The Florida Mental Health Act of 1971,[1] commonly known as the "Baker Act," allows for a) short-term, inpatient voluntary and involuntary examination, b) inpatient voluntary and involuntary admission of an individual for assessment and treatment of a mental illness, and c) involuntary outpatient treatment for mental illness.
The Florida Department of Children and Families makes resources available online for individuals and families to learn about the Baker Act[2] and to access training about it.[3] There was a 2023 Baker Act User Reference Guide published in the fall of 2023.[4] Reports of data about involuntary examination are available at the Baker Act Reporting Center.[5] Additional specifics about requirements for and carrying out the Baker Act are contained in Florida Administrative Code 65E-5, titled the "Mental Health Act Regulation," which some colloquially refer to as the "rule."[6] Mandatory and suggested forms to use for various activities, as allowed in the Baker Act, are part of a subsection of this Florida Administrative Code, 65E-5.120.[7]
History, language, and definitions
The 1971 legislation was nicknamed the "Baker Act" after state representative Maxine Baker (D–Miami),[8] who served from 1963 to 1972. She was strongly interested in mental health issues, served as chair of the House Committee on Mental Health, and sponsored the bill. Every state has a mental health statute, with many similar to the Baker Act, but also differences across states in short-term emergency commitment (the equivalent of an involuntary [Baker Act] examination in [9] Florida),[10] long-term involuntary commitment (the equivalent of involuntary inpatient placement in Florida),[11] and involuntary outpatient commitment (the equivalent of involuntary outpatient services in Florida).[12] Words and phrases are defined in the Baker Act as follows.[13]
Department: The use of the word "Department" in the Baker Act refers to the Department of Children and Families.
Mental illness: An "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 the person’s ability to meet the ordinary demands of living. For the purposes of this part, the term does not include a developmental disability as defined in chapter 393, intoxication, or conditions manifested only by dementia, traumatic brain injury, antisocial behavior, or substance abuse.
Treatment Facility: The term "treatment facility" in the Baker Act does not refer generically to any facility that provides treatment. Rather, it is defined as "a state-owned, state-operated, or state-supported hospital, center, or clinic designated by the department for extended treatment and hospitalization, beyond that provided for by a receiving facility, of persons who have a mental illness, including facilities of the United States Government, and any private facility designated by the department when rendering such services to a person pursuant to the provisions of this part. Patients treated in facilities of the United States Government shall be solely those whose care is the responsibility of the United States Department of Veterans Affairs. Some people colloquially refer to "treatment facilities" as defined in the Baker Act as "state hospitals," but the Baker Act does not use the term "state hospital."
The nickname has led to the term "Baker Act" being used as a transitive verb and "Baker Acted" being used as a passive-voice verb for invoking the involuntary examination.[14]
Short-Term Inpatient Voluntary and Involuntary Examination
While much of the focus of the Baker Act is on the involuntary nature of activities allowed, the Baker Act also addresses voluntary aspects of examination and treatment. The word "voluntary" appears 53 times in the Baker Act, while the word "involuntary" appears 224 times.[15] The Baker Act addresses "voluntary admission" (F.S. 394.4625), including the authority to receive patients, discharge of voluntary patients, notice of right to discharge, and transfer to voluntary status from an involuntary status.[16] Websites for Florida Judicial Circuits and Clerks of Court contain information about the Baker Act examination process, including how to pursue an ex-parte order.[17]
The Baker Act allows for involuntary examination, which can be initiated by an ex-parte order of a judge, law enforcement officials, or certain health professionals. These health professionals include physicians, clinical psychologists, nurses with certain types of training (psychiatric nurse, APRN), clinical social workers, mental health counselors, and marriage and family therapists. Although not specified in the Baker Act as a professional type that can initiate involuntary examinations, Physicians' Assistants are allowed to initiate involuntary examinations as per a 2008 Florida Attorney General opinion.[18] Forms for law enforcement and health professionals to initiate involuntary examinations and templates for petitions and orders for ex-parte orders for involuntary examinations are available on the Department of Children and Families website.[19] The Florida Judicial Circuits provide information about how to pursue an ex-parte order for involuntary examination.[17][20]
Examinations may last up to 72 hours after a person is deemed medically stable and occur in over 100+ Florida Department of Children and Families-designated receiving facilities statewide.[21] A "receiving facility" is defined in the Baker Act as "a public or private facility or hospital designated by the department to receive and hold or refer, as appropriate, involuntary patients under emergency conditions for mental health or substance abuse evaluation and to provide treatment or transportation to the appropriate service provider. The term does not include a county jail."[13] Note that what some colloquially call "state hospitals" and what the Baker Act calls "treatment facilities" are not receiving facilities, and people are not involuntary examined at these "treatment facilities." Additional details about treatment facilities are included in the Involuntary Inpatient Placement section of this page.
