Clarification of the “Baker Act”

 

            A “Baker Act” temporarily suspends an individual’s liberty when there is substantial evidence suggesting imminent risk of harm to self or other. This risk may be either intentional (such as suicide or homicide) or unintentional (such as acute psychotic break).  Appropriately, check-and-balance steps are incorporated into the Baker Act process, as briefly explained in the following.

Anyone who has justified concerns about the safety of another may request a Baker Act. An initial psychiatric examination is then completed by an authorized professional. Within the medical hospital setting authorized professionals include clinical psychologists and physicians. Within the outpatient setting also are included law enforcement, court mandate and other mental health professionals (psychiatric nurses, clinical social workers and licensed mental health counselors and marriage and family therapists).  If criteria are met for an Involuntary Examination then the familiar Baker Act form (BA52b; Certificate of Involuntary Examination) is completed and the individual is ultimately transferred to a psychiatric receiving facility for re-evaluation and treatment.[1] Note that criteria for law enforcement is based upon circumstance whereas for all others criteria are based upon direct observation. Thus, law enforcement may take into custody an individual who was reported by another to be at risk of self harm (i.e. circumstantial evidence). The individual is then either delivered to a medical facility (if necessary) or a psychiatric receiving facility for behavioral evaluation (i.e. direct observation) by individuals trained and experienced in this capacity (i.e. clinical psychologist or physician).  

            Psychiatric receiving facilities are required to accept medically stable patients. Five local facilities serve Alachua and surrounding counties. Meridian Behavioral Healthcare maintains Crisis Stabilization Units in Gainesville and Lake City. These public facilities accept the indigent and uninsured population. Shands at Vista and Shands Hospital Unit 52 (with 10 beds for medically compromised patients) are private. The fifth site is the Malcolm Randall VAMC for enrolled Veterans.

 

            Timelines and functional details associated with the Baker Act process are often misunderstood. The following provides some points of clarification.

1.      A Baker Act evaluation is valid for 48 hours. Regardless of how long a patient is medically hospitalized, the 48 hour period of validity for the Baker Act initiating evaluation must be observed. For example, if a suicidal patient presents with a drug overdose and is hospitalized for six days, valid Baker Acts must be completed on days 1, 3 and 5 if the patient is to be involuntarily held in the hospital pending transfer to a psychiatric facility.

2.      After the patient is ready for medical discharge s/he must be transferred to any available psychiatric receiving facility within 12 hours (with 2 hour advance notification).  Transportation is to be provided by either law enforcement or EMS or a transportation company under contract for this specific transport. Patients may not be transported by other conveyance, however family members may accompany the patient if the transporter is agreeable.

3.      Once a Baker Act is initiated a re-evaluation is required to “rescind” the Baker Act, documenting that the individual no longer meets criteria for Involuntary Examination. This is common for patients presenting to the hospital with unintentional drug overdose.

4.      An individual may not opt to voluntarily refer themselves to a psychiatric receiving facility if a Baker Act has already been initiated.

5.      An individual may be involuntary held for a maximum of 72 hours after the Baker Act is signed however the 72 hour period does not begin until the patient receives medical clearance.  In practice, the most common length of stay at a psychiatric facility is 24-36 hours.

6.      The Baker Act ensures the provision of crisis oriented treatment for persons with mental illness.[2] Individuals with dementia may meet mental illness criteria however impairment must be profound as dementia is otherwise viewed as a medical (and not mental) deficit.  It is common for individuals to have dual diagnoses such as an underlying thought disorder with superimposed substance abuse or personality disordered behavior. In such cases the underlying thought disorder may meet criteria for a mental illness.

 

A Variant: The “Marchman Act”

The Marchman Act is functionally identical to the Baker Act, however it’s use is reserved for individuals who are significantly judgment  impaired because of substance abuse and because of this impairment are at risk of harm to self or others through carelessness or neglect.[3] An example is a patient who presents with failure to thrive because of extended methamphetamine abuse yet is unable to comprehend the relationship.

            The mechanics of a Marchman Act are identical to a Baker Act with a few exceptions. These are that only an MD physician may initiate a Marchman Act, and that the initial exam and involuntary psychiatric admission periods are each five days (120 hours).

Facilities are only required to provide detox, but not rehabilitation unless court directed.

 


[1]  Baker Act (BA-52) Involuntary Examination criteria (FS 394.463(1)):  

Reason to believe person has a mental illness and because of mental illness, person has refused or is unable to determine if examination is necessary

and either:

1)    Without care or treatment, is likely to suffer from neglect or refuse to care for self, and such neglect or refusal poses a real and present threat of substantial harm to one’s well-being and it is not apparent that such harm may be avoided through the help of willing family members, friends, or the provision of other services; or

2)    There is substantial likelihood that without treatment person will cause in the near future serious bodily harm to self or others, as evidenced by recent behavior.

[2] Definition of mental illness (FS394.455): Impairment of the mental or emotional processes that exercise conscious control of one's actions or of the ability to perceive or understand reality, which impairment substantially interferes with a person's ability to meet the ordinary demands of living, regardless of etiology. For the purposes of this part, the term does not include retardation or developmental disability...intoxication, or conditions manifested only by antisocial behavior or substance abuse impairment.

[3] Marchman Act criteria (FS397.6811):  Good faith reason to believe a person is substance abuse impaired and because of the impairment has lost the power of self-control over substance use and either has inflicted or attempted to inflict (or unless admitted is likely to inflict) physical harm on self or other, or is in need of substance abuse services and, by reason of substance abuse impairment, his/her judgment has been so impaired the person is incapable of appreciating the need for services and of making decision in regard thereto.