lps laws definition

es1. Participants will be able to discuss the intent of both the Marchman and Baker Acts.2. Participants will be able to define terms specific to the language of these laws.3. Participants will be able to select the appropriate action in response to mental health or substance abuse emergencies.4. Participants will be able to describe patient rights for both the Marchman and Baker Acts.

Marchman Act and Baker Act: Florida Emergency Services Legislation

Back to Courses Marchman Act and Baker Act: Florida Emergency Services Legislation Newly licensed in Florida? Learn about the emergency services legislation regarding involuntary commitment protocols for providing care for persons with substance abuse problems and mental illness.

Developed by: Karen Albig Smith, LMFT, LCAS, MAC, CAP, SAP, SAERevised 2012NOT APPROVED FOR OHIO SOCIAL WORK, MARRIAGE AND FAMILY, AND PROFESSIONAL COUNSELING LICENSEESDescription: Addiction is a disease where abstinence is difficult and often impossible to manage without outside help. Individuals with severe mental illness or experiencing crisis episodes often will not decide to obtain care when it is needed. It has long been recognized that legislation providing for the public to assist individuals who were unable to act on their own behalf would enable the access to the care they required.

Adjudicated admissions, however, do not guarantee successful outcomes. The state of Florida seeks to help persons elect voluntary services when possible and provide protections when they don't. This course looks at the Florida laws that govern these types of treatment episodes and the steps in implementation for successful outcomes. Objectiv

5. Participants will be able to complete the required reporting and documentation for persons receiving services under the Marchman and Baker Acts.

CE Credits: 4CE Broker#: HS 20- 338855 OL 20- 338856Agenda: Hour One: Baker acts, Definition of terms. Hour Two: Steps in the involuntary commitment proceeding, Patient rights. Hour Three: Marchman act, Definitions.

Hour Four: Steps in the involuntary commitment proceeding, Patient rights Methods: Pre-test, study guide, post test and evaluation, internet sources via URLs, Q&A by email. Content Area; Professional orientation/readiness, Legal and regulatory, Research and evaluation, Clinical evaluation and assessment, Documentation/treatment planning, Ethics, Risk management.

Purpose: It is the intent of this offering to provide a current overview about Florida regulations for implementation of involuntary commitment for patients who are a danger to themselves or others due to mental illness or substance abuse impairment.

Target Audience: Psychologists, school psychologists, social workers, marriage and family therapists, licensed professional counselors, mental health counselors, nurses, employee assistance professionals, addiction professionals, behavioral health technicians, and other allied professionals. Online Course CE Broker#:20-338856CE Credits:4Price:$40.00Online Course Disclaimer

By the time Ronald Reagan assumed the governorship in 1967, California had already deinstitutionalized more than half of its state hospital patients. That same year, California passed the landmark Lanterman-Petris-Short (LPS) Act, which virtually abolished involuntary hospitalization except in extreme cases.

Ronald Reaganâs shameful legacy: Violence, the homeless, mental illness

"Ronald Reagan’s shameful legacy: Violence, the homeless, mental illness As president and governor of California, the GOP icon led the worst policies on mental illness in generations Dr. E. Fuller Torrey09.29.2013 • 5:00 AMExcerpted from“American Psychosis”In November 1980, Republican Ronald Reagan overwhelmingly defeated Jimmy Carter, who received less than 42% of the popular vote, for president. Republicans took control of the Senate (53 to 46), the first time they had dominated either chamber since 1954.

Although the House remained under Democratic control (243 to 192), their margin was actually much slimmer, because many southern “boll weevil” Democrats voted with the Republicans. One month prior to the election, President Carter had signed the Mental Health Systems Act, which had proposed to continue the federal community mental health centers program, although with some additional state involvement.

Consistent with the report of the Carter Commission, the act also included a provision for federal grants “for projects for the prevention of mental illness and the promotion of positive mental health,” an indication of how little learning had taken place among the Carter Commission members and professionals at NIMH.

With President Reagan and the Republicans taking over, the Mental Health Systems Act was discarded before the ink had dried and the CMHC funds were simply block granted to the states.

The CMHC program had not only died but been buried as well. An autopsy could have listed the cause of death as naiveté complicated by grandiosity. President Reagan never understood mental illness. Like Richard Nixon, he was a product of the Southern California culture that associated psychiatry with Communism.

Two months after taking office, Reagan was shot by John Hinckley, a young man with untreated schizophrenia. Two years later, Reagan called Dr. Roger Peele, then director of St. Elizabeths Hospital, where Hinckley was being treated, and tried to arrange to meet with Hinckley, so that Reagan could forgive him.

Peele tactfully told the president that this was not a good idea. Reagan was also exposed to the consequences of untreated mental illness through the two sons of Roy Miller, his personal tax advisor. Both sons developed schizophrenia; one committed suicide in 1981, and the other killed his mother in 1983. Despite such personal exposure, Reagan never exhibited any interest in the need for research or better treatment for serious mental illness.

* * *California has traditionally been on the cutting edge of American cultural developments, with Anaheim and Modesto experiencing changes before Atlanta and Moline.

This was also true in the exodus of patients from state psychiatric hospitals. Beginning in the late 1950s, California became the national leader in aggressively moving patients from state hospitals to nursing homes and board-and-care homes, known in other states by names such as group homes, boarding homes, adult care homes, family care homes, assisted living facilities, community residential facilities, adult foster homes, transitional living facilities, and residential care facilities. Hospital wards closed as the patients left.

Thus, by the early 1970s California had moved most mentally ill patients out of its state hospitals and, by passing LPS, had made it very difficult to get them back into a hospital if they relapsed and needed additional care. California thus became a canary in the coal mine of deinstitutionalization. The results were quickly apparent.

As early as 1969, a study of California board-and-care homes described them as follows: These facilities are in most respects like small long-term state hospital wards isolated from the community. One is overcome by the depressing atmosphere. . . . They maximize the state-hospital-like atmosphere.

. . . The operator is being paid by the head, rather than being rewarded for rehabilitation efforts for her “guests.”The study was done by Richard Lamb, a young psychiatrist working for San Mateo County; in the intervening years, he has continued to be the leading American psychiatrist pointing out the failures of deinstitutionalization.

By 1975 board-and-care homes had become big business in California. In Los Angeles alone, there were “approximately 11,000 ex-state-hospital patients living in board-and-care facilities.” Many of these homes were owned by for-profit chains, such as Beverly Enterprises, which owned 38 homes.

Many homes were regarded by their owners “solely as a business, squeezing excessive profits out of it at the expense of residents.” Five members of Beverly Enterprises’ board of directors had ties to Governor Reagan; the chairman was vice chairman of a Reagan fundraising dinner, and “four others were either politically active in one or both of the Reagan [gubernatorial] campaigns and/or contributed large or undisclosed sums of money to the campaign.” Financial ties between the governor, who was emptying state hospitals, and business persons who were profiting from the process would also soon become apparent in other states.

Many of the board-and-care homes in California, as elsewhere, were clustered in city areas that were rundown and thus had low rents. In San Jose, for example, approximately 1,800 patients discharged from nearby Agnews State Hospital were placed in homes clustered near the campus of San Jose State University.

As early as 1971 the local newspaper decried this “mass invasion of mental patients.” Some patients left their board-and-care homes because of the poor living conditions, whereas others were evicted when the symptoms of their illness recurred because they were not receiving medication, but both scenarios resulted in homelessness.

By 1973 the San Jose area was described as having “discharged patients...living in skid row...wandering aimlessly in the streets . . . a ghetto for the mentally ill and mentally retarded.”Similar communities were becoming visible in other California cities as well as in New York.

In Long Beach on Long Island, old motels and hotels were filled with patients discharged from nearly Creedmore and Pilgrim State Hospitals.

By 1973, community residents were complaining that their town was becoming a psychiatric ghetto; at the local Catholic church, patients were said to “have urinated on the floor during Mass and eaten the altar flowers.” The Long Beach City Council therefore passed an ordinance requiring patients to take their prescribed medication as a condition for living there. Predictably, the New York Civil Liberties Union immediately challenged the ordinance as being unconstitutional, and it was so ruled.

By this time, there were about 5,000 board-and-care homes in New York City, some with as many as 285 beds and with up to 85% of their residents having been discharged from the state hospitals.

As one New York psychiatrist summarized the situation: “The chronic mentally ill patient has had his locus of living and care transferred from a single lousy institution to multiple wretched ones.”California was the first state to witness not only an increase in homelessness associated with deinstitutionalization but also an increase in incarceration and episodes of violence.

In 1972 Marc Abramson, another young psychiatrist working for San Mateo County, published a landmark paper entitled “The Criminalization of Mentally Disordered Behavior.” Abramson claimed that because the new LPS statute made it difficult to get patients admitted to a psychiatric hospital, police “regard arrest and booking into jail as a more reliable way of securing involuntary detention of mentally disordered persons.” Abramson quoted a California prison psychiatrist who claimed to be “literally drowning in patients.

. . . Many more men are being sent to prison who have serious mental problems.” Abramson’s paper was the first clear description of the increase of mentally ill persons in jails and prisons, an increase that would grow markedly in subsequent years.

By the mid-1970s, studies in some states suggested that about 5% of jail inmates were seriously mentally ill. A study of five California county jails reported that 6.7% of the inmates were psychotic.

A study of the Denver County Jail reported that 5% of prisoners had a “functional psychosis.” Such figures contrasted with studies from the 1930s that had reported less than 2% of jail inmates as being seriously mentally ill. In 1973 the jail in Santa Clara County, which included San Jose, “created a special ward...to house just the individuals who have such a mental condition”; this was apparently the first county jail to create a special mental illness unit.

Given the increasing number of seriously mentally ill individuals living in the community in California by the mid-1970s, it is not surprising to find that they were impacting the tasks of police officers. A study of 301 patients discharged from Napa State Hospital between 1972 and 1975 found that 41% of them had been arrested.

According to the study, “patients who entered the hospital without a criminal record were subsequently arrested about three times as often as the average citizen.” Significantly, the majority of these patients had received no aftercare following their hospital discharge.

By this time, police in other states were also beginning to feel the burden of the discharged, but often untreated, mentally ill individuals.

In suburban Philadelphia, for example, “mental-illness-related incidents increased 227.6% from 1975 to 1979, whereas felonies increased only 5.6%.”Of all the omens of deinstitutionalization’s failure on exhibit in 1970s California, the most frightening were homicides and other episodes of violence committed by mentally ill individuals who were not being treated.1970: John Frazier, responding to the voice of God, killed a prominent surgeon and his wife, two young sons, and secretary. Frazier’s mother and wife had sought unsuccessfully to have him hospitalized. 1972: Herbert Mullin, responding to auditory hallucinations, killed 13 people over 3 months. He had been hospitalized three times but released without further treatment. 1973: Charles Soper killed his wife, three children, and himself 2 weeks after having been discharged from a state hospital.

1973: Edmund Kemper killed his mother and her friend and was charged with killing six others. Eight years earlier, he had killed his grandparents because “he tired of their company,” but at age 21 years had been released from the state hospital without further treatment.

1977: Edward Allaway, believing that people were trying to hurt him, killed seven people at Cal State Fullerton. Five years earlier, he had been hospitalized for paranoid schizophrenia but released without further treatment. Such homicides were widely publicized. Many people perceived the tragedies as being linked to California’s efforts to shut its state hospitals and to the new LPS law, which made involuntary treatment virtually impossible.

The foreman of the jury that convicted Herbert Mullin of the murders for which he was charged reflected the sentiments of many when he publicly stated: I hold the state executive and state legislative offices as responsible for these ten lives as I do the defendant himself—none of this need ever have happened.... In recent years, mental hospitals all over this state have been closed down in an economy move by the Reagan administration.

Where do you think these . . . patients went after their release? . . . The closing of our mental hospitals is, in my opinion, insanity itself.

In response to queries about the homicides, the California Department of Mental Health had its deputy director, Dr. Andrew Robertson, testify before a state legislative inquiry in 1973. His testimony must rank among the all-time least successful attempts by a public official to reassure the public: It [LPS] has exposed us as a society to some dangerous people; no need to argue about that.

People whom we have released have gone out and killed other people, maimed other people, destroyed property; they have done many things of an evil nature without their ability to stop and many of them have immediately thereafter killed themselves.

That sounds bad, but let’s qualify it. . . . the odds are still in society’s favor, even if it doesn’t make patients innocent or the guy who is hurt or killed feel any better.1980s: THE PROBLEMS BECOME NATIONALUntil the 1980s, most people in the United States were unaware that the deinstitutionalization of patients from state mental hospitals was going terribly wrong. Some were aware that homicides and other untoward things were happening in California, but such things were to be expected, because it was, after all, California.

President Carter’s Commission on Mental Health issued its 1978 report and recommended doing more of the same things—more CMHCs, more prevention of mental illness, and more federal spending.

The report gave no indication of a pending crisis. The majority of patients who had been discharged from state hospitals in the 1960s and 1970s had gone to their own homes, nursing homes, or board-and-care homes; they were, therefore, out of sight and out of mind. In the 1980s, this all changed. Deinstitutionalization became, for the first time, a topic of national concern.

The beginning of the discussion was heralded by a 1981 editorial in the New York Times that labeled deinstitutionalization “a cruel embarrassment, a reform gone terribly wrong.” Three years later, the paper added: “The policy that led to the release of most of the nation’s mentally ill patients from the hospital to the community is now widely regarded as a major failure.” During the following decade, there were increasing concerns publicly expressed about mentally ill individuals in nursing homes, board-and-care homes, and jails and prisons.

There were also periodic headlines announcing additional high-profile homicides committed by individuals who were clearly psychotic.

But the one issue that took center stage in the 1980s, and directed public attention to deinstitutionalization, was the problem of mentally ill homeless persons.

During the 1980s, an additional 40,000 beds in state mental hospitals were shut down. The patients being sent to community facilities were no longer those who were moderately well-functioning or elderly; rather, they included the more difficult, chronic patients from the hospitals’ back wards.

These patients were often younger than patients previously discharged, less likely to respond to medication, and less likely to be aware of their need for medication. In 1988 the National Institute of Mental Health (NIMH) issued estimates of where patients with chronic mental illness were living.

Approximately 120,000 were said to be still hospitalized; 381,000 were in nursing homes; between 175,000 and 300,000 were living in board-and-care homes; and between 125,000 and 300,000 were thought to be homeless. These broad estimates for those living in board-and-care homes and on the streets suggested that neither NIMH nor anyone else really knew how many there were.

