The Baker Act, Part III: Voluntary Patient Admission

At one point in American history, treatment facilities everywhere experienced a massive influx of mental health patients. In response to the stress put on mental hospitals and their patients, more and more over-the-counter psychiatric medications became available. This made it possible for voluntary patients to treat common mental health issues from the safety of their homes, with little to no need for long-term hospitalization. Still, over-institutionalization continued because, unfortunately, the rights of mental health patients were very vague. It was for this reason, along with many others, that the state of Florida introduced the Baker Act in 1971.

About the Baker Act

Before 1971, Florida’s regulations surrounding mental health treatment services were unsystematic and uncomprehensive. This changed with the introduction of the Mental Health Act, or, the Baker Act. In the State of Florida, the Baker Act outlines the proper procedures for everything surrounding mental health treatment. It ensures that patients receive the treatment they need for the maintaining or improving their mental health. As such, anyone who receives treatment under the Baker Act can expect:

  • minimally restrictive means of medical intervention
  • comprehensive services during intensive treatment, whether it’s short- or long-term
  • emergency service and/or temporary holding for as-needed mental health evaluation
  • protection of individual dignity and other human rights throughout the examination and/or treatment process
  • any involuntary examination or treatment to take place in an appropriate clinical setting under professional supervision
  • the facility to prioritize not only the patient’s treatment but also his or her timely reintegration into the community

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The Purpose of the Baker Act

When Florida Legislation first passed the Baker Act, it did so to protect the rights of involuntary mental health patients. In fact, the Baker Act provides clear criteria for what does or does not qualify as grounds for involuntary admission to a treatment facility.

For involuntary treatment to be lawful, there must be a reason to believe that the patient in question is actually mentally ill. This includes those struggling with addiction whose long-term health is at risk. In addition, at least one of the following must be true for the patient under consideration for involuntary admission:

  1. He or she has refused examination or treatment despite understanding why it’s necessary.
  2. The patient is not competent enough to determine for him- or herself whether or not mental health care is necessary. As it pertains to addiction treatment, this criteria is especially relevant to those who claim “I don’t have an addiction.”
  3. Refusing voluntary treatment will undoubtedly put the patient at risk of self-imposed neglect. In other words, he or she will not take good care of themselves without professional help.
  4. There is a sizeable chance that the patient will harm him- or herself, or possibly others, without professional care or treatment.

Who Does the Baker Act Protect?

Initially, the Baker Act focused on protecting involuntary mental health patients to reduce the rate of unnecessary institutionalization. Today, the Baker Act protects anyone in need of emergency or long-term mental health treatment in the state of Florida. This includes patients who:

  • are any age, from underage to elderly
  • receive treatment on an outpatient basis
  • receive treatment on an inpatient or partial hospitalization (PHP) basis
  • can afford private health care (i.e., those who have some degree of insurance)
  • cannot afford treatment (i.e., those who are uninsured, underinsured, underprivileged, etc.)
  • enter treatment involuntarily (i.e., those who are unable or unwilling to make the best choices regarding their mental health)
  • enter treatment voluntarily (i.e., those who are competent enough to decide the best course of action for their mental health)

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Voluntary Admissions and Patient Status Under the Baker Act

Florida lawmakers have revised the Baker Act several times since it passed in 1971. Most of the amendments were designed to improve civil and due process rights for mental health patients. In the most recent amendments from 1996, the Act also extended its rights and protections to voluntary mental health patients. This includes anyone who admits themselves to an addiction treatment facility. After all, addiction falls under the category of a mental health disorder. To qualify as a voluntary mental health patient, you must consent to treatment and be competent enough to do so. Simply put, you must fully recognize that you need treatment, and why.

What Are the Major Differences Between Voluntary and Involuntary Admission Under the Baker Act?

Anyone who enters mental health treatment on an involuntary basis is usually considered incompetent to consent. In cases like this, the patient’s mental illness has impacted his or her judgment or decision-making. When it comes to addiction recovery, involuntary admission becomes necessary when patients lack the ability to make good decisions about their health. So, the Baker Act allows mental health facilities to accept patients admitted by a parent or guardian, doctor, or judge. Alternatively, when patients have voluntary status, they demonstrate the capacity to make well-informed, fair decisions about their health. And, unlike involuntary patients, voluntary mental health patients have more of a say in the kind of treatment they receive, where they get it, and for how long.

