Baker Act, Which Can Bring Long-Term Healing, on the Rise in Polk County and Florida

Published: Saturday, July 27, 2013 at 9:58 p.m.

Last Modified: Saturday, July 27, 2013 at 9:58 p.m.

Jordan, a Lakeland resident, said he grew up in an abusive home, raised by relatives who often locked him in his room for 23 hours a day.

One day Jordan snatched a revolver that belonged to one of those guardians and ran away, fully intending to shoot himself. As Jordan agonized over whether he could go through with it, the gun fell from his bag full of possessions, hit the ground and fired. He still has a scar from where the bullet hit him in the leg.

Police officers arrived and invoked the Baker Act, the Florida law that allows law-enforcement officers (as well as mental health professionals and judges responding to a petition by a family member or guardian) to have residents taken into custody for involuntary mental evaluations that can lead to forced admissions to treatment centers lasting a few days or longer.

The number of residents taken to mental health centers under the Baker Act has been rising in recent years. Some 150,466 Floridians, an average of 412.2 per day, were Baker Acted in 2011, the most recent year for which figures are available. That's a 50.8 percent increase from 2002, when the average was 273.3 a day.

In Polk County, an average of 13.1 residents were confined under the Baker Act in 2011, up from 7.9 a day in 2002.

Jordan, now 26, is one of several local residents who shared their experiences of having been Baker Acted, the phrase commonly used to describe application of the Florida statute. Most of them said the Baker Act is necessary and generally produces positive results.

"I wasn't going, ?Yay, I'm in the psych ward,'" Jami Campbell of Winter Haven said of being taking to a hospital under the Baker Act. But she added, "It got me on the journey to recovery."

Act changed system

The Florida Mental Health Law, passed in 1971 and informally named for former legislator Maxine Baker, was intended to bring Florida into the modern age of mental-health treatment. Before the Baker Act, Floridians with mental illnesses could be declared incompetent in court, have their civil rights revoked and be sent to a state mental hospital, where they might remain for life without any systematic review of their cases.

Even after release, the citizens rarely had their civil rights restored, leaving them unable to marry or vote, according to a history from the Louis de la Parte Florida Mental Health Institute at the University of South Florida.

The Baker Act, its rules delineated in a 496-page state manual, says anyone taken into custody for a mental exam must be transported to the nearest receiving facility. Polk County has three such facilities: Lakeland Regional Medical Center (up to 58 beds), Winter Haven Hospital (28 beds) and Peace River Center's Crisis Stabilization Unit in Bartow (34 beds).

LRMC reported taking in 3,419 patients under Baker Act orders from June 6, 2012, through June 17 of this year, an average of 9.1 per day. WHH reported receiving 1,887 Baker Act patients in 2012, an average of 5.2 per day. Peace River Center reported doing examinations on 2,687 people last year.

Florida Hospital Heartland in Lake Placid only accepts Baker Act patients ages 55 and older. Anyone younger Baker Acted in Highlands County is taken to Peace River Center.

?Saved my life'

Jordan, who said he has chronic injuries resulting from his childhood abuse, estimated he has been Baker Acted at least 35 times, though not for nearly four years. Jordan, a cheerful fellow with a broad face and floppy hair, said he was diagnosed at age 12 with post-traumatic stress disorder and schizoaffective disorder, a condition that combines symptoms of schizophrenia and mood disorders. He said he sustained physical, emotional and sexual abuse during his childhood, and he suspects the hallucinations arose as a coping instinct during his forced isolation.

"I have flashbacks and I hear voices every once in a while because of everything that's happened," he said.

Jordan said the Baker Act provided a mechanism for temporary escape from his miserable home life. He said he became a "cutter," intentionally slicing his own skin, a common practice among victims of abuse. He said he also sometimes wound up in jail after acting out.

"Whenever I got Baker Acted, it was kind of like a safe haven," he said. "At that time, I kind of felt between jail and Peace River (Center) and the Baker Act, it was safer than my home. ... I'd run away and then on top of that a few times I tried to kill myself again. Pretty much, I'd try any way I could to get Baker Acted at that time."

About four years after his first Baker Act, Jordan said, he was moved to foster care. He said later episodes occurred after he was prescribed medication that didn't work.

"Basically the Baker Act's what saved my life because they're the ones who called DCF (the Department of Children and Families) about it," Jordan said. "It kind of makes you think, with all the abuse and everything, what if I didn't get Baker Acted?"

Jordan now lives with his fiancee. He is a founding member of Club Success, a Lakeland gathering place that provides social support, educational help and job training for people with severe mental illnesses. He said he is in the process of getting a job with help from Peace River Center, a nonprofit agency that provides treatment, education and advocacy for people with mental illnesses.