Abuse of mentally ill persons in nursing homes had originally come to public attention during 1974 hearings of the Senate Committee on Aging. Those hearings had described nursing homes actually bidding on patients in attempts to get those who were most easily managed; bounties of $100 paid by nursing homes to hospital psychiatrists for every patient sent to them; and exorbitant profits for the nursing homes.

As a consequence of such hearings and a 1986 study of nursing homes by the Institute of Medicine, Congress passed legislation in 1987 requiring all Medicaid-funded nursing homes to screen new admissions to keep out patients who did not qualify for admission because they did not require skilled nursing care. Follow-up studies indicated that the screening mandate had little effect on admission policies or abuses.

Abuse of mentally ill persons in board-and-care homes also periodically surfaced at this time:1982: “Nine ragged, emaciated adults” were found in an unlicensed home for mentally ill individuals in Jackson, Mississippi.

They were living in a 10-by-10 foot building with “no toilet or running water, only a plastic bucket to collect body wastes. A hose and faucet outside the building were used for washing. There were two mattresses on the concrete floor and a single cot in the room.” There were also “two vicious dogs chained outside the room.” 1984: Seven “former patients” died in a fire in a “rooming house” in Worcester, Massachusetts.

“The report released this week said officials of Worcester State Hospital who referred the former patients to the rooming house had been warned by community health workers that the privately owned house was not safe.”Sociologist Andrew Scull in 1981 summarized the economics of the board-and-care industry: “The logic of the marketplace suffices to ensure that the operators have every incentive to warehouse their charges as cheaply as possible, since the volume of profit is inversely proportional to the amount expended on the inmates.” In addition, because many board-and-care homes were in crime-ridden neighborhoods, mentally ill individuals living in them were often victimized when they went outside.

A 1984 study of 278 patients living in board-and-care homes in Los Angeles reported that one-third “reported being robbed and/or assaulted during the preceding year.”The problems of mentally ill individuals in nursing homes and board-and-care homes rarely elicited media attention in the 1980s. By contrast, the problem of homeless persons, including the mentally ill homeless, became a major story. In Washington, Mitch Snyder and the National Coalition for the Homeless burst onto the national scene by staging hunger strikes and sleep-ins on sidewalk grates.

Their message was that homeless persons are just like you and me and all they need is a house and a job. Snyder challenged President Reagan, accusing him of being the main cause of homelessness, and the media extensively covered the controversy.

By the time Snyder committed suicide in 1990, homelessness had become a major topic of national discussion. Despite the claims of homeless advocates, media attention directed to homeless persons made it increasingly clear that many of them were, in fact, seriously mentally ill.

In 1981, Life magazine ran a story titled “Emptying the Madhouse: The Mentally Ill Have Become Our Cities’ Lost Souls.” In 1982, Rebecca Smith froze to death in a cardboard box on the streets of New York; the media focused on her death because it was said that she had been valedictorian of her college class before becoming mentally ill.

In 1983, the media covered the story of Lionel Aldridge, the former all-pro linebacker for the Green Bay Packers; after developing schizophrenia, he had been homeless for several years on the streets of Milwaukee.

In 1984, a study from Boston reported that 38% of homeless persons in Boston were seriously mentally ill. The report was titled “Is Homelessness a Mental Health Problem?” and confirmed what people were increasingly beginning to suspect—that many homeless persons had previously been patients in the state mental hospitals.

By the mid-1980s, a consensus had emerged that the total number of homeless persons was increasing. The possible reasons for this increase became a political football, but the failure of the mental health system was one option widely discussed.

A 1985 report from Los Angeles estimated that 30% to 50% of homeless persons were seriously mentally ill and were being seen in “ever increasing numbers.” The study concluded that this was “in part the product of the deinstitutionalization movement....

The ‘Streets’ have become ‘The Asylums’ of the 80s.”The appearance of Joyce Brown on the streets of New York in 1986 added a new dimension to the national dialogue.

Prior to taking up residence on a steam grate at the corner of East 65th Street and Second Avenue, Brown had worked for 10 years as a secretary.

She had then become mentally ill, was hospitalized, and discharged. While living on the street, Brown was observed urinating on the sidewalk, defecating in the gutter, tearing up money given to her by passersby, and running into traffic. New York mayor Ed Koch ordered her to be involuntarily hospitalized, well aware that the Civil Liberties Union’s lawyers would contest the case. Koch’s statement reflected the sentiments of many: “If the crazies want to sue me, they have every right to sue, and by crazies I’m .

. . talking about those who say, ‘No, you have no right to intervene to help.’ ” The civil liberty lawyers prevailed, and the civil right to be both psychotic and homeless thus added another legal wrinkle to the ongoing homeless debate.

By the end of the 1980s, the origins of the increasing number of mentally ill homeless persons had become abundantly clear. A study of 187 patients discharged from Metropolitan State Hospital in Massachusetts reported that 27% had become homeless.

A study of 132 patients discharged from Columbus State Hospital in Ohio reported that 36% had become homeless.

In 1989, when a San Francisco television station wished to advertise its series on homelessness, it put up posters around the city saying, “You are now walking though America’s newest mental institution.” Psychiatrist Richard Lamb added: “Probably nothing more graphically illustrates the problems of deinstitutionalization than the shameful and incredible phenomenon of the homeless mentally ill.”* * *At the same time that mentally ill homeless persons were becoming an object of national concern during the 1980s, the number of mentally ill persons in jails and prisons was also increasing.

A 1989 review of available studies concluded that “the prevalence rates for major psychiatric disorders . . . [in jails and prisons] have increased slowly and gradually in the last 20 years and will probably continue to increase.” Various studies reported rates ranging from 6% (Virginia) and 8% (New York) to 10% (Oklahoma and California) and 11% (Michigan and Pennsylvania).

By 1990, a national survey concluded: Given all the data, it seems reasonable to conclude that approximately 10 percent of inmates in prisons and jails, or approximately 100,000 individuals, suffer from schizophrenia or manic-depressive psychosis [bipolar disorder].

This 10% estimate contrasted with the 5% prevalence rate that had been widely cited a decade earlier. Amid the various studies, disturbing trends were evident. Among 132 patients discharged from Columbus State Hospital in Ohio, 17% were arrested within 6 months.

In California, seriously mentally ill individuals with a history of past violence, including armed robbery and murder, were being discharged from mental hospitals without any planned aftercare.

In Colorado in 1984, George Wooton, diagnosed with schizophrenia, was booked into the Denver County Jail for the hundredth time; he would be the first prominent member of a group that would become widely known as “frequent flyers.” In several states the bizarre behavior of mentally ill inmates was also becoming problematic for jail personnel; in Montana a man “tried to drown himself in the jail toilet,” and in California inmates tried to escape “by smearing themselves with their own feces and flushing themselves down the toilet.” To make matters worse, civil liberties lawyers frequently defended the rights of mentally ill prisoners to refuse medication and remain psychotic.

At a 1985 commitment hearing in Wisconsin, for example, a public defender argued that his jailed mentally ill client, who had been observed eating his feces, “was in no imminent danger of physical injury or dying” and should therefore be released; the judge agreed. As more and more mentally ill individuals entered the criminal justice system in the 1980s, local police and sheriffs’ departments were increasingly affected. In New York City, calls associated with “emotionally disturbed persons,” referred to as “EDPs,” increased from 20,843 in 1980 to 46,845 in 1988, and “experts say similar increases have occurred in other large cities.” Many such calls required major deployments of police resources.

The rescue of a mentally ill man from the top of a tower on Staten Island, for example, “required at least 20 police officers and supervisors, half a dozen emergency vehicles, several highway units and a helicopter.” In an attempt to deal with these psychiatric emergencies, the police department in Memphis, Tennessee, in 1988 created the first specially trained police Crisis Intervention Team, or CIT, as it would become known as it was replicated in other cities.

* * *Finally, the 1980s witnessed increasing episodes of violence, including homicides, committed by mentally ill individuals who were not receiving treatment. The decade began ominously with three high-profile shootings between March 1980 and March 1981. Former congressman Allard Lowenstein was killed by Dennis Sweeney, John Lennon was killed by Mark David Chapman, and President Ronald Reagan was shot by John Hinckley. All three perpetrators had untreated schizophrenia. Sweeney, for example, believed that Lowenstein, his former mentor, had implanted a transmitter in his teeth through which he was sending harassing voices.

As the decade progressed, such widely publicized homicides became more common:1985: Sylvia Seegrist, diagnosed with schizophrenia and with 12 past hospitalizations, killed three and wounded seven in a Pennsylvania shopping mall. Bryan Stanley, diagnosed with schizophrenia and with seven past hospitalizations, killed a priest and two others in a Wisconsin Catholic church.

Lois Lang, diagnosed with schizophrenia and discharged from a mental hospital 3 months earlier, killed the chairman of a foreign exchange firm and his receptionist in New York.

1986: Juan Gonzalez, diagnosed with schizophrenia and psychiatrically evaluated 4 days earlier, killed two and injured nine others with a sword on New York’s Staten Island Ferry. 1987: David Hassan, discharged 2 days earlier from a mental hospital, killed four people by running them over with his car in California.

1988: Laurie Dann, who was known to both the police and FBI because of her threatening and psychotic behavior, killed a boy and injured five of his classmates in an Illinois elementary school. Dorothy Montalvo, diagnosed with schizophrenia, was accused of murdering at least seven elderly individuals and burying them in her backyard in California.

Aaron Lindh, known to be mentally ill and threatening, killed the Dane County coroner in Madison, Wisconsin. This was one of six incidents in that county during 1988 “involving mentally ill individuals . . .

[that] resulted in four homicides, three suicides, seven victims wounded by gunshots, and one victim mauled by a polar bear” when a mentally ill man climbed into its pen at the local zoo.

1989: Joseph Wesbecker, diagnosed with bipolar disorder, killed 7 and wounded 13 at a printing plant in Kentucky. Another indication that such episodes of violence were increasing was a study that compared admissions to a New York state psychiatric hospital in 1975 and 1982.

It reported that “the percentage of patients who had committed violence toward persons while living in the community in the 1982 cohort was nearly double the percentage in the 1975 cohort.” In addition, “the percentage of patients who had had encounters with the criminal justice system in the 1982 cohort was more than quadruple the percentage in the 1975 cohort.”Is there any way to estimate the frequency of these episodes of violence committed by mentally ill person who were not being treated?

There was then, and continues to be, no national database that tracks homicides committed by mentally ill persons.

However, a small study published in 1988 provided a clue. In Contra Costa County, California, all 71 homicides committed between 1978 and 1980 were examined. Seven of the 71 homicides were found to have been done by individuals with schizophrenia, all of whom had been previously hospitalized at some point before the crime. The 10% rate was also consistent with the findings of another small study in Albany County, New York. Therefore, by the late 1980s, it appeared that violent acts committed by untreated mentally ill persons was one of the consequences of the deinstitutionalization movement, and the problem appeared to be a growing one. Excerpted from ""American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System"" by E. Fuller Torrey with permission from Oxford University Press USA. Copyright 2014 E. Fuller Torrey. Return To Home Page MORE INBooks California Editor's Picks Health Care Ronald Reagan Dr. E. Fuller Torrey More from Dr. E. Fuller Torrey "

This means that you can commit someone to treatment against their will if you reference the Baker Act, as your loved one is displaying symptoms that can lead others to believe that he or she is mentally ill due to their substance abuse.

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How to Commit Someone to Treatment Against Their Will08/12/2013 Posted by Living Sober Addiction is never an easy issue to handle, and it can get much worse when you have to witness a loved one suffer as a result. It is likely that you have tried a number of different things to help you addicted loved one, from stopping any and all support to holding a surprise intervention.

If nothing has worked, it is understandable that you are at the end of your rope. You might begin thinking of how to commit someone to treatment against their will, as it is one of your last ditch efforts to provide your loved one with help.

However, you need to learn about how to commit someone to treatment against their will, as there can be a number of roadblocks that can prevent you from doing so. How To Commit Someone to Treatment Against Their Will You are likely going to run into some dead ends as you begin learning how to commit someone to treatment against their will.

Some of the most common issues you will likely face include:• Age restrictions – If your loved one is 18 years or older, most states will not allow you to commit someone to treatment against their will primarily because it violates civil rights.

• Lack of resources – How to commit someone to treatment against their will can become even more complicated because there are not as many resources readily available to help an individual who is involuntarily committed.

Despite restrictions on age as well as limited resources, there are a few things can provide you with promise when learning how to commit someone to treatment against their will. These rays of hope can include the following:• Baker acting them – The Baker Act is defined as providing individuals with emergency services and temporary detention for mental health evaluation and treatment when requires, either on a voluntary or involuntary basis.

This can only happen, however, if the loved one is unable to decide if this type of treatment is right for them. • Enforcing treatment – When you are deciding on how to commit someone to treatment against their will, the Baker Act might not always be appropriate, especially if your loved one is under 18.

In this case, you can bring a minor to a treatment facility to be committed if he or she is not of age to decide for himself or herself.

How to commit someone to treatment against their will can be a defeating subject to learn about, however there are silver linings. These include the Baker Act as well as being able to commit someone if they are under age. If you are struggling with deciding on how to commit someone to rehab against their will, you can contact your loved one’s doctor, therapist or even the state to learn more about your options.

Start Your Journey to Recovery with Northbound (866) 311-0003Share Post Facebook Twitter Pinterest NEXT POSTHow to Prepare a Loved One Prior to Attending Drug and Alcohol Treatment Centers Orange County, CARead More

d To say that an individual has been subject to involuntary commitment means that they have been court ordered into treatment for a mental health problem. Before the individual is committed they may be first put into a psychiatric institution for assessment – this can last for as long as 72 hours.

Involuntary Commitment for Addiction

Home > Educate Yourself with Articles on Addiction > Involuntary Commitment for Addiction Involuntary Commitment for Addiction Helplessness and Addiction Watching a loved one self destruct is one of the hardest things that any human has to face.

This is what happens when one individual falls into the hell of addiction – they will usually take their family with them. Those people around the addict may feel completely powerless to resolve the situation. The addict denies they have a problem and refuse to consider any suggestions that they get help. The family then have to choice of watching this person slowly kill themselves or they can try to disengage.