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Criteria for Voluntary Admission into Treatment

The Baker Act allows anyone to come forward for mental health treatment. Still, there are certain criteria that even voluntary mental health patients must meet. The following circumstances would allow someone to qualify for voluntary admission into a mental health facility:

Evidence of Mental Illness

In order for a patient to enter treatment under the Baker Act, there must be evidence to support that there is a mental illness to treat— like an addiction. This is true even for voluntary patients. For example, a woman would not be able to enter herself into treatment for alcoholism if she didn’t exhibit any signs of alcoholism. After all, you can’t treat a condition that isn’t there.

Competence to Consent

A patient must be competent enough to provide express and informed consent for examination or admission. Competence to consent is just as important for voluntary patients as it is for involuntary patients. This is true for a variety of reasons. For example, a woman in her 60s with dementia may not be competent enough to voluntarily consent to any changes in her routine at the nursing home she lives in. Instead, she would have to give consent through a loved one or a representative of some kind to ensure the best possible treatment. This same idea applies to people looking for addiction treatment services.

Typically, a patient’s competence to consent is determined during a pre-admission hearing. There, voluntary patients can verify their desire to enter treatment of their own volition. If no such hearing takes place, then the admitting physician at the facility must evaluate the patient and document his or her consent within 24 hours of admission.

Legal Adult Status

The Baker Act allows individuals 18 years old or older to enter themselves into treatment whenever they see fit, given that they meet the other criteria. If the voluntary patient in question is a minor, then the responsibilities surrounding admission falls on the parents or legal guardian. For example, a teenaged boy who wants to enter rehab for alcohol addiction must receive help from his parents to do so.

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Making the Transition from Involuntary Patient to Voluntary Patient

While the Baker Act lays out distinct criteria for both voluntary and involuntary mental health patients, it’s also important to note that an involuntary patient can switch to “voluntary status” during the course of treatment (and vice versa). In fact, any involuntary patient who applies for voluntary patient status is transferred immediately. The only time this isn’t the case is if the patient:

  1. has been charged with a crime
  2. continues to meet all the criteria for involuntary placement, and/or
  3. was initially placed into involuntary treatment by a court under S.394.467 of the Baker Act

If an involuntary patient qualifies for transfer to voluntary status, notice is given as provided in S.394.4599 of the Baker Act.

Discharge for Voluntary Patients

For voluntary patients, facilities that operate under the Baker Act are legally obligated to inform them of their right to request release. In fact, the facility must do this both at the time of admission and at least every six months after that.  These notices have to be written out for facility documentation. And, unlike involuntary patients, voluntary patients can ask to leave at any point after admission. Mental health facilities might release voluntary patients for any of the following reasons:

The Patient’s Condition Improves

The whole point of entering treatment voluntarily is to get better. So, everyone with voluntary patient status has the right to leave when they feel their condition has improved. This is especially true for people in addiction recovery. Now, the facility staff may try to encourage a patient to stay if they feel he or she isn’t quite ready to reenter society. However, the decision to stay or leave is up to the patient who chose to be there.

It’s also important to note that an improvement in condition might mark a transition in treatment methods. For example, someone who stayed at a residential rehab facility might make the decision to transfer to an outpatient program. It all depends on if he or she thinks it’s the best next step for their recovery.

The Patient Requests Discharge

Voluntary patients can request discharge at any time through written documentation or discussions with the staff (i.e., written or oral requests). When a patient submits a request for discharge, the facility must oblige within 24 hours unless the request is rescinded or denied. The only instance where a facility can deny a patient’s request for discharge is if the patient was reassigned to involuntary status. Otherwise, the facility honors the request for discharge and documents it in the patient’s clinical record.

The Patient Refuses or Revokes Consent to Voluntary Treatment

In addition to the other rights granted by the Baker Act, voluntary mental health patients also have the right to refuse or revoke consent at any time. If a voluntary patient refuses to enter treatment, even after the admission process, the facility must release him or her immediately. Similarly, if a voluntary patient decides to revoke consent to treatment during the treatment process itself, the facility must release him or her within 24 hours. The only exception to these circumstances is if the patient in question has shifted to involuntary patient status.

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Baker Act-Compliant Addiction Treatment at TTC Care

When the Baker Act was first signed into law, it was a landmark in involuntary mental health patient rights. Today, it continues to protect mental health patients whether they have entered treatment voluntarily or not— especially those who need help recovering from an addiction. If you or someone you know is in need of addiction treatment and recovery services, it’s important to know your rights under the Baker Act. Every addiction treatment facility in Florida must comply with the Baker Act’s regulations. For more information about our programs and services, please call The Treatment Center Residential Care at (844) 201-3136.

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