This post will only apply to people living in Florida but there are similar laws in other states for 
involuntary hospitalization for mental health issues. It is important to understand your state laws concerning this because people’s rights are being taken away. I do not know of any other illness where this happens that you can be hospitalized even though you do not want to. In the next post or posts I will further explore the Baker Act but I think people need to understand it first.
It is important to understand that the Baker Act is not designed to keep patients in the system but keep them out. Before 1971, what happened was a person could be placed in a state hospital if three people signed affidavits and a county judge approved. Any destitute person was required to be in the jail before transport. You were only allowed one person to communicate with on the outside and the judge did not have any time period to review your case. Basically you could be there forever and nobody would care.
After the Baker Act was enacted in 1972 there were certain provisions enacted. The Baker Act is intended to ” provide comprehensive services for persons requiring intensive short term and continued treatment” (State of Florida, 2002). A person can only be in a facility for a maximum of six months. When the initial Baker Act is done you can be held without your consent for 72 hours. You must be seen by a medical doctor and a psychiatrist within 24 hours in a Baker Act receiving facility. It is important to note that the 24 hours starts with the admission and not the initiation of the Baker Act. You can have the Baker Act initiated in an emergency room for instance by a physician and that is when the 72 hour starts but the 24 hours for the psychiatrist to see you. There are only 6 groups of people that can Baker Act. They include psychiatrists, doctors, the police, masters in social work, marriage and family counselors and psychologists. In Florida, most Baker Acts are done by physicians and the police. Under doctors, physicians assistants can Baker Act. Under psychiatrists, ARNP’s can Baker Act but they must have 50% of their courses in psychiatry.
There are psychiatric institutions that are not Baker Act receiving. These are generally places that take voluntary patients only. Substance Abuse impairment is part of the Marchman Act and not the Baker Act. In general, you will go to the nearest facility that is Baker Act receiving.
What do you get Baker Acted for? In general you must be a harm to yourself or others. This is not to be used just because you are refusing treatment. That is your right as a patient. Many people believe that once you get to a psychiatric facility we can make people take their treatment. That is far from the truth, as psychiatric nurses we can counsel you to take your treatment but we cannot force except in instances where on the unit you exhibit no control over your actions. Under you gain control we may have to temporarily take control but this is not a topic for this discussion at this time.
Once you get to an institution under a Baker Act, what can you expect? You will be orientated to their unit and procedures and you will be formally admitted probably both by an intake counselor and a nurse. When the psychiatrist see you, he has three options. One is for you to remain voluntary at the institution. There are certain privileges given to voluntary patients including the ability to sign out. However, you must give the facility 24 hour notice before you leave. You sign for all your treatments and psychiatric medications. He can make you Baker Act competent, which means you can sign for your treatments and medications but you cannot leave. Or he can make you Baker Act incompetent which means there is another individual that you can name who will sign for your treatments and psychotropic medications. Medical medications are always offered. If you are under the Baker Act and want to leave you have the right to fill out a writ of habeas corpus. This will be presented to the court on the next business day and the court has five business days to decide whether you should be released or not. If the court sends a court order to release you the facility has 24 hours from the receipt of the court order to release you. It is important to remember business days here, weekends and holidays do not count.
Can the facility keep you more than the three days? Yes they can and they do this by writing a petition to the court. Another psychiatrist has to recommend this also and this petition is taken to the court no later than the three days in the Baker Act. The only exception is if the court is not open. So if your Baker Act ends on a Saturday as long as the second opinion is done by that Saturday, they can keep you and file the papers Monday morning. Once it is filed to the court, the court has to review the petition within 5 days. Generally, the facility has a place for the magistrate to come and a lawyer for the facility and a lawyer for the patient is present. A lawyer for the patient is obtained for them at no charge to the patient. The patient may or may not be present depending on what their lawyer decides. Other people can come but they may or may not be allowed to speak depending on the judge. The judge then decides whether the patient stays or can be released. If the judge decides the patient should stay the judge then states when the case will be reviewed again. This can happen up to a six month period. The psychiatrist can discharge at any time he deems fit. It can only be a psychiatrist, the medical doctor may not discharge. The discharge also must be to an address, the patient cannot be discharged to be homeless.
There are severe cases that are referred to the state hospital. I do not want to get into this too much except to say no one goes to the state hospital without being court ordered. They are then kept at the facility until the state transfer can be completed. For patients not in the prison system there are only three hospitals in the state of Florida. So you can imagine their is a long wait for beds and we sometimes keep these patients for up to four months waiting for a bed. When the patient gets to the state hospital, the six month period starts all over again.
Again, I encourage everyone to review the Baker Act although it is a very long law. There are books that you can buy to help with this.
Reference:
State of Florida Department of Children and Families Mental Health Program Office (2002) History of the Baker Act it’s Development & Intent Retrieved from: www.dcf.state.fl.us/programs