They may even consider the possibility of having this loved one committed to treatment against their will. This drastic step will appear appealing when there appears to be no other option to save the addict. Involuntary Commitment Define

Involuntary commitment is usually only used as a last resort for addicts when they appear to be putting their own life in imminent danger or they are a risk to other people. Autonomy and Involuntary Commitment Autonomy is an ethical principle that most humans feel strongly about – particularly in western countries.

It can be defined as a state of being self governed. In practice it means that the individual is given the right to manage their own affairs according to their own motives and affairs. Autonomy is particularly important in regards to any type of medical procedure. It is now expected that the individual needs to give their informed consent before commencing any type of medical treatment.

Even taking a person’s blood pressure measurement could be considered assault if the person has not given their permission – in practice consent is often implied. The importance of the individual’s autonomy runs counter to the idea of involuntary commitment. In previous centuries there was far less concern about the individual’s personal autonomy and anyone could be committed to an asylum on the say so o their family or a medical professional.

In modern times interfering with a person’s autonomy is a step that is not taken lightly. This is why taking away a person’s autonomy only occurs if it is felt that the individual is incapable of making rational decisions, and they are a real danger to themselves or other people.

The goal of involuntary commitment is to protect the individual and society. As soon as they are well enough to make rational choices their personal autonomy will be restored.

Involuntary Commitment for Addiction It was once quite common for those trapped in addiction to be committed involuntarily for treatment. Relatives could alert the family physician about what was happening, and this professional would arrange for the commitment to hospital.

This happens far less these days because of a number of factors. Since the 1960s there has been a growing concern for civil liberties. It became obvious that people were being committed to psychiatric units far too easily – sometimes just on the say so of a relative. The fear of infringing on civil liberties means that that the professionals these days are far less willing to get involved with this type of action.

A legal case involving Addington v. Texas led to changes in the interpretation of the law. The burden of proof now needs to be far higher before it is reasonable to interfere with the individual’s autonomy.

Another reason for why enforced addiction treatment is rare is a lack of funding. There are just not enough financial resources available to manage all the requests for involuntary commitment.

Reasons for Committing an Individual for Addiction Treatment There are a number of reasons for why involuntary commitment might seem like a good idea:* Family members have tried every other option, and they feel powerless to help their loved one who is in decline.

They may seek involuntary commitment because they feel there is no other option. * The extent of the substance abuse means that the individual is putting their own life in danger. * The addict is a danger to themselves or other people when they are intoxicated. Some people can get completely out of control when they are under the influence.

* The substance abuse is exacerbating another mental health problem, and this is putting that person (or those around them) in danger. US Laws for Involuntary Commitment The laws for involuntary commitment vary between states in the US.

In 1975 the Supreme Court ruled that involuntary hospitalization or treatment violates the individual’s civil liberties. This violation can only be justified in extreme conditions – usually because a person has become a danger to themselves or other people. It is considered unconstitutional to keep a person in hospital against their will if they are not an imminent threat to themselves or others.

Different states will interrupt laws concerning involuntary commitment differently, but the individual will usually continue to have certain rights even after they have been hospitalized against their will.

For example, in Florida the person who has been committed will have the right to contact people outside and to have their case reviewed every six months. Alternatives to Involuntary Commitment It can be terribly frustrating to watch a loved one slowly kill themselves with alcohol or drugs.

It may not be possible to have that person committed, but there are still things that can be done including:* An addiction therapist is trained to help addicts develop the motivation to quit.

This professional can help the individual see beyond their denial into the reality of their situation. * The substance abuser is likely to have times when they are more open to the idea of addiction help. This can be at times after they have behaved particularly badly or when they are feeling ill because of the substance abuse.

* The most common reason for why people are able to walk away from addiction is that they have hit rock bottom.

It is not necessary for the individual to lose everything before they reach this point. * It is common for relatives to try to protect the individual from the worst consequences of their behavior. This might not be such a good idea because it may be enabling the addict and preventing them from hitting rock bottom. * The addict may resist any direct suggestions that they get help for their addiction. It can be a better idea to leave recovery literature lying around the home. * Groups such as Al-anon and Alateen can help family members cope with the behavior of the addict. They will also be able to get advice and support in dealing with the situation. (Visited 14,069 times, 31 visits today)

When a patient has a serious psychiatric disorder or mental health problem, he may be admitted to a mental hospital, also referred to as a psychiatric facility, for evaluation and treatment.

Role of a Clinical Psychologist in a Mental Hospital

Related Articles1The Average Salary of Clinical Psychologist Work in a Hospital Setting2The Role of Clinical Psychologists & Psychiatrists3What Does a Clinical Psychologist Do?4Role of Psychiatric Nursing

Psychiatric facilities are staffed by a wide range of multidisciplinary mental health professionals, including psychiatrists, psychiatric nurse practitioners, social workers and clinical psychologists. Clinical psychologists play important roles in helping patients recover and, in many cases, return to their everyday lives. Assessment Psychiatric facilities usually have different wards or departments divided by area of specialization.

For example, there may be special units for eating disorders, schizophrenia, acute care and geriatrics. In most cases, people who are admitted to mental hospitals are usually in some type of severe psychiatric distress. They may be in danger of harming themselves or others, experiencing severe depression or anxiety or suffering from hallucinations or delusions.

When such patients are first admitted to psychiatric facilities, they undergo comprehensive assessments and evaluations by members of the multidisciplinary team. Clinical psychologists are involved in the assessment process by helping formulate diagnoses and providing psychological evaluations. Psychological Testing Psychologists are uniquely qualified to administer a variety of psychological tests. Psychological tests are designed to measure variables such as intelligence or the presence and extent of disorders like depression or anxiety.

In a general psychiatric facility, clinical psychologists may administer these tests to assist in the diagnostic process. Some clinical psychologists work in children's psychiatric facilities, in which case they may administer tests to evaluate for the presence of childhood learning, behavioral or emotional disorders.

Treatment In many cases, patients in psychiatric facilities receive a combination of treatments, including psychiatric medication, family and group therapy, individual psychotherapy and psychoeducation, such as instruction in stress reduction and relaxation. Clinical psychologists often play an important role in the treatment process. They may provide psychotherapy, discuss a patient's progress in treatment with other providers or with family members, teach coping skills and educate patients and family members about specific mental health disorders or illnesses.

Consultancy Clinical psychologists also often act as consultants within psychiatric facilities. They might consult with other professionals to educate them about psychological treatments or encourage the use of specific psychological interventions, when appropriate.

For example, a clinical psychologist might consult with a psychiatrist to determine whether psychotherapy could be useful in a patient's treatment, or whether a patient might benefit from psychoeducational techniques. They also participate in multidisciplinary team meetings and help other professionals understand the psychological aspects to treatment.

References (3)About the Author Ashley Miller is a licensed social worker, psychotherapist, certified Reiki practitioner, yoga enthusiast and aromatherapist. She has also worked as an employee assistance program counselor and a substance-abuse professional. Miller holds a Master of Social Work and has extensive training in mental health diagnosis, as well as child and adolescent psychotherapy. She also has a bachelor's degree in music. Photo Credits Hemera Technologies/Photo Objects.net/Getty Images Cite this Article

Conservatorship is a legal term referring to the legal responsibilities of a conservator over the affairs of a person who has been deemed gravely disabled by the court and unable to meet his or her basic needs of food, clothing, and shelter.

Conservatorship

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(November 2010)Conservatorship is a legal concept in the United States. A guardian or a protector is appointed by a judge to manage the financial affairs and/or daily life of another due to physical or mental limitations, or old age. [1] A person under conservatorship is a ""conservatee,"" a term that can refer to an adult. A person under guardianship is a ""ward,"" a term that can also refer to a minor child. The conservator may be only of the ""estate"" (financial affairs), but may be also of the ""person,"" wherein the conservator takes charge of overseeing the daily activities, such as health care or living arrangements of the conservatee.

A conservator of the person is more typically called a legal guardian. [2]Contents [ hide ]1 Appointment2 Conservatorship of persons2.1 Limited conservatorship2.1.1 California3 Conservatorship of organizations4 See also5 References6 Further reading7 External links Appointment [ edit]Conservatorship is established either by court order (with regard to individuals) or via a statutory or regulatory authority (with regard to organizations such as business entities). In other legal terms, a conservatorship may refer to the legal responsibilities over a person who is mentally disordered, including individuals who are psychotic, suicidal, demented, incapacitated, or in some other way unable to make legal, medical or financial decisions on behalf of themselves.

[3]When referring to government control of private corporations such as Freddie Mac or Fannie Mae, conservatorship implies a more temporary control than does nationalization. Conservatorship of persons [ edit]

They are governed by the state's individual laws. Terminology varies, and some states or jurisdictions may refer to a conservator as a guardian of the estate or as a trustee. Conservatorships are generally put in place for severely mentally ill individuals who are gravely disabled, elderly individuals with dementia or Alzheimer's disease who lack mental capacity, or individuals with developmental disabilities who may or may not lack mental capacity.

Mental capacity normally must to be evaluated by a medical physician or a psychiatrist experienced in the field and is documented and provided to the court as evidence. [1]In the state of California there are two types of conservatorships: Lanterman–Petris–Short ( Lanterman–Petris–Short Act of 1967, referred to as LPS) and Probate conservatorships. These forms of conservatorship are governed by the California Probate Code, and Welfare and Institutions Codes. [4]Limited conservatorship [ edit]A ""limited conservatorship"" usually refers to the limited legal responsibilities of a conservator over the affairs of an individual who is developmentally disabled, but still capable of making important decisions for himself or herself.

[5] In these cases, the conservatee to whom the limited conservatorship applies can retain more control over his or her personal affairs than other conservatees can; for example, he or she may retain his or her right to decide where he or she may live.

An example of a conservator's duties includes: locating and marshalling assets, such as property and money, which belong to the conservatee; using the assets to buy food for the conservatee, secure and pay for placement in a facility which would take care of the conservatee or treat a mental illness, pay bills for the conservatee, manage property by paying for property insurance, mortgage payments or rent, property clean-up, or pay for a property management company to rent the property.

An example of a conservator or guardian's medical responsibilities would be the court granting medical authority to the conservator or guardian, and the conservator or guardian authorizing a physician to place a feeding tube to provide nourishment into the protected person's stomach if they are in medical need of it.

It is not uncommon for one person to hold both offices and be referred to as the ""guardian and conservator"" of the conservatee, even though a conservator or guardian can be appointed over the person only, the estate only, or both.

Generally, a conservator or guardian over the estate is only appointed if the conservatee has assets that need to be protected, marshalled, and managed. These terms may be found in use in U. P. C. jurisdictions, even though the U. P. C. uses the term ""protected person"" in either case.

In most states, an outside party or agency must review the facts of the case and submit a report, usually required to be in writing, to the court before the court makes a decision on the request to establish a conservatorship or guardianship.

Usually the outside party is a local County Mental Health representative called an investigator. They are often required to be experts in some appropriate field, such as social work, mental health, a medical field, or law.

Procedures for conservatorship of an adult are often different from those for minors. The court may appoint an attorney to represent the proposed conservatee or ward. If the proposed conservatee or ward is unable to have an attorney-client relationship because of some impairment, the court may appoint a guardian-ad-litem (who is often also an attorney).

A guardian-ad-litem does not take instruction from the client, but rather acts on their behalf and tells the court what they think is in the best interests of the proposed conservatee or ward, whether or not that is what the proposed conservatee or ward wants. The conservatee has the right to be represented by an attorney, and if they cannot afford a private attorney, they are appointed a public defender that will represent them free of cost.

California [ edit]LPS conservatorships begin with a temporary 30-day conservatorship, and if the conservatee remains gravely disabled, the conservator is reappointed for a year; the LPS conservatorship can be renewed annually, or terminated if no longer needed. Probate conservatorships are referred to as ""general conservatorships"", and typically do not have a temporary period unless an urgent emergency exists that is creating risk to the person or their estate.

Probate conservatorship do not automatically expire as LPS conservatorships do if they are not renewed by the conservator. In an LPS conservatorship, a court-appointed conservator over the person is responsible for managing the conservatee's placement, medical decisions, and mental health treatment. A conservator over the estate is responsible for marshalling, protecting, and managing the conservatee's assets that remain in their estate.

A conservator reports to the court that appointed them, and is monitored by the supervising judicial court in the county in which the conservatee permanently resides. LPS conservatorships usually begin in the County Mental Health system and are referred from acute psychiatric hospitals, where Probate conservatorships can result from any referral source if validated with property medical documentation.

Mental Health consumers have the right to a Patient's Rights advocate, and are taken through a series of hearings while they are in the acute hospital before they reach the point of needing a conservator.

Conservatorship of organizations [ edit]This section needs attention from an expert in Business or Law. Please add a reason or a talk parameter to this template to explain the issue with the section. Wiki Project Business or Wiki Project Law may be able to help recruit an expert.

(February 2009)In the United States, in some states, corporations can be placed under conservatorship, as a less extreme alternative to receivership. Whereas a receiver is expected to terminate the rights of shareholders and managers, a conservator is expected merely to assume those rights, with the prospect that they will be relinquished.

[6] Robert Ramsey & John Head, law professors who specialize in financial issues, suggest that an insolvent bank should go into receivership rather than conservatorship to guard against false hope and moral hazard. [7]At the federal government level in the United States, in July 2008, the failing Indy Mac Bank was taken into administrative receivership by the Federal Deposit Insurance Corporation (FDIC) and its assets and secured liabilities transferred to a specially established bridge bank called Indy Mac Federal Bank, FSB which was placed into conservatorship, also by the FDIC.

Again, in the U. S. at the federal level, in September 2008, the chief executive officers, and board of directors Fannie Mae and Freddie Mac were dismissed, and the companies were placed into the conservatorship of the Federal Housing Finance Agency (FHFA) via the determination of its director James B. Lockhart III, with the support and financial backing of U. S. Treasury via Treasury secretary Hank Paulson 's commitment to keep the corporations solvent.

[8] The intervention leading to the conservatorship of these two entities has become the largest in government history, and was justified as necessary step to prevent the damage to the financial system that would have been caused by their failure.

Entities like this are considered too big to fail. [9] [10] [11] [12]An even more ambitious use of the conservatorship model has been proposed by Duke professors Lawrence Baxter, Bill Brown and Jim Cox. They suggest that the troubled U. S. banks be placed in conservatorship, that some of their ""good assets"" be dropped into newly created ""good bank"" subsidiaries (presumably under new management), and the remaining ""bad assets"" be left to be managed under the supervision of a conservatorship structure.