Forced to treatment

Of course, not everyone dealing with a mental-health crisis willingly seeks a Baker Act admission.

"A lot of times when people are Baker Acted, they don't like to admit they need help," Jordan said, "and a lot of times that's when they need it the most."

Melvin Jones, another regular at Club Success, said he has been taken into custody under the Baker Act more than 50 times, starting at age 14. Jones, 40, said he has been diagnosed with schizophrenia and bipolar disorder. He said he has been stable since starting an effective regimen of medications four years ago.

Jones said his first Baker Act occurred after his mother took him to a hospital emergency room because he was having migraine headaches. During a long wait for treatment, he said, he grabbed a fire extinguisher and started "acting up" and then resisted police officers who responded.

Jones said he endured physical and sexual abuse in his childhood and admits he has problems with anger. He said he was Baker Acted about three years ago after pulling a knife on a roommate he said was constantly picking on him.

Other than an eight-month stay at Northeast Florida State Hospital in Macclenny, Jones said his longest time in treatment under the Baker Act was 18 days.

Jones expressed mixed feelings about his experiences with the Baker Act. He said he was committed once after his aunt wrongly reported he had threatened to harm himself.

"Sometimes I got Baker Acted when I wasn't doing nothing much," Jones said. "Police throw you in the back of a car and some want to talk bad to you sometimes. It's a trying experience. Then sometimes people don't understand people with mental illness, and they seem to put them on the back burner like they ain't really people."

But Jones said he benefited from being sent to the state mental hospital. While there, he said, he attended classes and community meetings and learned the techniques of anger management.

"A lot of times when I got Baker Acted I needed it because I needed time to rest and needed to settle down," he said. "There was a reason why I was there because if I wouldn't have went to some of these places to get some rest, I probably wouldn't be here now. I probably would have got in trouble or got hurt."

A question arises: Can someone who thinks he was wrongly Baker Acted take legal action?

State law provides immunity to those involved in Baker Act orders, from law enforcement to doctors to judges. It is possible to file a civil suit on the grounds of malicious action or negligence, but such a case would be difficult to win, said Ted Eastmore, a Sarasota lawyer and chair-elect of the Florida Bar's Trial Lawyers Division. One potential ground for a legal case: A passage in the statute says behavior resulting from a developmental disability does not meet the criteria for Baker Act detention. Some might fear the lasting effects of a Baker Act incident. Might potential employers find a record of an involuntary mental exam?

That is unlikely. Unlike arrest reports, Baker Act forms completed by law enforcement officers are confidential and exempt from Florida's broad public records laws. But incident reports compiled by officers who take a person into custody under the Baker Act are considered public records, according to DCF.

In practice, law enforcement agencies do not routinely release those records but are compelled to do so in response to a specific request. A potential employer would have to know about a Baker Act incident in order to request a report by date.

A law passed in this year's legislative session expands the list of Floridians barred from buying guns or obtaining concealed weapons permits to those detained under the Baker Act and then voluntarily placed in a mental-health facility. Previously, that ban applied only to those involuntary ordered to receive mental-health treatment. Under the new law, the names of Floridians Baker Acted and then admitted for treatment, whether voluntarily or otherwise, will be added to a federal database, the National Instant Criminal Background Check System. The law might have the unintended consequence of discouraging people from seeking voluntary treatment, said Risdon Slate, a professor of criminology at Florida Southern College.

"Most people who are mentally ill are not violent, but you'd never believe that based on what you see in the media," Slate said. "What I see the potential of this (law) doing is it's going to result in some individuals not even seeking treatment at all."

Uncovering issues

Joy McInerny of Lake Wales said she has been on "both sides of the fence" regarding the Baker Act. McInerny, who has been diagnosed with schizoaffective disorder, borderline personality disorder, major depression and post-traumatic stress disorder, said she was Baker Acted three or four times a year from 1994 through 2003 and was admitted to a state mental hospital twice.

McInerny now serves on the board of directors of the Polk County chapter of the National Alliance on Mental Illness (NAMI) and works as a consumer and family liaison for the Central Florida Behavioral Health Network, which administers funds from DCF.

"In general, I think the Baker Act is needed because sometimes people do need to be kept safe," said McInerny, 59. "Of course, sometimes the first Baker Act may uncover a much bigger problem the person has that hasn't surfaced until then, and that gives them a first chance to begin to receive treatment for that, which may of course get them back to work. It improves self-esteem if they go into recovery."

Even if the outcome is positive, McInerny said the initial act ? being handcuffed and taken into custody by law enforcement ? can be traumatic.

