) such other information as the Secretary may by regulation 
prescribe. 
PUBLIC LAW 99-319—MAY 23, 1986 
100 STAT. 483 
ALLOTMENT FORMULA AND REALLOTMENTS 
SEC. 112. (aXlXA) Except as provided in parsigraph (2) and subject 
to the availability of appropriations under section 117, the Secretary 
shall make allotments under section 103 from amounts appropriated 
under section 117 for a fiscal year to eligible systems on the basis of 
a formula prescribed by the Secretary which is based equally— 
(i) on the population of each State in which there is an eligible 
system; and 
(ii) on the population of each such State weighted by its 
relative per capita income. 
(B) For purposes of subparagraph (AXii), the term "relative per 
capita income" means the quotient of the per capita income of the 
United States and the per capita income of the State, except that if 
the State is Guam, American Samoa, the Commonwealth of the 
Northern Mariana Islands, the Trust Territory of the Pacific Is-
lands, or the Virgin Islands, the quotient shall be considered to be 
one. 
(2) Notwithstanding paragraph (1) and subject to the availability 
of appropriations under section 117— 
(A) the amount of the allotment of the eligible system of each 
of the several States, the District of Columbia, and the Common-
wealth of Puerto Rico shall not be less than $125,000; and 
(B) the amount of the allotment of the eligible system of 
Guam, American Samoa, the Commonwealth of the Northern 
Mariana Islands, the Trust Territory of the Pacific Islands, and 
the Virgin Islands shall not be less than $67,000. 
OaXD To the extent that all the amounts appropriated under 
section 117 for a fiscal year are not allotted to eligible systems 
because— 
(A) one or more eligible systems have not submitted an 
application for an allotment for such fiscal year; or 
(B) one or more eligible systems have notified the Secretary 
that they do not intend to use the full amount of their 
allotment, 
the amount which is not so allotted shall be reallotted among the 
remaining eligible systems. 
(2) The amount of an allotment to an eligible system for a fiscal 
year which the Secretary determines will not be required by the 
system during the period for which it is available shall be available 
for reallotment by the Secretary to other eligible systems with 
respect to which such a determination has not been made. 
(3) The Secretary shall make reallotments under paragraphs (1) 
and (2) on such date or dates as the Secretary may fix 0)ut not 
earlier than 30 days after the Secretary has published notice of the 
intention of the Secretary to make such reallotment in the Federal 
Register). A reallotment to an eligible system shall be made in 
proportion to the original allotment of such system for such fiscal 
year, but with such proportionate amount for such system being 
reduced to the extent it exceeds the sum the Secretary estimates 
such system needs and will be able to use during such period. The 
total of such reductions shall be similarly reallotted among eligible 
systems whose proportionate amounts were not so reduced. Any 
amount so reallotted to an eligible system for a fiscal year shall be 
deemed to be a part of its allotment under subsection (a) for such 
fiscal year. 
42 u s e 10822. 
District of 
Columbia. 
Puerto Rico. 
Guam. 
American 
Samoa. 
Northern 
Mariana 
Islands. 
Trust Territory 
of the Pacific 
Islands. 
Virgin Islands. 
Federal 
Register, 
publication. 
100 STAT. 484 
PUBLIC LAW 99-319—MAY 23, 1986 
PAYMENTS UNDER ALLOTMENTS 
42 use 10823. 
SEC. 113. For each fiscal year, the Secretary shall make payments 
to each eligible system from its allotment under this title. Any 
amount paid to an eligible system for a fiscal year and remaining 
unobligated at the end of such year shall remain available to such 
system for the next fiscal year for the purposes for which it was 
made. 
REPORTS BY THE SECRETARY 
42 use 10824. 
SEC. 114, (a) The Secretary shall include in each report required 
under section 107(c) of the Developmental Disabilities Assistance 
42 use 6006. 
and Bill of Rights Act a separate statement which contains— 
(1) a description of the activities, accomplishments, and 
expenditures of systems to protect and advocate the rights of 
mentally ill individuals supported with payments from allot-
ments under this title, including— 
(A) a specification of the total number of mentally ill 
individuals served by such systems; 
(B) a description of the types of activities undertaken by 
such systems; 
(C) a description of the t3rpes of facilities providing 
care or treatment with respect to which such activities are 
undertaken; 
(D) a description of the manner in which such activities 
are initiated; and 
(E) a description of the accomplishments resulting from 
such activities; 
(2) a description o
f
— 
(A) systems to protect and advocate the rights of mentally 
ill individuals supported with pajmients from allotments 
under this title; 
(B) activities conducted by States to protect and advocate 
such rights; 
(C) mechanisms established by residential facilities for 
mentally ill individuals to protect and advocate such rights; 
and 
(D) the coordination among such systems, activities, and 
mechanisms; 
(3) a specification of the number of systems established with 
allotments under this title and of whether each such system was 
established by a public or nonprofit private entity; and 
(4) recommendations for activities and services to improve the 
protection and advocacy of the rights of mentally ill individuals 
and a description of needs for such activities and services which 
have not been met by systems established under this title. 