[3]See also [ edit]Legal guardian Receivership Custodial account References [ edit]^ a b Larson, Aaron (20 August 2016). ""What is a Conservatorship"". Expert Law.com. Retrieved 20 December 2017.^ ""Lawbytes"". Southeast Tennessee Legal Services.

Retrieved 20 December 2017.^ a b Baxter, Lawrence; Brown, Bill; Cox, Jim (February 27, 2009). ""Finally, A Bridge to Somewhere"". Huffington Post.^ ""How are Lanterman-Petris-Short (LPS) and Probate conservatorships different?"". Superior Court of California, County of Los Angeles. Retrieved 20 December 2017.^ ""Limited Conservatorship"". Superior Court of California, County of Alameda. Retrieved 20 December 2017.^ Ramsey, Robert Lee; John W. Head (2000). Preventing Financial Chaos: An International Guide to Legal Rules and Operating Procedures for Handling Insolvent Banks.

Kluwer. p. 32. ISBN 90-411-8848-7.^ Ramsey & Head (2000), p.37^ Soloman, Deborah; Reddy, Sudeep; Craig, Susanne (September 8, 2008). ""MOUNTING Woes Left Officials With Little Room to Maneuver"". The Wall Street Journal. pp. A1.^ Paulson, Henry M., Jr. (2008-09-07).

""Statement by Secretary Henry M. Paulson, Jr. on Treasury and Federal Housing Finance Agency Action to Protect Financial Markets and Taxpayers"" (Press release). United States Department of the Treasury. Archived from the original on 2008-09-09. Retrieved 2008-09-07.^ Lockhart, James B., III (2008-09-07). ""Statement of FHFA Director James B. Lockhart"". Federal Housing Finance Agency. Archived from the original on 2008-09-12.

Retrieved 2008-09-07.^ ""Fact Sheet: Questions and Answers on Conservatorship"" (PDF). Federal Housing Finance Agency. 2008-09-07. Archived from the original (PDF) on September 9, 2008. Retrieved 2008-09-07.^ Goldfarb, Zachary A.; David Cho; Binyamin Appelbaum (2008-09-07). ""Treasury to Rescue Fannie and Freddie: Regulators Seek to Keep Firms' Troubles From Setting Off Wave of Bank Failures"". The Washington Post. pp. A01. Retrieved 2008-09-07. Further reading [ edit]Goldoftas, Lisa; Hendrickson, Elizabeth A. (2002). The Conservatorship Book for California (4th ed.). Berkeley, CA: Nolo Press. ISBN 978-0873377959. OCLC 48892898. External links [ edit]Montana Code Annotated 72-1-103 (8) (2005) Example state law Authority control GND: 4266058-0 NDL: 00933057 "

What is the Florida Baker Act? The Florida Baker Act is actually the Florida Mental Health Act of 1971. The Florida Baker Act allows for involuntary examination or what some know it as, involuntary commitment. The Florida Baker Act can be initiated by judges, law enforcement, physicians or mental health professionals.

What is the Florida Baker Act?

What is the Florida Baker Act? By: Admin | Published on: 14th March, 2013.

In order for an individual to have the Florida Baker Act initiated on them there must be proof that the person has a mental illness or is a danger to themselves, a danger to others or is self-neglectful.

The Florida Baker Act was name after Maxine Baker, who was a State representative from Miami who sponsored the Act, while serving as chairperson of the House Committee on Mental Health. The Florida Baker should only be used in situation where a person has a mental illness and meets the criteria for voluntary and involuntary admission. What are the criteria for a voluntary admission under the Florida Baker Act? The Florida Baker Act actually encourages voluntary admission for people who need psychiatric care.

The criteria for a voluntary admission under the Florida Baker Act are that the individual seeking treatment must be 18 years old or older. If the individual is not over 18 then the individual can be admitted but only after having a hearing to verify the voluntariness of the consent.

Each person entering a facility, regardless of age, must be asked to give express and informed consent for admission and treatment.

If the person is a minor, express and informed consent for admission and treatment must also be requested from the person’s guardian. Once voluntary admission has been admitted they must stay in the facility for 72 hours. Most Florida Baker acts are involuntary.

The criteria for an involuntary admission under the Florida Baker Act are: They refused voluntary placement or they are unable to know if placement is necessary They are incapable of surviving on their own without the help of others and without treatment is most likely going to suffer from neglect which poses a real threat of harm to their being or someone else There is a high change that they will inflict bodily harm on themselves or someone else as seen by their recent behavior causing, attempting, or threatening such harm All other available less restricting treatment which would give them the opportunity for improvement have been judged inappropriate for them.

If someone is being involuntarily committed under the Florida Baker Act they must go through an initial examination. The examination must include a review of the person’s recent behavior, a review of the document initiating the Florida Baker Act, a brief psychiatric history and a face-to-face examination of the person.

The person after being committed under the Florida Baker Act cannot leave the facility they are in until documented approval of a psychiatrist, clinical psychologist, or physician.

A person cannot be held against their will or involuntarily for longer than 72 hours under the Florida Baker Act. The person must be given opportunity to let others know about their whereabouts too. After 72 hours has passed under the Florida Baker Act an individual must be released unless they have been charged with a crime.

IF they haven’t been charged with a crime, The Florida Baker Act states that an individual can choose to remain in treatment voluntarily from that point forward.

The law also allows for the petition for a longer involuntary placement that must be filed with the circuit courts within the 72 hour holding period. What is the Marchman Act? If your loved one is in need of addiction treatment, please give us a call at 800-951-6135Sources: http://www.smabehavioral.org/Bakerand Marchman Acts Page.html Categories: Addiction, Florida Baker Act, Mental Health | Tags: Baker Act, baker act and addiction, baker act law, Baker Acted, Florida Baker Act, florida baker act law, Mental Health Services, What is the Florida Baker Act.

If the psychiatrist believes this person to have a mental illness and to be in danger of imminent harm, the psychiatrist and another person fill out a certification of the need for involuntary commitment, which is also signed by a Justice of the Peace. This constitutes the initial involuntary commitment.

"Involuntary Commitment Alicia Curtis Bad Subjects, Issue # 58 , December 2001For those of us who work in the mental health system, and for those who live with a mental illness, our work and our lives intersect with the legal system around a complex and delicate decision.

In certain situations, people with a mental illness can be made to go into a psychiatric hospital or institution against their will. This process is called an involuntary commitment and every state has a law for it, although those laws are not well known.

In the state of Maine, where I live and work, this law means that if a person has a mental illness, and if they are in imminent danger of harming themselves or someone else, they can be put into a psychiatric hospital against their will. The police can initiate this process. They have the authority to take individuals into police custody if they have reason to believe the person has a mental illness and is at risk of substantial harm. Once the person is in custody, the police can then take them to the hospital for evaluation by a psychiatrist.

The slang term for the certification process that is used by both workers and patients in the mental health community is ""blue paper."" The form authorizing the involuntary commitment is blue, and the phrase is used liberally as a verb: ""Gee, I hope they don't blue paper me.""

Slang adds a touch of drollness to a controversial act that represents a difficult decision for doctors, as well as an often very upsetting process for the person being ""blue-papered,"" and sometimes their family. (Although sometimes the family gets upset if the person is not blue-papered.) This initial blue paper holds the ill individual in the hospital for five working days.

At the end of these five days, patients may sign in to the hospital on a voluntary basis or they may be discharged. Alternatively, if the psychiatrist feels that the patient continues to be an imminent risk of harm to themselves or others, and if the patient continues to refuse to stay in the hospital on a voluntary basis, there is another, more formal process of commitment which involves a court hearing before a judge.

Many people outside of the mental health system are not necessarily aware of the law surrounding involuntary commitment. Yet most of the time those of us who work inside the mental health system take it for granted. I would like to step back from taking this law for granted and take a critical look at it.

From a civil rights perspective, involuntary commitment creates a class of people who, at the discretion of a police officer, can be taken briefly into police custody and then placed in a sort of preventive detention.

Patricia Deegan is an ex-patient and activist who refers to long stays in psychiatric institutions as incarceration, a word that is chosen for its political charge but I think also speaks to the lived experience of the patient.

Involuntary incarceration clearly imposes a different standard of civil ""liberty"" onto the mentally ill than that which is theoretically guaranteed to the rest of us. If you are not classified as mentally ill, can you be confined somewhere for something people believe you are going to do, but which you have not yet done?

Is there any evidence that persons with mental illness are actually more dangerous to others than random members of the general public?

These questions are starting places for looking beyond common assumptions about role that involuntary incarceration plays in the interplay between civil rights and civil protections. For mental health professionals, the law can seem exceptionally frustrating when we are working with patients who are tormented and debilitated by their illness and unable or unwilling to receive treatment in the community.

A patient who hears voices constantly, who exists in a state of fear about people she believes are trying to kill her, who does not take any medicines because she believes they are poisoned, and who is too distracted by her illness to cook meals or take showers, could probably not be committed to a hospital involuntarily.

For those of us who entered a helping profession in order to help people who are suffering, this fact often feels like a tremendous failure of the system.

Dr. Paul Chodoff, who has written several articles on the topic, points out that the focus of the involuntary commitment law on ""imminent harm"" as the main criterion for commitment, leads psychiatrists to feel frustrated that their work is aimed more at serving the police state in keeping dangerous people off the streets than in carrying out the aims of psychiatry.

He argues that the involuntary commitment law should be broadened to allow commitment of those with a mental illness who need hospitalization due to the severe state of their illness, whether they are dangerous or not.

The existing law about involuntary commitment is the result of a long dialectic between an attitude of paternalism toward the mentally ill and ideals of personal freedom and civil liberty. Both the state and the profession of psychiatry have evidenced paternalism towards those with a mental illness, which contrasts with constitutional rights that were revisited in the civil rights movements of the 1960s. Involuntary commitment has also been shaped by the history of psychiatry. The perceived need for involuntary hospitalization is a result of the way that psychiatric treatment was conceptualized and practiced in the nineteenth century.

It also arises out of a social contract, wherein the State and the profession of psychiatry join forces to protect the public from a group of people who are seen as both terrifying and burdensome.

The practice of involuntary commitment also arose as a result of the creation of the psychiatric institution as both the locus and the means for treatment of insanity.

The institution was born of several different social forces. In early New England there had been a smattering of psychiatric hospitals, which had mostly started as single wards within general hospitals and had grown into separate buildings. Starting in 1810 there was a movement towards building psychiatric hospitals and institutions that continued to gather steam throughout the first half of the nineteenth century.

This occurred in the context of overall changes in social welfare policy; there were new ideas and practices about the State being responsible for the indigent and the troubled, and other institutions for special populations such as the feeble-minded or epileptics were built at this time.

The Victorian era brought a lower tolerance for disorder and deviance, and a sense of urgency about maintaining public safety and social order. At the same time there was a growing sense of idealism and excitement about the possibilities of a cure for mental illness.

Whereas previous treatments for mental illness (exorcisms, bloodletting, emetics and purges) had generally not been successful and had contributed to a sense that insanity could only be subdued or confined, the new moral treatment being practiced in England promised the rehabilitation of the insane. Maine's public psychiatric hospital was built in the early nineteenth century to illustrate these new ideas and treatments. The Maine Insane Hospital (often referred to at the time as the ""Maine Insane"") was built in 1840 in Augusta, Maine.

Governor Dunlop's speech before the Maine Legislature in 1830, in which he advocated for the creation of such an institution, clearly expressed the rhetoric of collective social responsibility and hope for a cure: ""Humanity loudly calls for appropriate means of relieving and restoring to enjoyment and usefulness"" [those bereft of reason]""which means, are now not only beyond the reach of the poor and friendless, but cannot be commanded by the ordinary ability of our citizens or towns, on whom the duty of providing for their support may fall.""

In keeping with the ideas of moral treatment, the entire structure and experience of the hospital was designed as a kind of treatment. The buildings and grounds represented a clean and orderly environment which would restore the disordered mind to order.

There was proper ventilation to dissipate the bad vapors of insanity. Besides the physical environment of the hospital, there was work, or occupational therapy. The hospital was part of a 220 acre working farm, which represented the key point of moral treatment. As the first report of the hospital to the Maine legislature in 1841 stated: ""Employment of some kind is essential to the recovery of the insane.

No employment is so congenial to the human constitution as agriculture."" A hospital like this was seen as the means of treatment for insanity, and so the means of getting treatment was for the mentally ill to enter the hospital. The only problem was, how was it determined who needed treatment, and thus needed to be in the hospital?

Psychiatry was a fairly young profession with few standard ideas about mental illness. Was it a disease of the organs and physical body like other diseases, or a disease of the humors and spirits?

This was still a matter of debate. The only available basis for diagnosis was behavior, and for a young profession in a socially repressive age, the behaviors that supposedly expressed mental illness were often the same as the behaviors that expressed social aberrance, deviance, and ""immorality.""

Many people were hospitalized with a diagnosis of ""moral insanity."" This concept may have been a precursor to the current diagnosis of antisocial personality disorder, but it also included such Victorian no-nos as masturbation and extramarital sex.

There were also claims that husbands brought their wives to institutions just to be rid of them. The commitment law was created as a move toward reform. In 1874, Mrs. E. B. W. Packard, a one-woman whirlwind of a reform movement, successfully lobbied in the state of Maine for passage of a law to protect against wrongful commitment.

She had been committed to an institution by her husband, a Calvinist minister, for arguing with him about Calvinist theology and feminism. Historians believe that Mrs. Packard probably did have a psychotic disorder, but that she would not need to be hospitalized according to modern standards.

Before passage of the commitment law, in some states a husband could commit a wife to a psychiatric institution solely at the discretion of the superintendent of the institution. Mrs. Packard felt that a law creating a more formal process of commitment would bring order and justice to the system.

In practice, though, people continued to be committed involuntarily for reasons having more to do with social control than psychiatric treatment. Husbands ridding themselves of wives via the psychiatric institution was still enough of a problem in the 1930s that the first woman in Maine's legislature, Gail Laughlin, authorized a bill penalizing husbands for bringing false testimony in the involuntary commitment hearings of their wives.

I worked with a patient who in the 1960s had been brought to the hospital by her husband. The chief complaint listed on the admitting record was: ""Patient does not do her housework.""