Specific criteria must be met in order to initiate involuntary examination. Among those criteria are the following elements, which do not individually qualify an individual as meeting the criteria. To initiate an involuntary examination, the Baker Act requires that there is reason to believe the individual:
has a mental illness as defined in section 394.455, Florida Statutes[22] and
is refusing voluntary examination after conscientious explanation and disclosure of the purpose of the examination OR is unable to determine for himself/herself whether the examination is necessary AND
without care or treatment, said individual is likely to suffer from neglect or refuse to care for himself/herself, and such neglect or refusal poses a real and present threat or substantial harm to his/her well-being and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services OR there is substantial likelihood that without care or treatment the individual will cause serious bodily harm to self and/or others in the near future, as evidenced by recent behavior. Note that the language in the bullets above is taken directly from the Baker Act.
The decisive criterion, as stated in the statute, mentions a substantial likelihood that without care or treatment, the person will cause serious bodily harm in the near future. Criteria are not met simply because a person has a mental illness, appears to have mental problems, takes psychiatric medication, has an emotional outburst, or refuses voluntary examination. Furthermore, if there are family members or friends that will help prevent any potential and present threat of substantial harm, the criteria for involuntary examination are also not met.
The following may not be used as a basis to initiate an involuntary examination:
Developmental disability
Intoxication
Conditions manifested only by antisocial behavior
Conditions manifested only by substance abuse impairment[23][24]
"Substantial likelihood" must involve evidence of recent behavior to justify the substantial likelihood of serious bodily harm in the near future. Moments in the past when an individual may have considered harming themselves or another do not qualify the individual as meeting the criteria.[25]
There are many possible outcomes following the involuntary examination of the individual. These include the release of the individual to the community (or other community placement), a petition for involuntary inpatient placement (often called civil commitment), a petition for involuntary outpatient placement (what some call outpatient commitment or assisted outpatient treatment[26]), or voluntary treatment (if the person is competent to consent to voluntary treatment and consents to voluntary treatment, such as specified in case law[27]). The involuntary outpatient placement language in the Baker Act took effect as part of the Baker Act reform in 2004.
Inpatient Involuntary Placement
People may be placed involuntarily at an inpatient facility. The main section of the Baker Act about involuntary inpatient placement (F.S. 394.467)[28] specifies the criteria for involuntary inpatient placement, as well as the petitioning process, the appointment of counsel, the continuance of the hearing, and the hearing. Note that people may be involuntarily placed for up to 90 days, except that the involuntary placement may be up to 6 months in a treatment facility. The "treatment facilities" at which people may be admitted for involuntary inpatient placement are Florida State Hospital (in Chattahoochee), Northeast Florida State Hospital (in MacClenny), and South Florida State Hospital (in Pembroke Pines).[29] While children may be involuntarily placed at an inpatient facility, children may not be involuntarily placed at state treatment facilities.
Involuntary Outpatient Services
The Baker Act has allowed for involuntary outpatient services. The criteria for involuntary outpatient services, as well as specifics about petitioning, the appointment of counsel, the continuance of hearings, and hearings, are specified in the Baker Act.[30] Other phrases used historically or currently on a local or national level to describe this legal mechanism are involuntary outpatient commitment and assisted outpatient treatment or AOT. Note that while the phrase "involuntary outpatient services" is used in the Baker Act, the prior phrase that was used in the Baker Act to describe this legal mechanism, "involuntary outpatient placement," still appears on some forms and in the relevant Florida Administrative Code (65E-5.285).[31]
Reception
An editorial in the Tampa Bay Times wrote "that crisis stabilization is a Band-Aid solution to emotional problems," and the Act should be reformed to allow public defenders to have access to the patient's medical records and ongoing counseling and outpatient mental health treatment should be provided to the patient.[32]
Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified person to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily. This treatment may involve the administration of psychoactive drugs, including involuntary administration. In many jurisdictions, people diagnosed with mental health disorders can also be forced to undergo treatment while in the community; this is sometimes referred to as outpatient commitment and shares legal processes with commitment.
Outpatient commitment—also called assisted outpatient treatment (AOT) or community treatment orders (CTO)—refers to a civil court procedure wherein a legal process orders an individual diagnosed with a severe mental disorder to adhere to an outpatient treatment plan designed to prevent further deterioration or recurrence that is harmful to themselves or others.