(b) In preparing each statement required by subsection (a), the 
Secretary shall use and include information submitted to the Sec-
retary in the reports required under section 105(a)(7). 
TECHNICAL ASSISTANCE 
42 use 10825. 
SEC. 115. The Secretary shall provide technical assistance to 
eligible systems with respect to activities carried out under this title. 
PUBLIC LAW 99-319—MAY 23, 1986 
100 STAT. 485 
ADMINISTRATION 
SEC. 116. The Secretary shall carry out this title through the 42 use 10826. 
Administrator of the Alcohol, Drug Abuse, and Mental Health 
Administration. 
AUTHORIZATION OF APPROPRIATIONS 
SEC. 117. For allotments under this title, there are authorized to 42 use 10827. 
be appropriated $10,000,000 for fiscal year 1986, $10,500,000 for 
fiscal year 1987, and $11,025,000 for fiscal year 1988. 
TITLE II—RESTATEMENT OF BILL OF RIGHTS FOR MENTAL 
HEALTH PATIENTS 
RESTATEMENT OF BILL OF RIGHTS 
SEC. 201. It is the sense of the Congress that, as previously stated 
in title V of the Mental Health Systems Act, each State should 
review and revise, if necessary, its laws to ensure that mental health 
patients receive the protection and services they require, and that in 
making such review and revision, States should take into account 
the recommendations of the President's Commission on Mented 
Health and the following: 
(1) A person admitted to a program or facility for the purpose 
of receiving mental health services should be accorded the 
following: 
(A) The right to appropriate treatment and related serv-
ices in a setting and under conditions that— 
(i) are the most supportive of such person's personal 
liberty; and 
(ii) restrict such liberty only to the extent necessary 
consistent with such person's treatment needs, ap-
plicable requirements of law, and applicable judicial 
orders. 
(B) The right to an individualized, written, treatment or 
service plan (such plan to be developed promptly after 
admission of such person), the right to treatment based on 
such plan, the right to periodic review and reassessment of 
treatment and related service needs, and the right to appro-
priate revision of such plan, including any revision nec-
essary to provide a description of mental health services 
that may be needed after such person is discharged from 
such program or facility. 
(C) The right to ongoing participation, in a manner appro-
priate to such person's capabilities, in the planning of 
mental health services to be provided such person (includ-
ing the right to participate in the development and periodic 
revision of the plan described in subpars^aph (B)), and, in 
connection with such participation, the right to be provided 
with a reasonable explanation, in terms and language 
appropriate to such person's condition and ability to under-
stand, o
f
— 
(i) such person's general mental condition and, if 
such program or facility has provided a physical exam-
ination, such person's general physical condition; 
(ii) the objectives of treatment; 
State and local 
governments. 
42 u s e 10841. 
42 u s e 9501. 
100 STAT. 486 
PUBLIC LAW 99-319—MAY 23, 1986 
Classified 
information. 
Classified 
information. 
(iii) the nature and significant possible adverse ef-
fects of recommended treatments; 
(iv) the reasons why a particular treatment is consid-
ered appropriate; 
(v) the reasons why access to certain visitors may not 
be appropriate; and 
(vi) any appropriate and available alternative treat-
ments, services, and types of providers of mental health 
services. 
(D) The right not to receive a mode or course of treat-
ment, established pursuant to the treatment plan, in the 
absence of such person's informed, voluntary, written 
consent to such mode or course of treatment, except 
treatment— 
(i) during an emergency situation if such treatment is 
pursuant to or documented contemporaneously by the 
written order of a responsible mental health profes-
sional; or 
(ii) as permitted under applicable law in the case of a 
person committed by a court to a treatment program or 
facility. 
(E) The right not to participate in experimentation in the 
absence of such person's informed, voluntary, written con-
sent, the right to appropriate protections in connection with 
such participation, including the right to a reasonable 
explanation of the procedure to be followed, the benefits to 
be expected, the relative advantages of alternative treat-
ments, and the potential discomforts and risks, and the 
right and opportunity to revoke such consent. 
