The Baker Act, Part II: Involuntary Examination and Admission

The medical community has considered addiction to be a mental health issue for decades. After all, it is a disease that alters the brain. In their efforts to reduce the tremendous national impact of addiction, many of the states have taken steps to protect the rights of those who need professional help. One such example is Florida, home of the famous Baker Act.

The Florida Mental Health Act, A.K.A. the Baker Act

In the state of Florida, the Baker Act protects the rights of anyone who enters treatment for mental health issues. The Florida Legislature initially passed this law back in 1971 to promote mental health services. Since then, lawmakers have revised it to protect a broader scope of patients. For example, in 1996, the Florida Legislature amended the Baker Act to protect the rights of voluntary patients, too. So, overall, the Baker Act protects anyone who enters treatment for mental health problems; including those who struggle with addiction.

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The Baker Act Then and Now

When the Baker Act first went into effect, it protected more than just mental health patients and their rights. In fact, it protected both patients and their loved ones. Florida Representative Maxine Baker, who created the Baker Act, designed it to separate the hospitalization process from any legal procedures that involved the patients in need of treatment. Before this law, there was no guarantee that mental health patients would receive the best possible quality of care. Any legal troubles they faced may have influenced whether or not they got treatment at all. Baker changed this by keeping the issues separate in the Baker Act.

Additionally, the Baker Act granted the right to family, judges, or law enforcement to enter patients into mental health facilities. This part of the Act protects patients who do not admit themselves into treatment for one reason or another. Virtually, the law ensures that patients receive help whether they feel it is necessary or not. This side of the Baker Act deals with involuntary treatment and is still in effect today.

While involuntary admission to a treatment facility might seem extreme, the Baker Law should not discourage or scare anyone struggling with mental health issues. It should do just the opposite. Representative Baker wanted to encourage those with mental illness to seek out help for themselves. In fact, the proposal only called for involuntary admission under special circumstances. These criteria are also still in effect today.

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Involuntary Examinations Under the Baker Act

Criteria for Involuntary Examinations

Mental health patients are eligible for involuntary examination under the Baker Act if there is evidence that it’s necessary. It must also be for the good of the patient. For example, a loved one only has the right to admit someone to a facility for examination (and possibly treatment) for addiction if there is substantial evidence of substance abuse. According to the 2014 Baker Act User Reference Guide, certain criteria determine if an involuntary examination is lawful. These criteria state that the person admitting the patient must do so for one of the following reasons:

The Patient Has Refused Help Knowing Why it’s Necessary

A loved one, judge, or law enforcement official has the right to enter someone into a treatment facility if the person refuses to do so even after “conscientious explanation and disclosure of the purpose of the examination” has been provided. Take, for example, an alcoholic husband who refuses to admit or even acknowledge his problem. In this situation, he will likely decline an exam at a treatment facility. So, the responsibility of getting the person to the facility would fall on someone else, like his wife.

The Patient Is Unable to Determine Whether or Not Help is Necessary

The Baker Act also allows a representative of the patient to admit him or her to a mental health facility if “there is [a] reason to believe that the person is unable to determine for himself or herself whether [an] examination is necessary.” Essentially, this means that someone can act on the mental health patient’s behalf if his or her competency for self-care is called into question. Using the prior example, the alcoholic’s sense of denial may inhibit his ability to make rational decisions about his health. So, his wife or another loved one may legally enter him into a facility for involuntary examination under the Baker Act.

The Patient’s Well-Being is at Risk

If there is a reason to believe that the mental health patient in question would “suffer from neglect or refuse to care for himself or herself [without help],” then involuntary examination and even treatment may be necessary. This is especially true if “the help of willing family members, friends, or the provision of other services” isn’t enough. Going back to the previous example, the alcoholic husband may need professional help if he has not made any progress getting sober, even with help from family and friends. In situations like this, someone can legally bring the patient to a facility for examination or treatment.

The Patient is in Danger Without Treatment

The Baker Act does more than protect the rights of mental health patients and their loved ones. It also serves to protect them from any potential “serious bodily harm… as evidenced by [the patient’s] recent behavior.” Essentially, if there is any reason to believe that a patient poses a threat to himself or herself, or to anyone else, then an involuntary examination (at the very least) becomes necessary. For instance, if the alcoholic mentioned in earlier examples becomes violent when he drinks, then his wife can admit him to a facility. The Baker Act protects her right to do so.