I think she did actually have a recurrent depression, a symptom of which was her inability to care for herself and her home, but there was obviously a large overlap conceptually between mental illness and not functioning in a proscribed social role. There is also a large history of the forced treatment of of homosexuality as mental ""illness."" One gay man I know has a familiar story.

He was brought, as a teenager, to a psychiatric hospital in the Midwest by his parents, when they found out he had been having gay sex. He was involuntarily committed to the institution and treated for his homosexuality. (The treatment didn't work).

Until the 1960s, the voice of paternalism asserted the need for involuntary commitment. But as African-Americans and women struggled for civil rights, there was renewed discussion and activism about civil rights for the mentally ill. Arguments for increased freedoms for the mentally ill took two paths, one somewhat fruitful and one less fruitful.

Against the voice of paternalism, some people posed the radical question: Is there even such a thing as mental illness? For example, R. D. Laing made the famous argument that mental illness is a privileged state, an alternative viewpoint on the world. This argument at least challenged many assumptions of the mental health profession and caused them to be re-examined.

On the other hand, the psychiatriast Dr. Thomas Szasz wrote a history of how early psychiatrists (such as Bleuler and Krepelin) created the diseases of mental illness by classifying certain behaviors that were disturbing to society in general, under the heading of a diagnosis, despite no evidence at the time of a cellular-level disease process.

He viewed this process as the manufacture of disease, a sort of large-scale hoax which created and justified the social roles of psychiatrist and mental patient, and justified the practice of placing these patients against their will in a psychiatric institution.

He regarded all of this as nothing more than a sanctioned form of social control. He saw a tacit contract existing between society as a whole and the class of psychiatrists, in which psychiatrists arrange to confine and control persons disturbing to society, in return for a social regard as members of the medical profession.

Neither R. D. Laing's nor Thomas Szasz' arguments ultimately changed the laws and practices of institutions and involuntary commitment as much as did the arguments based on the principles of freedom and personal liberty intrinsic to America's self-definition. These arguments hold that despite the existence of mental illness, and despite the fact that the mentally ill might benefit from treatment, personal freedom is a higher order good than treatment.

This focus on ideas of civil liberty coincided with a conceptual shift in the 1970s regarding the locus and modalities of treatment of mental illness.

The institution had devolved from being a type of treatment to being a type of warehouse, and the community was seen as the best healing environment. Models of community-based treatment, like the community mental health center and assertive community treatment, also known as the ACT model, were developed.

This change in thinking and practice shaped the current commitment law, which is based on the idea that someone cannot be detained or confined without extremely good cause. It also limits the duration of involuntary commitment, and ensures that no one individual or stakeholder may make commitment decisions. Currently dangerousness is the standard for commitment, as dangerousness is a relatively simple standard to define. But dangerousness is also a highly convenient standard, both because the criminal justice system already confines people who have been determined to be dangerous, and because of continuing public fears about the alleged dangerousness of those with a mental illness.

This spring there was news in the New York Times that political dissidents in China were being forced into special psychiatric hospitals run by the police and given electro-shock therapy against their will.

The mainstream organization of Chinese psychiatrist decried this practice. However this phenomenon makes obvious that wherever the mechanism of involuntary commitment exists, the possibility for abuse co-exists. It is still possible to distort the language and practice of psychiatry to overlap with social control.

For instance a Chinese official discussed the idea of a political mania, the symptoms of which would be unreasonable suspicion, excessive and unhealthy energy directed in an obsessive manner to political organizing, despite the obvious negative social consequences of this activity. In any troubled relationship between the powerful and the less powerful, like the relationship between a repressive totalitarian government and a dissident citizen, or between parents and a gay teenager, or between husband and wife in a patriarchal society, the language and ideas of psychiatry and mental health practice are open to abuse as a form of social control.

In these instances, the mechanism of involuntary commitment is also open to abuse as a way to confine those who are threatening to the social or political order.

I therefore hope to see the practice of involuntary commitment continue to evolve as a balance between civil liberty and the need to care for those who cannot adequately address their own safety. I would not wish for the end of involuntary commitment, because I still view it as a way to provide treatment to those who refuse out of the fear, hopelessness, and suspicion that a mental illness can bring, and who might not otherwise survive. Alicia Curtis is a psychiatric social worker and a writer. "

nt (Note: the following FAQs were developed by the DHHS Adult Mental Health Services based on the Maine Disability Rights Center's Involuntary Hospitalization Laws: a basic guide to laws covering involuntary admission to psychiatric hospitals The following is a link to the Involuntary Commitment statute:

Rights and Legal Issues - Involuntary Commitment

"Rights and Legal Issues - Involuntary Commitme

http://www.mainelegislature.org/legis/statutes/34-B/title34-Bsec3861.html Frequently Asked Questions about Involuntary Commitment What is Involuntary Commitment? What is a ""Blue Paper""? Who Can Request that Some One be Involuntarily Committed? What Happens After Some One Starts a Blue Paper? What Happens When the Person Gets to the Hospital? How Long Do Blue Papers Last? What Happens After the Blue Paper Admission?

What is a ""White Paper""? What Happens Once a Hospital Files a ""White Paper"" Requesting a Court Order of Hospitalization? Does the Person Have a Right to Choose an Independent Examiner? What Happens at a Court Commitment Hearing?

Does the Person Have a Right to Appeal the District Court Decision? What Happens at the End of the Commitment Period? What is Protective Custody? What is Convalescent Status? What is Involuntary Commitment? Involuntary Commitment is a process by which a person can be admitted to a psychiatric hospital (or psychiatric unit within a general hospital) against his or her will.

What is a ""Blue Paper""? The form that is used to request that someone be involuntarily committed is commonly referred to as the ""Blue Paper"". Who Can Request that Some One be Involuntarily Committed? Anyone, including health care providers and law enforcement officers, may request that a person be involuntarily committed.

They do that by filling out Part 1 of the ""Blue Paper"". The person making the request must state: His/her belief that the person has a mental illness His/her belief that the person poses a likelihood of serious harm because of the mental illness Why s/he believes this The person making the request must also provide name and address of the proposed patient's guardian, spouse, parent, adult child, next of kin, or (if none of those exists) friend, so that the hospital can fulfill its obligation to notify that person.

What Happens After Some One Starts a Blue Paper? The person making the request then finds a doctor or other clinical person to do a “certifying examination.” The examination is usually done by crisis staff or hospital staff.

The examiner completes Part 2 of the Blue Paper and must make an official statement that the person examined: Has a mental illness; and The illness causes a substantial risk of harm to self and/or others The examiner must explain the reasons for her/his opinions and must also specify the least restrictive form of transportation that would meet the patient's clinical needs.

The person making the request for involuntary hospitalization (usually crisis or hospital staff) then locates a hospital bed and somebody to provide transportation, and asks a judge or justice of the peace to sign Part 3 of the Blue Paper, indicating that the application was completed in accordance with the law.

The judge or justice of the peace doesn’t make a determination about whether the statements on the application are true or not. What Happens When the Person Gets to the Hospital? When someone is taken to the hospital on a Blue Paper, the person is not automatically admitted.

The head of the psychiatric hospital (or psychiatric unit) may do one of three things: Admit the person as an involuntary patient, so long as the certifying examination took place no more than two days before the date of admission Admit the person as a voluntary patient (if the person agrees)Not admit the person at all, if the hospital believes the person does not need involuntary hospitalization and does not need, or does not agree to, voluntary hospitalization A doctor or psychologist must examine the patient within 24 hours of admission to the hospital.

If that professional doesn't officially state that the patient has a mental illness and due to the mental illness poses a likelihood of serious harm, the person must be released. (The doctor or psychologist must be someone other than the professional who signed the Blue Paper). How Long Do Blue Papers Last? A hospital may keep a person on Blue Paper admission for 3 days, not counting the day of admission.

If the third day is on a weekend or legal holiday, then the hospital can make the person stay until the next business day. The patient may be discharged sooner if the hospital decides that the person may be safely discharged.

The hospital may also admit a person as a voluntary patient at any time during the Blue Paper period if the person agrees. What Happens After the Blue Paper Admission? If the hospital believes the person needs continued hospitalization beyond the blue paper period, then it may: Admit the person as a voluntary patient if the person agrees; ORFile for a court order of hospitalization If the hospital does neither of these, then it must discharge the person after the Blue Paper admission period.

What is a ""White Paper""? The application that the hospital files with the District Court in order to request a court order of hospitalization is commonly referred to as a ""White Paper"".

What Happens Once a Hospital Files a ""White Paper"" Requesting a Court Order of Hospitalization? Once the hospital files a ""White Paper"" several things happen: The hospital must give the person a copy of the application The hospital must also give the person and guardian/next of kin notice of: The right to hire an attorney or have an attorney appointed The right to choose an independent examiner or have his/her attorney select an independent examiner How to contact the District Court Within two days of the filing of the application the Court must notify the person and the person's guardian/next of kin that the application has been received, and include the date of the hearing.

Does the Person Have a Right to Choose an Independent Examiner? Yes. The court will appoint two professionals (physician or clinical psychologist) to examine the person. The person or his/her attorney can choose one of the examiners. If both examiners find that the person doesn't have a mental illness, or doesn't pose a likelihood of serious harm, the person must be discharged.

In other instances, a hearing will be held. What Happens at a Court Commitment Hearing? The hearing is held within 14 days of the application (unless a postponement of up to 10 days is requested by the hospital or patient for a good reason).

The hearing is conducted in an informal but orderly manner. The hearing may occur in a courthouse or at the hospital or other setting that is not likely to have a harmful effect on the mental health of the patient.

Sometimes, the commitment hearing occurs at the hospital, with the judge participating from the courthouse by a video link. The person has the right to appear at the hearing, to testify, to have witnesses testify and to cross-examine the hospital's witnesses.

The hospital must prove, by recent evidence of the person's behaviors, that the person poses a likelihood of serious harm and that inpatient hospitalization is the best available means for treatment.

The hospital must include expert psychiatric testimony in its evidence. The court must decide, based on ""clear and convincing evidence"" the following: Does the person have a mental illness? Does the person's recent actions and behavior demonstrate that the person poses a likelihood of serious harm?

Is hospitalization the best available means for treatment? And Is the individual treatment plan offered by the hospital satisfactory? If the court answers YES to all of the questions it may commit the person to the hospital as an involuntary patient for a period up to 4 months. If the court answers YES to the first three questions but is not satisfied with the treatment plan it may postpone the hearing for 10 days to let the hospital revise its treatment plan.

If the court answers NO to ANY of the first three questions, the application must be dismissed and the person must be discharged from the hospital. Does the Person Have a Right to Appeal the District Court Decision? Yes. The person may appeal an order of commitment to the Superior Court. The appeal must be filed within 21 days of the District Court's order. What Happens at the End of the Commitment Period?

The hospital may apply for recommitment for a period of up to 12 months if it believes that the person needs continued involuntary hospitalization. The hospital must discharge the person at the end of the commitment period unless it has started recommitment procedures, or unless the person is suitable for and has accepted voluntary admission.

A hospital is not required to hospitalize a person for the entire period of commitment. In fact, it must discharge a person during the commitment period if it determines that conditions have changed and that the person no longer needs hospitalization.

What is Protective Custody? Protective custody is the term for when a law enforcement officer takes a person into custody in order to bring that person to a doctor or psychologist for an evaluation for possible involuntary psychiatric hospitalization.

The law enforcement officer must use the least restrictive form of transportation that meets the security needs of the situation when taking the person to the evaluation. In order to take a person into protective custody, the law enforcement officer must have reasonable grounds, based on ""probable cause"" to believe that the person: May have a mental illness And Presents a threat of imminent and substantial physical harm to himself or to other persons due to mental illness What is Convalescent Status?

Link to Convalescent Status statute Maine statute allows hospitals to release patients on convalescent status. People on convalescent status technically remain patients of the hospital. Convalescent status is considered a means to assist transition from hospitalization to community tenure.

It is rarely used because the community mental health system now has the capacity to provide transition services to individuals leaving the hospital.

When it is used, it is done in accordance with hospital policy. A person who was a voluntary patient at the time convalescent status started may only be returned voluntarily unless “blue papers” are started.

A person who was an involuntary patient may be returned voluntarily OR involuntarily if: The hospital considered it in the person’s best interest or The hospital believes that the person poses a likelihood of serious harm, and The hospital issues an order for return and The order is endorsed by a judge or justice of the peace, and The judge decides it is in the person’s best interest to return or that the person poses a likelihood of serious harm. "

Florida citizens who might harm themselves or others may be held involuntarily for assessment up to 72 hours. The statute for mental illness is called the Baker Act, for substance abuse, the Marchman Act. There are very specific criteria for committing someone under the Baker Act or Marchman Act. Join us as Martha R. Lenderman, MSW clearly explains how to identify patients legally eligible to implement these statutes and the requirements under the Florida Mental Health Act for appropriate admission and discharge in compliance with the law.

Baker Act & Marchman Act Conference

Locations Live Event at Baptist Hospital Videoconference to Homestead Hospital Videoconference to Mariners Hospital Web Cast - Click to Access Webcast Target Audience Psychologists, Psychiatrists, Emergency Room Physicians, Licensed Mental Health Counselors, Social Workers, Licensed Marriage and Family Therapists, Nurses, Pharmacists, Occupational Therapists, Respiratory Therapists, Case Managers, Admission and Discharge Staff, Risk Managers and Legal Advisers.

Learning Objectives Implement the Baker Act voluntary and involuntary examination criteria. Identify which patients are legally eligible to consent to admission and treatment. Discuss requirements under the Florida Mental Health Act including appropriate admission and discharge in compliance with the law. Implement the criteria for involuntary admission of persons under Florida’s Marchman Act for substance abuse impairment.

Consistently comply with the federal Emergency Medical Treatment and Active Labor Act (EMTALA) and the Florida Baker Act laws. Registration is required. Please log in to register. Additional information Schedule:5:30 p.m. ♦ Dinner and Registration6:00 p.m. ♦ Lecture9:00 p.m. ♦ Adjourn

f The Florida Mental Health Act (Baker Act)Chapter 394 Part I, Florida Statutes The information provided using this web site is only intended to be general summary information to the public. It is not intended to take the place of either the written law or regulations.

Overview o

(Refer to Law for Specifics) (1) Voluntary Admission (2) Involuntary Examination (3) Patient Rights (1) Voluntary Admission (FL Statute 394.4625) An adult may apply for voluntary admission if found to show evidence of mental illness, to be competent to provide express and informed consent, and to be suitable for treatment.