(F) The right to freedom from restraint or seclusion, other 
than as a mode or course of treatment or restraint or 
seclusion during an emergency situation if such restraint or 
seclusion is pursuant to or documented contemporane-
ously by the written order of a responsible mental health 
professional. 
(G) The right to a humane treatment environment that 
affords reasonable protection from harm and appropriate 
privacy to such person with regard to personal needs. 
(H) The right to confidentiality of such person's records. 
(I) The right to access, upon request, to such person's 
mental health care records, except such person may be 
refused access to— 
(i) information in such records provided by a third 
party under assurance that such information shall 
remain confidential; and 
(ii) specific material in such records if the health 
professional responsible for the mental health services 
concerned has made a determination in writing that 
such access would be detrimental to such person's 
health, except that such material may be made avail-
able to a similarly licensed health professional selected 
by such person and such health professional may, in 
the exercise of professional judgment, provide such 
person with access to any or all parts of such material 
or otherwise disclose the information contained in such 
material to such person. 
PUBLIC LAW 99-319—MAY 23, 1986 
100 STAT. 487 
(J) The right, in the case of a person admitted on a 
residential or inpatient care basis, to converse with others 
privately, to have convenient and reasonable access to the 
telephone and mails, and to see visitors during regularly 
scheduled hours, except that, if a mental health profes-
sional treating such person determines that denial of access 
to a particular visitor is necessary for treatment purposes, 
such mental health professional may, for a specific, limited, 
and reasonable period of time, deny such access if such 
mental health professional has ordered such denial in writ-
ing and such order has been incorporated in the treatment 
plan for such person. An order denjdng such access should 
include the reasons for such denial. 
(K) The right to be informed promptly at the time of 
admission and periodically thereafter, in language and 
terms appropriate to such person's condition and ability to 
understand, of the rights described in this section. 
(L) The right to assert grievances with respect to infringe-
ment of the rights described in this section, including the 
right to have such grievances considered in a fair, timely, 
and impartial grievance procedure provided for or by the 
program or facility. 
(M) Notwithstanding subparagraph (J), the right of access 
to (including the opportunities and facilities for private 
communication with) any available— 
(i) rights protection service within the program or 
facility; 
(ii) rights protection service within the State mental 
health system designed to be available to such person; 
(iii) system established under title I to protect and 
Ante, p. 478. 
advocate the rights of mentally ill individuals; and 
(iv) qualified advocate; 
for the purpose of receiving assistance to understand, exer-
cise, and protect the rights described in this section and in 
other provisions of law. 
(N) The right to exercise the rights described in this 
section without reprisal, including reprisal in the form of 
denial of any appropriate, available treatment. 
(O) The right to referral as appropriate to other providers 
of mental health services upon discharge. 
(2XA) The rights described in this section should be in addi-
tion to and not in derogation of any other statutory or constitu-
tional rights. 
(B) The rights to confidentiality of and access to records as 
Classified 
provided in subparagraphs (H) and (I) of paragraph (1) should 
information. 
remain applicable to records pertaining to a person after such 
person's discharge from a program or facility. 
(3XA) No otherwise eligible person should be denied admission 
to a program or facility for mental health services as a reprisal 
for the exercise of the rights described in this section. 
(B) Nothing in this section should— 
(i) obligate an individual mental health or health profes-
sional to administer treatment contrary to such profes-
sional's clinical judgment; 
(ii) prevent any program or facility from discharging any 
person for whom the provision of appropriate treatment, 
consistent with the clinical judgment of the mental health 
100 STAT. 488 
PUBLIC LAW 99-319—MAY 23, 1986 
Classified 
information. 
professional primarily responsible for such person's treat-
ment, is or has become impossible as a result of such 
person's refusal to consent to such treatment; 
(iii) require a program or facility to admit any person 
who, while admitted on prior occasions to such program or 
facility, has repeatedly frustrated the purposes of such 
admissions by withholding consent to proposed treatment; 
or 
(iv) obligate a program or facility to provide treatment 
services to any person who is admitted to such program or 
facility solely for diagnostic or evaluative purposes. 
(C) In order to assist a person admitted to a program or 
facility in the exercise or protection of such person's rights, such 
person's attorney or legal representatives should have reason-
able access to— 
(i) such person; 
(ii) the areas of the program or facility where such person 
has received treatment, resided, or had access; and 
(iii) pursuant to the written authorization of such person, 
the records and information pertaining to such person's 
diagnosis, treatment, and related services described in para-
graph (1)(I). 