A psychiatric hospital, also known as a mental health hospital, a behavioral health hospital, or an asylum is a specialized medical facility that focuses on the treatment of severe mental disorders. These institutions cater to patients with conditions such as schizophrenia, bipolar disorder, major depressive disorder, and eating disorders, among others.
Voluntary commitment is the act or practice of choosing to admit oneself to a psychiatric hospital, or other mental health facility. Unlike in involuntary commitment, the person is free to leave the hospital against medical advice, though there may be a requirement of a period of notice or that the leaving take place during daylight hours. In some jurisdictions, a distinction is drawn between formal and informal voluntary commitment, and this may have an effect on how much notice the individual must give before leaving the hospital. This period may be used for the hospital to use involuntary commitment procedures against the patient. People with mental illness can write psychiatric advance directives in which they can, in advance, consent to voluntary admission to a hospital and thus avoid involuntary commitment.
The Lanterman–Petris–Short (LPS) Act regulates involuntary civil commitment to a mental health institution in the state of California. The act set the precedent for modern mental health commitment procedures in the United States. The bipartisan bill was co-authored by California State Assemblyman Frank D. Lanterman (R) and California State Senators Nicholas C. Petris (D) and Alan Short (D), and signed into law in 1967 by Governor Ronald Reagan. The Act went into full effect on July 1, 1972. It cited seven articles of intent:
An athletic trainer is a certified and licensed health care provider who practices in the field of sports medicine. Athletic training has been recognized by the American Medical Association (AMA) as an allied health care profession since 1990.
Laura's Law is a California state law that allows for court-ordered assisted outpatient treatment. To qualify for the program, the person must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards self or others.
Some jurisdictions may commit certain types of dangerous sex offenders to state-run detention facilities following the completion of their sentence if that person has a "mental abnormality" or personality disorder that makes the person likely to engage in sexual offenses if not confined in a secure facility. In the United States, twenty states, the federal government, and the District of Columbia have a version of these commitment laws, which are referred to as "Sexually Violent Predator" (SVP) or "Sexually Dangerous Persons" laws.
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.
Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors.
Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment also known as assisted outpatient treatment. It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply could result in commitment for up to 72 hours. Kendra's Law does not mandate that patients be forced to take medication.
Castle Peak Hospital is the oldest and largest psychiatric hospital in Hong Kong. Located east of Castle Peak in Tuen Mun, the hospital was established in 1961. It has 1,156 beds, providing a wide variety of psychiatric services such as adult psychiatry, forensic psychiatry, psychogeriatric services, child and adolescent psychiatry, consultation-liaison psychiatry and substance abuse treatments. All wards in the hospital are equipped to accommodate both voluntary and involuntary admitted patients.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.
The obligatory dangerousness criterion is a principle present in the mental health law of many developed countries. It mandates evidence of dangerousness to oneself or to others before involuntary treatment for mental illness. The term "dangerousness" refers to one's ability to hurt oneself or others physically or mentally within an imminent time frame, and the harm caused must have a long-term effect on the person(s).
The following outline is provided as an overview of and topical guide to psychiatry:
Mental health in Russia is covered by a law, known under its official name—the Law of the Russian Federation "On Psychiatric Care and Guarantees of Citizens' Rights during Its Provision", which is the basic legal act that regulates psychiatric care in the Russian Federation and applies not only to persons with mental disorders but all citizens. A notable exception of this rule is those vested with parliamentary or judicial immunity. Providing psychiatric care is regulated by a special law regarding guarantees of citizens' rights.
Health in Norway, with its early history of poverty and infectious diseases along with famines and epidemics, was poor for most of the population at least into the 1800s. The country eventually changed from a peasant society to an industrial one and established a public health system in 1860. Due to the high life expectancy at birth, the low under five mortality rate and the fertility rate in Norway, it is fair to say that the overall health status in the country is generally good.
Involuntary commitment or civil commitment is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily.
The Marchman Act, officially the "Hal S. Marchman Alcohol and Other Drug Services Act of 1993", is a Florida law that provides a means of involuntary and voluntary assessment and stabilization and treatment of a person allegedly abusing alcohol or drugs.
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↑ "History of the Baker Act"(PDF). State of Florida Department of Children and Families Mental Health Program Office. May 2002. Archived(PDF) from the original on 2019-06-05. Retrieved 2019-07-22.
"Crisis Services – Baker Act". Includes forms, links to resources, statement of patients' rights. Florida Department of Children and Families. Archived from the original on 2021-07-22. Retrieved 2021-07-22.{{cite news}}: CS1 maint: others (link)
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