A person is incompetent to consent to admission or treatment if his or her judgment is so affected by his or her mental illness that the person lacks the capacity to make a well reasoned, willful, and knowing decision concerning his or her medical or mental health treatment. If the person meets this definition, he or she must be examined under the involuntary provisions of the law.

Prior to giving consent to admission or treatment, the following information must be given to the patient or their substitute decision-maker:the reason for admission;the proposed treatment;the purpose of the treatment to be provided;the common side effects thereof;alternative treatment modalitiesthe approximate length of care, and that any consent may be revoked prior to or during the treatment period.

Any person admitted on a voluntary basis must be evaluated within 24 hours after arrival at a receiving facility by a physician to document the person’s competence to provide express and informed consent for admission.

(2) Involuntary Examination (FL Statute 394.463)A person may be taken to a receiving facility for involuntary examination if there is reason to believe that he or she is mentally ill and because of his or her mental illness: (1a) The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination; or (1b) The person is unable to determine for himself or herself whether examination is necessary; and (2a) Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or 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 (2b) There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior.

(3) Patient Rights (FL Statute 394.459)Individual Dignity: Ensures all constitutional rights and requires that persons be treated in a humane way while transported or treated for mental illness. Treatment: Prohibits the delay or denial of treatment due to inability to pay and requires prompt physical examination after arrival; requires treatment planning to involve the patient; and requires the least restrictive appropriate available treatment be based on the individual needs of each patient.

Express and Informed Consent: Encourages people to voluntarily apply for mental health services when competent to do so, to choose their own treatment, and to decide when they want to stop treatment.

The law requires that consent be voluntarily given in writing after sufficient explanation to enable the person to make a knowing and willful decision without any coercion. Quality of Treatment Requires medical, vocational, social, educational, and rehabilitative services suited to each patient’s needs to be administered skillfully, safely, and humanely.

Use of restraint, seclusion, isolation, emergency treatment orders, physical management techniques, and elevated levels of supervision are regulated. Complaint resolution is required. Communication, Abuse Reporting, and Visits: Guarantees persons in mental health facilities the right to communicate freely and privately with persons outside the facilities by phone, mail, or visitation.

If communication is restricted, written notice must be provided. No restriction of calls to the Abuse Registry or to the patient’s attorney is permitted under any circumstances.

Care and Custody of Personal Effects: Ensures that patients may keep their own clothing and personal effects, unless they are removed for safety or medical reasons. If removed, a witnessed inventory is provided. Voting in Public Elections: Patients are guaranteed the right to register and to vote in any elections for which they qualify.

Habeas Corpus: Guarantees patient the right to ask the court to review the cause and legality of the patient’s detention or unjust denial of a legal right or privilege or an authorized procedure. Treatment and Discharge Planning: Guarantees the opportunity to participate in treatment and discharge planning and to seek treatment from the professional or agency of patient’s choice upon discharge. End of an Overview of The Florida Mental Health Act (Baker Act)Chapter 394 Part I, Florida Statutes (Refer to Law for Specifics)

Baker Act The Baker Act is a Florida law that enables families and loved ones to provide emergency mental health services and temporary detention for people who are impaired because of their mental illness, and who are unable to determine their needs for treatment.

Baker Act

Baker Act

The Act was named after Maxine Baker, former Miami State representative who sponsored the Act in 1972.

People who require the use of the Baker Act have often lost the power of self-control, and they are likely to inflict harm to themselves or others. It is important that the Baker Act only be used in situations where the person has a mental illness and meets all the remaining criteria for voluntary or involuntary admission.

It does not substitute for any other law that may permit the provision of medical or substance abuse care to persons who lack the capacity to request such care Expert staff at UF Health Shands Psychiatric Hospital can assist loved ones and family members with the Baker Act process.

We have more than 25 years of experience in working with families, caretakers, friends and loved ones who have required special assistance with getting someone to treatment. If you would like to speak to one of our knowledgeable counselors, please call (352) 265-5481. Review the Baker Act Manual online.

The Health Law Firm represents individuals, families and friends in challenges to and hearings related to the Florida Baker Act and Marchman Act, when the basic criteria for confinement are not met and there is no medical necessity for further confinement. We realize that the Baker Act is a good thing.

Baker Act Cases, Involuntary Confinement

"Baker Act Cases, Involuntary Confinement Baker Act Defense, Involuntary Baker Act Confinement, Involuntary Confinement in Hospital, Confinement in Baker Act Facility, Mental Health Confinement, Psychiatric Confinement, Petition for Writ of Habeas Corpus We are frequently consulted by family members of individuals who are erroneously confined under Florida's Baker Act, Section 394.451, Florida Statutes, click here. An erroneous confinement under the Baker Act can occur for a number of different reasons. However, the result is that an independent citizen is confined in violation of his constitutional rights to liberty and privacy.

There is a similar law that legally authorizes involuntary confinement for drug addicts and other substance abusers. It is named the “Hal S. Marchman Alcohol and Other Drug Services Act"" or the ""Marchman Act"" in its shorter form, and is codified at Section 397.301, Florida Statutes.

To see the entire act, click here. Loosely speaking, the Baker Act allows a physician or other health professionals to order that an individual who is a threat to himself or to others because of a mental illness to be involuntarily held for a psychiatric evaluation for up to 72 hours, in certain designated health facilities.

Overzealous or overcautious physicians, emergency room personnel, school officials, Department of Children and Families (DCF) officials, nursing home staff and other authorities will often have those they suspect may have a mental problem and to be a threat seized and involuntarily confined under the Baker Act. Seniors living on their own and teenagers are often the ""victims"" of this. If the psychiatrist examining the involuntarily confined individual feels that he or she should be held for further evaluation, then he or she can be held another period of time, up to a week, for further evaluation and treatment.

Examples of abuses that can occur as a result include:-Individuals who do not have a mental condition and do not meet the basic criteria for the Baker Act are involuntarily confined and deprived of their freedom.-Children are involuntarily confined at facilities that are not really set up for children.-Because of overcrowding the person is taken to or transferred to a facility far away from his or her home, family and friends.-A person who has medical problems (especially true with the elderly) is confined in a Baker Act facility and is unable to receive regular medical care or attend scheduled appointments with their regular treating physicians.-A person who is taking one or more prescriptions for medical problems will not be allowed to take them while confined.

This can lead to a deterioration of the person's medical condition.-If the person has a regular psychiatrist or therapist, that person is not allowed to see or treat the person where he or she is confined because the therapist is not on the medical staff of the Baker Act facility.-Persons may be confined in a facility in which one or more dangerous patients are also confined.

Our clients have reported assaults and sexual molestation which have occurred at such facilities.-It has been reported to us by clients to whom this has happened that it seems if there is good insurance coverage they are kept longer because the insurance company (or Medicare) is paying the hospital for the inpatient stay, which can be a large amount of money.- Sometimes the family is located in another state and merely wants to have the person released so he or she can be taken to live with them and cared for by them.

Baker Act facilities are sometimes free-standing facilities. However, more often they are units in a hospital, usually called a ""behavioral health unit. ""

There are many people who may have serious mental health issues and fail to obtain treatment, who should be involuntarily confined under the Baker Act so that they can receive appropriate treatment. Sometimes this is the only way they will ever be treated. And it is also a good thing that police, deputy sheriffs and other law enforcement officers are receiving training which is now resulting in more Baker Act hospitalizations and fewer arrests.

This helps an individual to avoid a serious arrest and possible conviction of a serious offense (giving them a criminal record forever) when they may need only medical treatment for a mental condition. We often receive calls from the husband, wife, parents, children or friends of individuals who have been confined involuntarily to a mental facility. Often we are called on to respond urgently to obtain the release of someone who may have been incorrectly confined to a mental institution without their consent.

Occasionally we assist in cases in which the family may be located in another state and the patient is located here in Florida. Often we are able to obtain a prompt release of the confined person in cases in which the basic requirements for an involuntary confinement under Florida Law do not exist and the patient should not have been confined.

We have been involved in working on an expedited basis with the hospital, mental institution or court to obtain the release of individuals who should not be confined or who desire to be released into the custody and care of their family or back to their own independence.

For a sample of an Emergency Petition for Write of Habeas Corpus we prepared with its supporting documentation, and which contains citations to the appropriate legal authorities, click here .

A Memorandum of Law (legal brief) in support of the Petition for Writ of Habeas Corpus is also included with it. For a link to a website which contains additional information and forms for Baker Act cases, including the complete Baker Act and the state regulations (agency rules) implementing it, click here.

Examples of actual cases in which we have been retained to obtain the release of a Baker Act patient include the following: Case #1: An independent elderly woman who still works and is completely independent trips and falls in her condominium, injuring her face. Her roommate takes her to the local hospital emergency room. The emergency room staff has her involuntarily confined in the hospital's Baker Act Unit and will not release her.

She is not a danger to herself or to others. She is completely independent. Her roommate helps in driving her to her medical appointments. She has never been diagnosed with a mental illness before and has never been Baker Acted before. She has a pet dog she takes care of in her apartment and being involuntarily confined causes her to miss several medical appointments she had scheduled.

Case #2: President of a medium-sized manufacturing company in another state comes to Florida for a business convention at which his company has a display.

On the last night of the conference, he parties late, drinks too much and a friend takes him to a hospital emergency room. He has a plane ticket to leave the next day. The hospital emergency room staff diagnoses him with depression and has him involuntarily confined under the Baker Act.

He misses his flight home, and one of his company officials has to come to Florida to try to get him released. Case #3: The fairly new wife of a businessman who owns his own business, works a lot, and already has one child, delivers triplets. About six months later, the nanny quits and the wife and her husband finally received a solid offer on their house (which has been on the market for three years) and they will have to move in two weeks.

The wife goes to her OB/GYN for her routine follow-up visit. She is tired and run down from the loss of her nanny, getting ready to move, taking care of triplets, etc. Questioning by her OB/GYN indicates she may be depressed. The OB/GYN has two nurses from his office walk her over to the hospital (which is next door) emergency room to be Baker Acted.

Now her husband and kids are at home without a nanny and without mom. Mom is angry and upset because she is not suicidal, feels she has been betrayed by her doctor and is not a threat to herself, her children or anyone else. She feels she is a prisoner, confined without any rights. Case #4: A 14-year-old girl in high school breaks up with her best friend.

She is somewhat depressed and writes down her thoughts about ""ending it all."" Two months later, someone finds the anonymous note and turns it into a teacher. The teacher and principal are eventually able to identify the handwriting and confront the teenager. She admits that it is her note but denies any suicidal thoughts. The principal calls the sheriff's department and sheriff's deputies come and take her away to a Baker Act facility over her parents' protests and have her involuntarily confined there.

Case #5: A happily married mother of three young adults (who are in college and live with their mother and father) has had a long history of depression for which she sees her own psychiatrist on a regular basis (for more than ten years) and receives prescription medications to control it. Her psychiatrist routinely adjusts her medications as required. Her psychiatrist has recently adjusted her medications but is out of town on vacation for two weeks.

She has a reaction to the medication adjustment. She telephones her psychiatrist's office and is instructed to go to the nearest hospital emergency room to have her medications adjusted. She does this. Instead of getting her medications adjusted, she is involuntarily confined in the hospital's behavioral health unit under the Baker Act, her husband (an engineer) and her children, who live with her and depend on her are distraught and cannot convince the hospital or its medical staff to release her.

The cases above are all based on actual cases in which we have represented the family and been able to obtain the prompt release of the involuntarily confined individual.

SERIOUS PROBLEMS WE SEE WITH THE PROCESS:- The staff and treating physician constantly pressure the patient to convert their involuntary confinement (which may be expiring shortly, or there may be no grounds to renew it) to a voluntary admission.

If this occurs, then they can keep the person as long as they desire. However, they threaten that if the patient attempts to leave, even though the patient is now there voluntarily, then they will have the patient involuntarily confined under the Baker Act.- The patient is angry and upset at being imprisoned when he or she came to the hospital voluntarily for help.

As a result, he or she rants and raves and threatens the doctors and staff with litigation or refuses to talk to them.

This may serve to reinforce the doctor and staff's concerns that the patient is mentally ill or irrational.- Some of our clients have expressed concerns that because they have excellent health insurance, Medicare, Medicaid, or TRICARE coverage (all of which cover hospitalizations), that they are being held involuntarily against their will when they should not be, while indigents who really have serious mental health issues are discharged immediately.

They express concerns that they are being held involuntarily solely because the hospital and physician are getting paid to keep them.- Individuals who have medical problems, but are successfully living independently and obtaining regular medical treatment for their ailments, may not receive the appropriate type of medical care they need when they are being confined in a psychiatric facility.

Their prescription medications are at home, and they are not able to take their prescribed medications. Their regular treating physicians are not called or consulted. Their continuity of care is interrupted by the confinement.- The regular treating physicians of those confined may not visit or see them while they are confined in a different hospital from the one (s) in which the treating physician has approved clinical privileges.

Our firm has a process we follow to make sure that a person who should not be held under the Baker Act may be released in a very short time. If the basic criteria for a Baker Act confinement are not present, the person is not required to be held and should be released.

If the person has been living independently for decades, has family and a support system available, and has had no prior mental health problems, the odds are he or she should not be involuntarily confined. We act immediately to begin our representation, to make the hospital and its physicians aware that we are representing you, and to take measures to obtain release.

If required, we are prepared to file an emergency Petition for Writ of Habeas Corpus with the local Circuit Court to have you brought before the judge for an emergency release hearing. These cases can be time intensive, require a great deal of immediate work, but can yield fast results in most cases. "

Facilities that are recognized by the Department of Mental Health to provide civil involuntary detention services have mental health professionals who are designated and approved to initiate on-site civil involuntary detention for individuals in need of emergency evaluation and treatment.

Civil Involuntary Detention

"Civil Involuntary Detention» Mental Illness » How & Where to Get Help Civil Involuntary Detention Consumer Information Manual Facility Designee Manual for Civil Involuntary Detention - Psychiatric Services Facility Designee Manual for Civil Involuntary Detention - Substance Abuse Services Reference Guide for Civil Involuntary Detention Reference Guide for Civil Involuntary Detention Forms For some persons, a mental disorder or a mental illness leaves them unable to make decisions about caring for their basic human needs such as food, shelter, and medical care.