(D) Each program and facility should post a notice listing and 
describing, in language and terms appropriate to the ability of 
the persons to whom such notice is addressed to understand, the 
rights described in this section of all persons admitted to such 
program or facility. Each such notice should conform to the 
format and content for such notices, and should be posted in all 
appropriate locations. 
(4)(A) In the case of a person adjudicated by a court of 
competent jurisdiction as being incompetent to exercise the 
right to consent to treatment or experimentation described in 
subparagraph (D) or (E) of paragraph (1), or the right to con-
fidentiality of or access to records described in subparagraph (H) 
or (I) of such paragraph, or to provide authorization as described 
in paragraph (3)(C)(iii), such right may be exercised or such 
authorization may be provided by the individual appointed by 
such court as such person's guardian or representative for the 
purpose of exercising such right or such authorization. 
(B) In the case of a person who lacks capacity to exercise the 
right to consent to treatment or experimentation 
under 
subparagraph (D) or (E) of paragraph (1), or the right to con-
fidentiality of or access to records described in subparagraph (H) 
or (I) of such paragraph, or to provide authorization as described 
in paragraph (3)(C)(iii), because such person has not attained an 
age considered sufficiently advanced under State law to permit 
the exercise of such right or such authorization to be legally 
binding, such right may be exercised or such authorization may 
be provided on behalf of such person by a parent or legal 
guardian of such person. 
(C) Notwithstanding subparagraphs (A) and (B), in the case of 
a person admitted to a program or facility for the purpose of 
receiving mental health services, no individual employed by or 
receiving any remuneration from such program or facility 
should act as such person's guardian or representative. 
PUBLIC LAW 99-319—MAY 23, 1986 
TITLE III—CONSTRUCTION 
100 STAT. 489 
CONSTRUCTION 
SEC. 801. (a) Titles I and II shall not be construed as establishing 42 use I085i. 
any new rights for mentally ill individuals. 
(b) For purposes of this section, the term "mentally ill individual" 
has the same meaning as in section 102(3). 
TITLE IV—OTHER PROGRAMS 
ALZHEIMER'S DISEASE 
SEC. 401. Part B of title III of the Public Health Service Act is 42 use 243. 
amended by inserting before section 317 the following: 
"FAMILY SUPPORT GROUPS FOR ALZHEIMER'S DISEASE PATIENTS 
"SEC. 316. (a) Subject to available appropriations, the Secretary, 42 use 247a. 
acting through the National Institute of Mental Health, the Na-
tional Institutes of Health, and the Administration on Aging, shall 
promote the establishment of family support groups to provide, 
without charge, educational, emotional, and practical support to 
assist individuals with Alzheimer's disease or a related memory 
disorder and members of the families of such individuals. In promot-
ing the establishment of such groups, the Secretary shall give 
priority to— 
"(1) university medical centers and other appropriate health 
care facilities which receive Federal funds from the Secretary 
and which conduct research on Alzheimer's disease or provide 
services to individuals with such disease; and 
"(2) community-based programs which receive funds from the 
Secretary, acting through the Administration on Aging. 
"Ot)) The Secretary shall promote the establishment of a national 
network to coordinate the family support groups described in subsec-
tion (a). 
"(c) The Secretary shall report to Congress, not later than one Reports, 
year after the date of the enactment of this section, on family 
support groups and the network of such groups established pursuant 
to this section.". 
100 STAT. 490 
PUBLIC LAW 99-319—MAY 23, 1986 
BALANCED BUDGET PROVISION 
42 use 10801 
SEC. 402. This Act shall not be construed as superseding any of the 
note. 
balanced budget provisions set forth in section 3(7) of the Congres-
2 use 622. 
sional Budget and Impoundment Control Act of 1974. 
Approved May 23, 1986. 
LEGISLATIVE HISTORY—S. 974 (H.R. 3492) (H.R. 4055): 
HOUSE REPORTS: No. 99-401 and Pt. 2 accompanving H.R. 3492 (eomm. on Energy 
and eommerce) and No. 99-576 (eomm. of Conference). 
SENATE REPORTS: No. 99-109 (Oomm. on Labor and Human Resources). 
CONGRESSIONAL RECORD: 
Vol. 131 (1985): July 31, considered and passed Senate. 
Vol. 132 (1986): Jan. 30, H.R. 4055 considered and passed House; S. 974, 
amended, passed in lieu. 
Feb. 5, Senate disagreed to House amendment. 
May 13, House agreed to conference report. 
May 14, Senate agreed to conference report. 
WEEKLY COMPILATION OF PRESIMNTIAL DOCUMENTS, Vol. 22 (1986): 
May 23, Presidential statement.