Baker Act being overused?
Published: Sunday, November 24, 2013 at 6:01 a.m.
Last Modified: Saturday, November 23, 2013 at 10:25 p.m.
On Mary Williams' first day at Northeast Florida State Hospital in Macclenny, she was told about the “hitters.”
The woman assigned to show Williams around told her, “You can hit them back if they hit you,” Williams recalled.
That same day, Williams said she saw a patient shoved to the ground by staff and dragged to her room.
“When I thought of what state might be like, it exceeded my every nightmare,” Williams said.
In July 2012, Williams was taken in under the state's Baker Act, involuntarily placed under psychiatric examination for 72 hours. Her then-boyfriend, unable to rouse her from a drugged sleep, called police and told them Williams was suicidal.
Williams, 43, said she had been drinking and took some medication to help her sleep but was not suicidal. She was held at UF Health Shands Psychiatric Hospital for 72 hours and then released.
When she got home, her boyfriend wasn't there. She panicked and ingested some ammonia. She was Baker Acted again, this time sent to Northeast Florida State Hospital for six months.
The doctors cited non-compliance with medications as one of the reasons for Williams' hospitalization. She said her lack of insurance and Medicaid (as a single, childless adult) made taking her medications a constant battle.
The judge sided with the doctors, and Williams was sent to the state hospital.
On her first day, Williams said she felt she was in a place that was not going to help with her lifelong battle against depression and anxiety.
Williams has a history of hurting herself that began when she was 5 years old.
“I would jump on my knees and bite my wrists,” she said.
She also went through bouts of bulimia. “I tried everything that was self-destructive,” she added.
Her parents didn't know what to do about her struggles, she said.
Her father was a renowned wild turkey expert and her mother an elementary school teacher. Williams attended P.K. Yonge Developmental Research School. Her family, she said, had an image to protect.
“They didn't want me labeled,” Williams said, adding that she wishes she had been labeled as a child so that she might have avoided struggling as an adult.
At the state hospital, Williams said she felt trapped but not voiceless.
She decided to speak up about the woman who was shoved to the ground — the first of many times Williams spoke out against what she saw there.
“She didn't have a voice. I have a voice,” Williams said, a year after her release.
Use of the Baker Act has increased nearly 80 percent over the past decade in Florida. The vast majority of Baker Act cases occur with people believed to be at risk of harming themselves and 20 percent because they pose a potential danger to others.
Mental health professionals initiate about half, with law enforcement officials responsible for the other half.
The Baker Act was enacted in 1971 to create safe havens for mentally ill people following the closure of mental institutions about four decades ago, said Jean Theurer, the president of Gainesville's chapter of NAMI, or the National Alliance on Mental Illness. “Unfortunately they did not establish alternatives … a lot of people have ended up in jails and on the streets,” Theurer said.
While the Baker Act is intended as a safety net, the recent surge in its usage has some experts concerned that it is being overused and misused.
People assume that those who are Baker Acted are mentally ill and should be hospitalized, said a Florida-based lawyer who specializes in freeing people who claim they have been unjustly Baker Acted. But “a good number” of those who are Baker Acted are not mentally ill and are the victims of vengeance and mistakes, said the lawyer, who asked that he not be identified because of security concerns.
Laurie Anspach, the executive director of the Citizens Commission on Human Rights of Florida in Clearwater, said she gets about 10 calls a day about people who believe they have been wrongfully Baker Acted, from the elderly to parents who think their elementary school-age children have been unfairly Baker Acted.
“Girls who are cutting themselves and get picked up by police at school, a kid who pushed his cousin to the ground, a college kid who drank too much and they questioned him at the ER when he was too drunk to respond lucidly,” Anspach said. “We've seen way too much misuse of the law.”
Law enforcement officials and emergency room physicians don't have a disincentive for Baker Acting because of liability concerns, the lawyer said.
His own concern is the violation of civil liberties since people can be held for 72 hours in a way similar to criminals — locked in their rooms, strip-searched — without visitors or judicial review.
The lawyer said he also is concerned that some patients are coerced into signing voluntary submission forms once they've been Baker Acted.
Mark Poulin said he didn't understand that he had signed a form for voluntary submission when he was Baker Acted last year.
Two years before, Poulin, 53, had suffered a traumatic brain injury after a chunk of tree he was sawing in his yard in Gainesville hit him in the head. Complications from the injury caused him to lose his ability to read or write. At the time of his accident, he was going through a divorce and a custody battle for his 5-year-old son.
“My ex-wife said, 'You can't take care of your son,' ” and took him, Poulin said.
He said that when his son said, “Daddy, I'm never going to see you anymore — only in my dreams,” he became suicidal.
He tried slitting his wrists. But he woke up “happy I was alive,” Poulin said. “I knew that I made a mistake.”
He stayed for three months at Shands Psychiatric Hospital, where he said the staff treated him well, but he was heavily medicated. “They just hammered me with pills. I didn't even know where I was,” he said.
Poulin ended up at Northeast Florida State Hospital for six months.
“I kept asking, 'Why am I here?' ”
Since Poulin couldn't read, and watching television gave him a headache, he said he spent most of his time playing Sudoku in his room. He gained 30 pounds — which he attributes to all the medications.