A few people who are experiencing a mental disorder or a mental illness may be in danger of hurting themselves or others. This can be a very confusing and frightening experience for them as well as for their families and friends.

With appropriate evaluation, treatment, and continued care, most people with mental illness can return to their normal lives. Similarly, individuals who are misusing alcohol or drugs may be unable to make decisions about caring for their basic human needs such as food, shelter, and medical care.

Alcohol or drug misuse may also place a person in danger of hurting themselves or others. As with most types of medical evaluation and treatment, people may decide to participate voluntarily, may refuse to participate or may choose alternatives to the recommendations.

For some people, the symptoms of a mental disorder or a mental illness or the effects of alcohol or drug misuse compromise their cognitive or reasoning ability, and they are left unable to understand sufficient information to make decisions about necessary and appropriate medical treatment. Missouri Statutes, Chapter 632 RSMo, provide the statutory authority to allow involuntary treatment under certain conditions with appropriate due process. This process is called Civil Involuntary Detention. Who can initiate a Civil Involuntary Detention?

If the situation is an emergency, what do I do? If the situation is not an emergency, what do I do? How long will a person be detained, evaluated and treated? What happens in court? Will I be asked to testify in court?

Does Missouri have an outpatient commitment law? Do Missouri statutes include ""gravely disabled"" criteria? Are there any other laws that can be used to help persons who are incapacitated by mental illness? Does a person have to be homicidal or suicidal before he or she is able to be civilly detained? Who can initiate a Civil Involuntary Detention? Any adult person may file an application for detention, evaluation, and treatment with the probate division of the circuit court where the person may be found.

Law Enforcement personnel, under their police power authority, may detain a person believed to be imminently harmful due to a mental disorder or substance use disorder and transport the person to an appropriate facility for evaluation for admission. Staff of the Access Crisis Intervention (ACI) system, the 24-hour crisis hotline, can also assist with the civil involuntary detention process. By calling the toll-free 24-hour ACI crisis number, the caller will be able to speak to a mental health worker who will evaluate the current situation and assist with the appropriate response.

These professionals may be psychiatrists, licensed physicians, psychiatric residents, psychologists, nurses or social workers, licensed professional counselors or a qualified addiction professional. If the situation is an emergency, what do I do? If possible and safe to do so, get the person to the emergency room of a hospital that treats persons with mental disorders. If the person is currently receiving mental health treatment, call the person responsible for the treatment and that person should provide you with an emergency plan and assist with crisis intervention.

Call the police or sheriff; tell them about the situation and explain why it is an emergency. If appropriate to do so, the law enforcement officer may take the person into custody and transport the person to an appropriate facility. If the situation is not an immediate emergency, what do I do? If the person is currently receiving mental health treatment, call the person providing the treatment.

That person should assist you. Call the toll-free 24-hour Access Crisis Intervention (ACI) 24-hour crisis hotline. You will be able to speak to a mental health worker who will evaluate the current situation and assist you with the appropriate response. If you have sufficient information that the person has a mental disorder and presents a likelihood of harm, you may petition the Probate Court for civil detention.

How long will a person be detained, evaluated and treated? The initial period is for up to 96 hours, excluding weekends and certain holidays. After the initial period, the person's treating physician and treatment team will decide if further detention, evaluation, and treatment are needed.

If so, the treating psychiatrist and treatment team may initiate a court hearing for the appropriate time frame, 21 days, 90 days, or one year for mental health treatment and 30 or 90 days for alcohol or drug treatment.

What happens in court? If an application for 96 hours is presented to the Probate Division of the Circuit Court, the judge will decide whether to order the person detained, evaluated, and treated in an appropriate facility for up to 96 hours. If a petition is filed for commitment beyond the initial 96-hour period, a formal hearing will be held in the court to hear facts supporting the petition. During this hearing the person against whom the petition is filed will be represented by an attorney; if the person cannot afford an attorney, the court will appoint one.

The judge will hear the evidence and make the final decision as to whether the person will be committed for an additional period. Will I be asked to testify in court? If you have observed recent behavior of a person that supports the allegation in the petition, you will usually be asked to testify.

Sometimes family members or friends are the only persons who have witnessed harmful behavior. Does Missouri have an outpatient commitment law? Missouri has provisions for releasing a person from a mental health facility to outpatient commitment. These statutory provisions allow for a mental health facility to set conditions for a person's release and provides authority to return a person to a mental health facility if the conditions are not met.

Do Missouri statutes include ""gravely disabled"" criteria? Yes. The criteria that a person must be mentally disordered and, as a result, present harm to self or others includes a standard that a person may be harmful if, as a result or an impairment, he or she is unable to make decisions regarding hospitalization or treatment as evidenced by not providing for basic necessities of food, clothing, shelter, safety, or medical care.

Are there any other laws that can be used to help persons who are incapacitated by mental illness? Yes. If a person continues to be unable to make basic decisions because of an impairment, guardianship should be considered. This legal process places the personal decision making in the hands of another person who is legally able to authorize needed services.

This law has provisions for limited guardianship that allows the guardian to only have decision-making powers under certain conditions. Does a person have to be homicidal or suicidal before he or she is able to be civilly detained? No. Verbal threats to do harm are sufficient, or even placing a person in fear of harm is sufficient. The standard is ""a likelihood of serious physical harm to self or others."" Past patterns of behavior that have historically have resulted in harm may also be considered. "

Then Gov. Jeb Bush signed HB 463/SB 700, the Florida Sheriffs Association's legislation to reform that state's mental illness treatment law, known as The Baker Act. The law allowed court-ordered outpatient treatment for people with severe mental illnesses, like schizophrenia and bipolar disorder, who have a history of noncompliance combined with either repeated Baker Act admissions or serious violence.

What is equivelant to Fla Baker Act called in other states?

Politics & Government Law & Ethics What is equivelant to Fla Baker Act called in other states?since law is titled in fla, was it originated in fla, or taken a different name from other states for state statute?4 following 6 answers Answers Relevance Rating Newest Oldest Baker Act California Source (s):https://shrinke.im/a0Ymidavaz · 1 year ago0 0 Comment For the best answers, search on this site https://shorturl.im/avk Uo

The Baker Act is legislation enacted in Florida, but, I'm pretty sure every state and the District of Columbia have some some kind of involuntary mental health commitment statute. In 1975, the Supreme Court ruling on O'Connor v. Donaldson pretty much made those statutes universal.

? · 2 years ago0 0 Commentwhat is equivelant to FLA Baker Act in PAEsther · 2 years ago0 0 Comment I am not sure what the law is called in other states, however,at one time Florida was one of only nine states that did not allow court-ordered outpatient treatment for people with untreated severe mental illnesses.

. This basically eliminated services for people struggling with mental illness. He made similar decisions while he was the governor of California, releasing more than half of the state’s mental hospital patients and passing a law that abolished involuntary hospitalization of people struggling with mental illness.

Did Reaganâs Crazy Mental Health Policies Cause Todayâs Homelessness?

Opinion Topics: homelessness • institutions • mental health • politics • Ronald Reagan Did Reagan’s Crazy Mental Health Policies Cause Today’s Homelessness?

By Joel John Roberts | Oct 14, 2013 49 Comments Tweet Share Recently, a 34-year-old woman rammed her car into barricades outside the White House while her infant daughter was in the back seat.

The police, thinking it was an act of terror, chased her down and shot her to death. Later, we learned she was actually struggling with mental illness. This came not long after another 34-year-old, this one a man who heard voices and thought people were out to hurt him, walked into the Washington Navy Yard and gunned down 12 people.

It is getting crazy out there, and these two people were not even dealing with the added pressure of living on the streets. Within our country’s homeless population, a quarter of a million people—or one-third of the homeless population —struggle with some sort of mental illness.

For those of us who encounter people experiencing homelessness on a daily basis, this is not surprising.

We see that man walking down the sidewalk angrily screaming at an imaginary person, haunted by some phantom or past memory, every day. We also see people steering their children across the street to get away from the potential danger.

In America’s cities, many of us are so immune to such disturbances that we just continue reading our email on our smartphones without even looking up. It is just another crazy part of our urban lifestyle. But when I see people like this, my first thought is always the same: Why isn’t this man institutionalized?

He certainly is not living a dignified life out here on the streets. When I ask my mental health colleagues about this, the one political figure that typically comes up is former President Ronald Reagan. It’s like an urban legend in our field. People say the reason so many people with mental illness are homeless or in jail—one-third of all homeless individuals and half of all people behind bars —is because of President Reagan. Really? What did he do? Let all of the mentally ill patients loose? Well, yes, that’s exactly what they say he did. Over 30 years ago, when Reagan was elected President in 1980, he discarded a law proposed by his predecessor that would have continued funding federal community mental health centers

This started a national trend of de-institutionalization. In other words, if you are struggling with mental illness, we can only help you if you ask for it. But, wait. Isn’t one of the characteristics of severe mental illness not having an accurate sense of reality?

Doesn’t that mean a person may not even realize he or she is mentally ill? There certainly seems to be a correlation between the de-institutionalization of mental health patients in the 1970s and early 1980s and the significant number of homelessness agencies created in the mid-to-late 1980s. PATH itself was founded in 1984 in response to the significant increase in homelessness in Los Angeles.

It’s ironic that a political leader who made such sweeping decisions affecting Americans with mental health issues ultimately came face-to-face with the dangers of untreated mental illness. In 1981, President Reagan was shot by John Hinckley Jr., a man suffering from several different types of personality disorders.

Where has Hinckley been for the last 30 years? In a psychiatric hospital. It makes me wonder just how many people living on the streets today would also be safer and better cared for in an institutional setting.photo: by Michael Evans, 1982 (NARA/Reagan Library)

New Hampshire Hospital (NHH) provides inpatient psychiatric treatment to patients admitted on an involuntary basis through an emergency admissions process, a non-emergency court order, or on a limited voluntary basis, depending on the availability of facilities.

"Involuntary Emergency Admission Involuntary Emergency Admission Hearings Involuntary Admission Petitions Probate Hearings Conditional Discharges Revocation of a Conditional Discharge Revocation of a Conditional Appeal Hearings Emergency Treatment Authorization Hearings Involuntary Admissions

Most admissions to NHH are through the Involuntary Emergency Admission (IEA) process (pursuant to NH state law, RSA 135-C:27-33 ). NHH does not provide walk-in emergency or crisis services. Contact your local hospital Emergency Department or the local Community Mental Health Center (CMHC) serving your region of residence for an in-person evaluation. Involuntary Emergency Admission (IEA)The IEA process begins with a visit to a local hospital Emergency Department or CMHC, and the completion of an IEA Petition requesting admission to New Hampshire Hospital.

The person being admitted must pose a likelihood of danger to self or others as a result of a mental health condition. The person who signs the petition is the ""Petitioner."" Other witnesses to the person's behavior may also describe those behaviors on the petition.

IEA Petition forms are available at local police departments, Community Mental Health Centers (CMHC), and hospital Emergency Departments. The Petitioner may bring the person to the local hospital Emergency Department or CMHC for evaluation, or ask the local Police Department for assistance in transporting the person.

A Complaint and Prayer form can be completed, and if signed by a Justice of the Peace, will direct law enforcement officers to transport the person to the Emergency Department or CMHC. A doctor at the Emergency Department or CMHC will perform a medical evaluation, and a psychiatrist or a mental health clinician will perform a psychiatric/mental health evaluation.

The results of the evaluations must be included with the Petition. If the doctor determines that an involuntary inpatient admission to NHH is appropriate, the Emergency Department will make arrangements with the NHH Admitting Department for the person to be transported to NHH. Because NHH has a limited bed capacity, the person may have to wait at the Emergency Department or CMHC until a bed at NHH becomes available.

Upon arrival at NHH, the person will be assigned a room in one of the acute psychiatric treatment units. The person will meet with an assigned mental health treatment team to discuss treatment options, and to develop a treatment plan.

The treatment team includes a psychiatrist, primary nurse, social worker, mental health worker, rehabilitation specialists, and a medical doctor if needed. The patient's progress is monitored daily by the treatment team, and other treatment options are considered in light of the patient's progress.

When the treatment team determines that the patient no longer poses a likelihood of danger to self or others and is stable [see RSA 135-C:27 IEA Criteria ], the treatment team will discharge the patient from NHH back to their home, and arrange for follow-up treatment at the patient's local Community Mental Health Center.

IEA Hearings Within three days of admission to NHH (not counting Sundays and holidays), a court hearing is scheduled to consider whether there was reasonable cause to confine the person at NHH, due to alleged behaviors that were dangerous to self or others, as a result of mental illness.

This provides the patient with the opportunity to object, with an assigned attorney, to the involuntary confinement at NHH. IEA Hearings are convened by the 6th Circuit Court – District Division, and take place in the IEA Court Room on the second floor of NHH. They are scheduled on Mondays, Tuesdays, Wednesdays and Fridays. These hearings are closed, non-public hearings.

Family members, friends, or onlookers are only allowed into the courtroom by agreement of all parties. The Petitioner must either attend the hearing, or be available by telephone. If the Petitioner does not attend, or is unreachable by phone, the Court may dismiss the petition and the patient may be immediately discharged from NHH and allowed to return home.

At the hearing, the Hearing Officer ""swears in"" the petitioner and asks questions about the behaviors described on the petition. A court-appointed attorney, assigned to represent the patient, may ask the petitioner further questions. Any other witnesses who included allegations or information on the petition may also be questioned about the behaviors they witnessed.

Testimony will only be taken from witnesses named on the petition. After the hearing, the Court will issue an order as to whether probable cause was found, or not.

If probable cause is not found, the case will be dismissed, the petition and supporting documents will be sealed, and the IEA will be annulled. The patient will be discharged from NHH within 24 hours of receipt of the written order, unless any further IEA petitions, or other admissions criteria, are received.

If probable cause is found, patients may be required to remain confined at NHH for no more than a total of 10 days (not counting Saturdays and Sundays) from the first date of their admission.

However, the treatment team may at any time discharge the patient from NHH when they determine that a patient no longer is in such a mental condition that she or he poses a likelihood of danger to self or others as a result of mental illness. Involuntary Admission Petitions If, after 10 days, the treatment team determines that the patient is not able to safely return to the community, they will file a further non-emergency Petition for Involuntary Admission with the 6th Circuit Court – Probate Division, in Merrimack County (pursuant to NH state law, RSA 135-C:34-54 ).

The Court will schedule a hearing within 15 days of receiving the petition (not including weekends or holidays).