"The bad thing, of course, is it's involuntary," she said. "Who wants their usual, daily life interrupted? Nobody likes to get Baker Acted ? well, not many people, anyway."

Paul Cesarano of Lakeland said he has been admitted under the Baker Act "a few times." Cesarano, 52, said he has been diagnosed with schizophrenia and bipolar disorder.

Cesarano, a New York native, said he used to drink heavily in an attempt to relieve his depression and chronic neck and back pain resulting from a childhood accident. He said one Baker Act incident arose after his mother, with whom he was living at the time, called the police because he was acting "edgy." He said an admission to Lakeland Regional Medical Center led a doctor to prescribe Invega, an anti-psychotic medication. He now receives the injections at Peace River's Florida Assertive Community Treatment (FACT) Team in the Gilmore Complex in Lakeland.

"They finally figured me out," said Cesarano, who now lives in a group home operated by Peace River Center. "I feel a lot better now. The pressure was off. It was like I was born again."

Campbell, 41, said a combination of drug addiction and mental illness yielded her one admission to Lakeland Regional Medical Center and then Peace River Center under the Baker Act. She said she has also been taken into custody under the Marchman Act, a Florida law that allows relatives to have a resident involuntarily admitted for substance abuse treatment. At the time she was Baker Acted, Campbell said, she was abusing Xanax, a drug she had been prescribed for anxiety.

"I don't remember a lot about it because I was really messed up," Campbell said. "I remember being transported to Peace River and being there, like, three days. ... They were good to me. They took care of me because I went through really bad withdrawals."

Dementia and Baker

The rising number of Americans with age-related dementia can create circumstances that mimic mental-health crises.

One example occurred last year at an assisted-living facility in Lakeland. A man with Alzheimer's disease had recently begun living at Emeritus at Lakeland when he became agitated, said his wife, who asked not to be identified.

An employee from Emeritus called 911, reporting that the man had threatened to leave the facility and possibly walk into traffic, the man's wife was later told. An emergency medical crew arrived and called for police, and a unit soon came and took the man into custody under the Baker Act.

The man spent about a week in the psychiatric unit at LRMC, his wife said. The woman criticized both Emeritus and LRMC, saying the entire episode was unnecessary and traumatic and resulted in a $17,000 hospital bill.

The woman said she was working and unavailable by phone at the time of the incident but said Emeritus only attempted to reach her and none of the three other emergency contacts before calling 911. Dementia alone can be justified in invoking the Baker Act, according to guidance from the DCF. After the man was taken to LRMC, his wife said, it took 40 hours before she received a call from the hospital.

She said she arrived at the hospital to find her husband physically restrained and wearing an adult diaper, though he was capable of using the toilet. The episode led the woman to remove her husband from Emeritus after his release from LRMC.

Elizabeth Gamez, resident care director at Emeritus of Lakeland, said she wasn't working the night of the incident but remembers being told about it. Gamez said it's rare for Emeritus employees to call 911 when dealing with a resident, but she said staffers can choose to do so if they conclude the resident is a threat.

A spokeswoman for LRMC said she couldn't comment on that particular incident.

Following through

Like others with mental disorders, Cathy Burroughs of Lakeland seems to accept the possibility of being Baker Acted as a consequence of her illness. Burroughs, 58, said she has a primary diagnosis of bipolar disorder and a secondary diagnosis of schizoaffective disorder.

Burroughs said her bipolar disorder includes psychotic features ? such as delusions and hallucinations ? if she fails to take her medications properly. She recalled one incident in which a roommate called the police after she varied from her regimen.

"The officers who have taken me to the hospital have always been very polite and respectful," Burroughs said. "Of course, I didn't give them any trouble. ... Most of the officers who've been through Crisis Intervention Training, I think they're very well-trained."

Burroughs said she has become familiar with the psychiatric ward at LRMC after being taken there by Lakeland police officers.

"I hate being in LRMC," she said. "I get so bored. There aren't hardly any (support) groups, and I didn't see a counselor. I went to every group they offered, and they were few and far between."

Burroughs said she has been more stable since sticking to a regimen of three medications. She said she is pursuing certification to become a recovery peer specialist, allowing her to mentor others with mental illnesses.

She said she shares her Baker Act history with peers in the Lakeland NAMI chapter but not with everyone.

"I don't normally mention it," she said. "It's not something I bring up in casual conversation."

[ Gary White can be reached at gary.white@theledger.com or 863-802-7518. Join his discussion of books at http://ledgerlit.blogs.theledger.com or facebook.com/ledgerlit. ]

Source: http://www.theledger.com/article/20130727/news/130729355

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