“I was really quiet. I didn't make waves,” he said.
But he did become increasingly depressed, unable to work or talk to his son, he said. “I'm a working kind of guy,” Poulin added.
Poulin used to run his own small business, building porch screenings and pool enclosures. Going back to work would have been more therapeutic than being hospitalized, he said.
“(The state hospital) wasn't rehabbing,” he said. “It was going the opposite way.”
He also said that staff sometimes treated him poorly.
“They would tell me, 'Mark, we've been watching you, and you can read and write.' They didn't understand that mine was an injury,” Poulin said.
One day, Poulin said he asked his case manager how much longer he had to stay, and the case manager said, 'You're here voluntarily. You can leave.' ”
Poulin said that was the first time he learned about his voluntary status.
He said he thought to himself, “Wait a minute, guys. I lost my house, my son. Everyone is putting the blame on me, but someone dropped the ball.”
One year later, Poulin said he is not suicidal but is depressed. He still hasn't seen his son.
But Poulin hasn't lost hope.
“I want to move on with my life, and I want to get better for my son. I want our relationship back,” he said.
Poulin goes to counseling every week at Meridian Behavioral Healthcare and said that he is generally “stressed out.” He's staying with a friend and receives food stamps.
He said he often wonders, “Am I going to pay my phone bill this week?”
Poulin's period of hospitalization coincided with Williams'. The two hit it off. “Mary was my advocate,” Poulin said.
Williams considers herself a born caregiver. She studied nursing at Santa Fe College and worked for years as a baby sitter and nanny.
“Taking care of people is my comfort zone,” she said.
And that's what made the atmosphere at the state hospital so hard to stomach, she said.
At 6:30 a.m., all of the patients had to be in the common room, where they had to watch “Good Morning America,” she said.
“That's when the fighting started,” Williams said. “They would say, 'If you guys are acting up, there's no coffee today.' ”
Staff routinely cursed at patients, she said, and told people like Williams — who spoke up — to keep their mouths shut. “The culture of abuse is just accepted,” she said.
Patients scavenged out of garbage cans and stole, she said.
“It was like a bad neighborhood. There was littering, stealing, fighting, begging, yelling, slamming doors and going through trash cans,” Williams continued. “One of the sports was flushing shirts down the toilet.”
During the day, patients went to behavioral therapy classes and group therapy sessions, Williams said. She met with a psychiatrist once a month.
“The head psychiatrist was actually a wonderful man,” Williams said. “I told him, 'This place is scaring me to death.' He said, 'This place is not for you.' ”
Most of the workers at the state hospital, called “psychiatric technicians,” don't have an educational background in psychology or psychiatry, said hospital administrator Joseph Infantino. But they are required to undergo a two-week training program before they can step foot on a floor. They are primarily responsible for dispensing medications and keeping order in the units.
Infantino said facilities such as Northeast Florida State Hospital “are at the deep end of the problem.”
The average length of stay in the 633-bed facility is a little under three years, he said. Fifty-five percent of patients are in and out in a year.
He calls the therapeutic approach “individualized person-centered recovery” that takes into account what the person has experienced throughout his or her life — be it abuse as a child or other challenges.
The hospital also has a staff of psychiatrists, psychologists, nurses, certified nursing assistants and primary-care doctors.
Infantino, who has a background in education and criminal justice, has worked at the state hospital for 24 years. “You like it or you're gone,” he said. Asked what he likes about it, he didn't hesitate: “Seeing people get better … from their sickest to shaking their hand and telling them goodbye and good luck.”
Infantino said he doesn't recall Williams or Poulin. When told about her grievances, he said: “I wish I could say every patient who comes to us involuntarily is happy.”
For Williams, getting out of the hospital in December 2012 was both euphoric and scary.
“I was thinking, 'Am I gonna feel weird?' Or are people gonna look and say, 'Oh, she's crazy.' ”
The lease on her apartment had run out while she was at the state hospital, so she went to live with her mother. “I don't know what I would have done if a friend hadn't packed up a trailer with my things,” she said. “What are people supposed to do? You could totally destroy someone's life.”
Williams said she also had several thousand dollars' worth of bills, mostly from Shands Psychiatric Hospital, but a charity program there helped her pay them off.
Recovering from her time at Northeast Florida State Hospital has not been easy, she said. She filed complaints about her experience with the Department of Children and Families but has not heard back from them.
She said she feels liberated from her experience and ready to move on. She's eager to be on her own financially and wants to go back to school to study education.
While many people who have been Baker Acted and institutionalized, including some of Williams' closest friends at the state hospital, prefer to quietly turn the page on that chapter of their lives, Williams said she wanted to share her story because she feels the system for people with mental health conditions is broken.
One of her lifelines at the hospital was her journal. She's kept journals throughout her life, sometimes filling them with poems, she said. But the trauma of her experience sucked out her creativity, she said — so she just wrote down what she saw.
“It's a very jail-like community,” Williams said. “Exposing someone to that who hasn't committed a crime is a crime in itself.
“I don't know how much the state spent to lock me up, but it would have been much better to provide me with therapy,” she continued.
“I often wondered, 'Isn't there a better way to deal with this?'”