When the hearing is convened, the Court will then consider whether a longer period of involuntary admission will be necessary to treat the patient's symptoms of mental illness. Probate Hearings Probate hearings are convened every Thursday in the probate courtroom on the second floor of New Hampshire Hospital.

The hearings are conducted by a 6th Circuit Court – Probate Division judge. These hearings are closed and non-public. Additional witnesses or onlookers are only allowed into the courtroom by agreement of all parties.

The IEA Petitioner and witnesses may be called to testify at the probate hearing, as well as others named on the Petition for Involuntary Admission who have witnessed potentially dangerous behaviors, including law enforcement officers, and NHH staff. Members of the patient's treatment team will testify as to the patient's symptoms, psychiatric diagnosis, treatment plan, prognosis, and progress-to-date in recovering from mental illness. An independent court-appointed psychiatrist will also interview the patient and present a report to the Court, providing the Court with a second opinion. The standard of evidence is higher at the probate hearing than at the initial IEA probable cause hearing.

Witnesses must be eyewitnesses to behaviors, and second-hand testimony is not usually allowed. Witnesses may be cross-examined by the court-appointed attorneys representing the patients, or by the patient if the patient chooses not to have an attorney represent him or her.

If the Court finds clear and convincing evidence that the patient is ""in such mental condition as a result of mental illness as to create a potentially serious likelihood of danger to himself or to others,"" the Court may issue an order for continued Involuntary Admission to New Hampshire Hospital for a period of up to 5 years.

The Court may also allow for a Conditional Discharge from NHH during that time period. Conditional Discharges A Conditional Discharge is a doctor's order that allows a patient to return home from NHH before the order for involuntary admission expires, so that the patient may be in a less-restrictive setting and receive continuing outpatient treatment at the Community Mental Health Center in the region where the patient resides.

Conditional Discharges are allowed under NH state law RSA 135-C:45 (II) and RSA 135-C:50-51. When a patient is ""Conditionally Discharged,"" the NHH and Community Mental Health Center treatment teams specify a list of conditions that the patient must adhere to upon return to the community. These conditions often include taking medications on a regular basis, attending appointments at the Community Mental Health Center, refraining from substance abuse, avoiding certain activities, and not engaging in dangerous behaviors.

The patient must agree that she or he understands and commits to follow these conditions over the Involuntary Admission period of time specified in the court order.

If the patient agrees to the conditions, she or he is returned to the community, and appointments are scheduled at the Community Mental Health Center for the patient to begin outpatient treatment. Signatures for Conditional Discharge Continuation of Conditional Discharge Transfer/Revisions Revocation of a Conditional Discharge If a Community Mental Health Center (CMHC) representative receives evidence that a patient has not followed one or more of the conditions agreed to on the Conditional Discharge order, or has engaged in dangerous behaviors, a staff member from the CMHC may revoke the patient's Conditional Discharge, and return the patient to NHH.

CMHC staff are required to explain the revocation documents to the patient and offer a copy. Revoking a patient's Conditional Discharge is a three- or four-step process.

Staff must make reasonable efforts to locate the patient and direct the patient to attend an examination to evaluate the patient's mental condition. If necessary, staff can request a law enforcement officer to locate the patient, if the patient is not readily available, and bring the patient to the examination.

Once located, staff offer copies of documents and explain the revocation process to the patient. They conduct an examination, and after evaluating the results of the examination, a Community Mental Health Center psychiatrist or Advanced Practice Registered Nurse (APRN) may direct staff to temporarily revoke the patient's Conditional Discharge.

The patient is then transported back to New Hampshire Hospital. Upon re-admission to NHH, the patient's NHH psychiatrist will conduct a further evaluation of the patient's mental status.

If circumstances warrant, the psychiatrist may issue an Absolute Revocation of the patient's Conditional Discharge, explain it to the patient, and offer the patient a copy of the documents. If the patient wants to appeal the Absolute Revocation of the Conditional Discharge, an appeal hearing will be scheduled within 5 working days.

Absolute Revocation of Conditional Discharge Notice Proposed and Temporary Revocation of Conditional Discharge Notice RCD Appeal Hearings The DHHS Administrative Appeals Unit (AAU) schedules and conducts hearings for patients who appeal a Revocation of Conditional Discharge (RCD). ( RSA 135-C:51, and Administrative Rules He-M 609.06 and He-M 609.07 ). The AAU is independent of New Hampshire Hospital and other DHHS divisions.

It conducts impartial hearings and renders decisions in accordance with the requirements of NH Statutes and Administrative Rules. While these hearings are formal legal proceedings, they are conducted in an informal manner, allowing patients who challenge a NHH decision to explain to an impartial hearing officer why they object to the revocation.

At the hearing, the hearing officer will review documentary evidence of the procedures followed in revoking the patient's Conditional Discharge. The hearing officer will hear testimony, under oath, from the doctors and staff involved in the revocation, and allow the patient and the patient's appointed attorney to question and cross-examine those witnesses.

Within 3 working days after the hearing, the AAU will issue a final written legal decision that may uphold or reverse the decision to revoke the patient's Conditional Discharge. If the decision is reversed, the patient may be discharged back to the community under the terms of the original Conditional Discharge. If the decision is upheld, the patient may continue treatment at NHH until the treatment team determines the patient is once again stable and ready to be conditionally discharged home again.

Emergency Treatment Authorization Hearings Patients admitted to NHH for psychiatric care on an involuntary basis may refuse any or all medications proposed by the treatment team, unless the patient has a guardian.

NHH staff must gain the informed consent of the patient or guardian before administering medications. However, if a patient's condition deteriorates into a psychiatric or medical emergency requiring treatment, the psychiatrist can request authorization to administer medications on an emergency basis, without the patient's consent, for up to 45 days (pursuant to Administrative Rule He-M 306 ).

Once the psychiatrist makes a request to administer emergency treatment, the patient is appointed an attorney and the AAU schedules an administrative hearing within three days.

Once the hearing begins, the hearing officer is responsible for determining that: 1) the patient lacks the capacity to make an informed treatment decision; 2) a medical or psychiatric emergency exists; 3) the proposed treatment is the least restrictive appropriate alternative available; and 4) a reasonable person would consent to the treatment. Only two Emergency Treatment Authorization requests may be approved during any single admission period. For chronic cases, the treatment team will assess the patient's need for the appointment of a guardian.

Renovations completed in the fall of 2013 at New Hampshire Hospital created a new office suite for Legal Services that includes a dedicated waiting room and courtroom. Click on an image for larger view. Adobe Acrobat Reader format. You can download a free reader from Adobe. "

. The State of California; 5015: Involuntary 72 Hour Hold: The 5150 code falls under The California Welfare and Institutions Codes, it is in no way a Penal Code advisement. A person must meet three criteria to be 5150’d.

What is a 5150? (AKA 72 Hour Hold)

"What is a 5150? (AKA 72 Hour Hold)Catherine September 27, 2010What is a 5150? If I have a record my job will fire me, and it’s no easy getting a job w/ a record.~~~~~~~~~~~~~~~~~~~~~~~~~~~~Well now you’d think working in Mental Health, specifically the ER Department of Psychiatric Triage, I could write this answer in my sleep. WRONG! I just assumed (and we all know what that means, but in this case it only includes the me part) everyone lives in California.

Sometimes I think my brain has left the building in Elvis’s pocket. FB has how many millions of users?

And I know many of you wouldn’t even want to live here and I don’t think you’d all fit anyway. But I digress. Basically a 5150 is an involuntary hold for someone who shows possible signs of a mental illness. This is a California code. All but 4 states have some version of this type of hold. Some of these versions, for lack of a better word, are harsh.

Some in my humble opinion even border on the violation of a persons constitutional rights. While doing research to answer this question some of the information I discovered left me quite unsettled.

I’m going to give you examples from three different states. I’ll let you, the reader decide which ones you find disturbing and ones you find a bit more reasonable.

State of Florida; The Baker Act: Voluntary Hold: The Baker act was first introduced into Florida law in 1971 by legislator Maxine Baker. It was first called The Florida Mental Health Act. Ms. Baker was a mental health advocate who saw the elderly being institutionalized by their adult children to embezzle their money, husbands and/or wives doing the same thing as to avoid divorce that could leave them penniless.

These intolerable acts and others like them encouraged her to put into law The Florida Mental Health Act.

After her passing it became the Baker Act. Now this act is used to allow family members to have another family member forced into psychiatric care or to involuntarily place a person into psychiatric care under some rather questionable acts and criteria. If a family member wants someone placed into psychiatric care all they have to do is go to the court house, fill out an affidavit stating they witnessed behavior from a family member that was a danger to self , others or gravely disabled.

A judge signs an order and local law enforcement is called upon to take the person into custody and deliver them to an ER. Then they will be placed in a psychiatric facility. Of course under the law this behavior must be “witnessed”. Almost all judges will sign the order as a matter of routine. I don’t think Ms. Baker EVER intended to see her law used as it is today!State of Florida; The Baker Act: Involuntary 72 Hour Hold: Anyone from a judge, mental health care provider, family member or friend can state or suggest that a person possibly 1) has a mental illness, 2) could be a harm to self or others, or 3) be self neglectful.

A judge signs an ex parte order and then law enforcement can be called, the person picked up, handcuffed and sometimes with no explanation be taken to an ER to be medically cleared.

After that they are taken to a facility where a designated person, usually the charge nurse who checks to make sure the person meets basic criteria for a 72 hour hold.

A qualified examiner has 24 hours to decide if the person meets official criteria for the hold, if they don’t meet criteria they are discharged from the facility. If they do meet criteria the treatment team has five days to create a treatment plan. So even if the person’ 72 hour hold is up they can’t leave.

The team still has five days to create a treatment plan. So they still have to wait up to five days to leave. Hmmmmm sounds like a little more than 72 hours to me, but hey my math isn’t all that great. State of Pennsylvania; 302: Involuntary 72 Hour Hold: A person meets the criteria for a 72 hour hold if 1) They have had a mental illness for at least 30 days.

2 ) They are a danger to themselves; this includes verbalization’s of threats to mutilate, to commit suicide or in any other way harm themselves (these statements can be made to counselor, therapist or a physician).

3) They are a danger to others by threatening, attempting to or inflicting serious bodily harm on another. 4) They cannot satisfy need for food, clothing, shelter or provide safety for their own protection that could possibly lead to death. The petitioner writing the 302 for the hold must have first hand knowledge of these behaviors and have the 302 signed by the Office of Behavioral Health. From here on out any action that requires paperwork must be received by the OBH. Then the person is either transported by law enforcement or ambulance to an ER for medical clearance and the need for a psychiatric evaluation.

If the person has to wait more than 12 hours the hospital must file a reason for just cause. Events that are accepted as just cause are; a population with a high acuity or one or more trauma situations. Once the person is medically cleared from the hospital they are then taken to a psychiatric facility. If after 72 hours the treating psychiatrist feels that the patient no longer meet criteria they must be discharged immediately. Wow! Only a twelve hour wait, I can remember sitting with sick babies longer than that! Of course this was before the advent of Urgent Care’s

. The State of California; 5015: Involuntary 72 Hour Hold: The 5150 code falls under The California Welfare and Institutions Codes, it is in no way a Penal Code advisement. A person must meet three criteria to be 5150’d.

All three of these criteria must be met under the assumption that a person could have a mental health issue.

1) Danger to self, a person must be in imminent danger of harming themselves. If they verbalize words or phrases such as suicide, I want to die, I don’t want to live anymore or he/she is hearing voices telling them to harm themselves they meet criteria.

2) danger to others, must be in imminent danger of harming another person. If they verbalize words or phrases such as I’m gonna kill that guy, you just wait till I get out of here and see what I do to her or he/she is hearing voices telling them to hurt someone they meet criteria. 3) Gravely Disabled this person has no means of food, shelter or clothing or is unable to keep themselves safe they meet criteria.

A 5150 advisement is not an application for involuntary admission. A designated person sometimes the charge nurse or other licensed staff must assess this person face to face to see if they possibly meet criteria. The psychiatrist can only make that final decision. Then one of two things happen, the psychiatrist chooses to keep them on full 72 hour hold or they are deemed as a Disposition Pending. This means the psychiatrist wants to observe the patient overnight and see how they are doing the next day.

If the psychiatrist feels they no longer meet criteria they are released. In most states that I’m aware of a 72 hour involuntary hold is confidential and should not prevent you from getting a job. You cannot own, purchase or posses a firearm for five years after being placed on a 72 hour involuntary hold. The Department of Justice does keep a record of this. They can’t say why you’re just placed on a list that gun and firearm dealers are given.

The only type of employment you might have some trouble with (and I’m not 100% sure about this, they could look at each case on an individual basis) is any type of law enforcement job, but like I said I’m not completely sure.

I certainly hope I helped you understand a little better what “5150” is. They are called many different things in other states, but they all mean the same thing; a 72 hour involuntary hold. One other bit of information that is somewhat important, a psychiatrist is who ONLY one who can rescind a 72 hour involuntary hold.

Link to this post!Related5150 Involuntary Psychiatric Hold and Anorexia October 19, 2011In ""Bipolar""Hidden or Obvious? November 9, 2011In ""Bipolar""Is there anything that I can do to help support someone with this disorder? November 17, 2011In ""Bipolar""How believing in a higher power has contributed to my recovery. The Dr told me I was bipolar. What does that mean? I’ll get better right then I won’t have to take meds for long right? "

In addition to the Marchman Act for substance abuse, the Baker Act is a Florida statute that provides for court ordered involuntary assessment for mental health disorders. If carefully applied to a unified and strategically supportive care plan, it may represent a critical first step towards the long-term recovery process.

Although Care Plan Pro does not provide legal advice, we do provide professional services to support all those impacted by substance abuse and mental health disorders.

With Care Plan Pro you no longer have to wait for a crisis to take action. Your licensed Care Plan Pro intervention counselor may be able to initiate the Baker Act on-site provided specific criteria are met. Otherwise we will support efforts with local courts and first responders to initiate the process. Once the Baker Act is in place, we will continue to work to support manageable treatment solutions based on the clinical findings.

An individual may be taken to a secured receiving facility for an involuntary mental health examination under the following conditions: The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination; or the individual is unable to determine whether examination is necessary; and Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or 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 person will cause serious bodily harm to self or others in the near future, as evidenced by recent behaviors.

Give us a call to see how our services can assist your family. Share this