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Starting Involuntary Examinations

For a facility to begin an involuntary examination, including for addiction patients, one of three things must happen first:

A Judge Gives a Court Order

No matter who acts on behalf of the patient during the admission process, an examination cannot take place without a court order. For there to be a court order, the person admitting the patient must give a sworn testimony that is then documented and used “when there is [a] reason to believe [that the patient in question meets] the criteria for involuntary examination.” Then, the patient and the ex parte order issued by the judge go to the receiving facility. Any documentation from this process becomes part of the patient’s clinical record at the facility.

A Law Enforcement Officer Brings a Patient in for the Examination

For the Baker Act to cover officers who bring patients to a facility, it must be an on-duty action. If the patient meets the criteria for involuntary examination, the officer must fill out a “Report of Law Enforcement Officer Initiating Involuntary Examination.” Then, the facility can accept the patient, keep the document, and perform an examination.

A Doctor Provides a Professional Certificate

A medical professional— such as a physician, psychologist, or nurse— may perform his or her examination and find that a patient fits the Baker Act’s criteria for involuntary examination by a mental health facility. In cases like this, the professional can send the patient in for involuntary examination by filling out and submitting a “Certificate of Professional Initiating Involuntary Examination.” However, this form has to be the submitted within the 48 hours before admission. Like the court order or law report, a professional certificate goes into the patient’s file.

Discharge After Involuntary Examination

Even though the Baker Act enforces involuntary examination for patients in need of mental health services, it also implements a 72-hour limit. Once that 72-hour period is over, the facility’s administrator must:
1. release the patient to family or friends
2. file for involuntary inpatient placement with the court
3. file for involuntary outpatient placement with the court
4. keep or transfer the patient if he or she gives express and informed consent for treatment

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Involuntary Admissions into Treatment Under the Baker Act

Criteria for Involuntary Admissions

When a family member, judge, or law enforcement official tries to submit someone into a mental health treatment facility, they must abide by a list of criteria outlined in the Baker Act. If these requirements are overlooked or ignored, it is a violation of both the patient’s Constitutional rights and the rights granted by the Baker Act itself.

Involuntary Inpatient Placement

Whether or not an involuntary examination takes place, a mental health patient may be required to enter inpatient treatment. However, as with examination, involuntary placement into treatment can only happen if there is sufficient evidence that the patient in question needs help. Also, the Baker Act covers instances of admission for involuntary inpatient treatment if the patient:

1. has refused voluntary placement
2. is unable to decide for himself or herself whether treatment is necessary
3. is unable to survive without treatment, even with help from others
4. is highly likely to suffer substantial harm to his or her well-being without treatment
5. poses a risk to himself or herself— or to others— without treatment, as evidenced by recent behavior, or
6. does not have access to any less restrictive treatment alternatives which would improve his or her condition

Involuntary Outpatient Placement

As is the case with examinations and inpatient treatment, involuntary outpatient treatment is only covered by the Baker Act if there is sufficient evidence to suggest that it’s absolutely necessary for the good of the patient. For someone to admit a patient into involuntary outpatient treatment, the patient must have:

  1. an inability to survive without professional help
  2. caused, or be at risk for, physical harm to him- or herself or others
  3. a high risk of suffering “substantial harm” without professional help
  4. a high likelihood of benefiting from involuntary outpatient placement
  5. a need for involuntary outpatient treatment to prevent potential relapse
  6. a history of lack of compliance during mental health examination or treatment
  7. been involuntarily admitted to a treatment facility at least twice within the last 36 months
  8. an inability to determine for him- or herself whether or not treatment is necessary for his or her health
  9. refused voluntary placement into inpatient treatment after learning why it’s required for his or her health
  10. tried all available, less restrictive alternatives for the improvement of his or her condition, with little to no success
  11. committed one or more attempts at or acts of severe violent behavior (toward self or others) within the last 36 months, or
  12. refused to voluntarily participate in the recommended treatment plan as a result of the mental health issue (i.e., the addiction)

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Addiction Treatment Services at TTC Care

The Baker Act is Florida law that protects a wide scope of mental health patients who need professional help, including those who struggle with addiction. For more information about patient rights under the Baker Act, be sure to review The Baker Act, Part I. If you or someone you know is having trouble getting or staying sober, call The Treatment Center’s Residential Facility at (844) 201-3136 for more information about inpatient recovery programs.