Experts alarmed by increase in Baker Acts


Published: Sunday, November 24, 2013 at 6:01 a.m.
Last Modified: Saturday, November 23, 2013 at 9:26 p.m.

Dr. Steve Pittman, the chief operating officer at Meridian Behavioral Healthcare and a clinical psychologist, likes to think of the Baker Act as mental health ER.

"The Baker Act is designed as the ultimate safety net," Pittman said.

People who are Baker Acted in Gainesville are taken to either UF Health Shands Psychiatric Hospital or Meridian Behavioral Healthcare. Within the first 24 hours, a psychiatrist decides if a person really needs to be there and if that person can make decisions about their mental health care, Pittman said.

"I'm sure any given individual would question why they had been Baker Acted," he said.

Hospitalization happens to a small percentage of people, but it's not uncommon, he added.

"I wouldn't wish it (hospitalization) on anyone who is stable," he said, adding that hospitalization is also a costly option for the state.

Baker Acting has increased 79 percent in Florida over the past decade, according to the Baker Act Reporting Center at the University of South Florida. Part of the reason for the surge may be that, "you have an economic environment where people lose jobs … that also increases the pressure that they feel. People get to the breaking point," Pittman said.

Kristina Ragosta, the director of advocacy at the Treatment Advocacy Center in Washington, D.C., said she isn't sure if the spike is necessarily a red flag for over-usage of the law, or a red flag regarding inadequate follow-up treatment with patients.

A significant number of the calls the center gets come from Florida, Ragosta said, mostly from people trying to get help for their loved ones.

Ragosta applauded Florida's reform of the Baker Act in 2004 to allow involuntary outpatient placement (IOP), which in Seminole County led to a 43 percent decrease in hospital stays over an 18-month period.

She added that she's not aware of other counties in the state that are actively using IOP, nor the reason for the implementation delay in other counties.

The focus on outpatient treatment for non-compliant patients uses a team approach — there's a care manager and several medical experts involved in the oversight of all patients — and avoids the "revolving door" syndrome of people who repeatedly are Baker Acted, coming in and out of inpatient care.

That's also costly — $81,000 for one patient Baker Acted four times, according to one study.

The data in Seminole County showed that using IOP instead cut costs for 36 patients by more than $4,000 per patient. IOP also reduced incarcerations significantly.

That's important because it's not uncommon for untreated mentally ill patients to enter the criminal justice system, Pittman said.

"There are folks who end up in the prison system who probably could have avoided it if the proper treatment had been in place," Pittman said, adding that prisons are one of the largest mental health providers in the state.

Florida jails five times more mentally ill patients than it hospitalizes, according to the Treatment Advocacy Center.

Nationwide, about 40 percent of the prison population receives some form of mental health care, compared with about 10 percent in the 1950s, said Elizabeth Kelley, a lawyer based in Spokane, Wash., who specializes in clients with mental health conditions and intellectual disabilities.

"Our prisons have become de facto mental institutions," Kelley said. "We as a society have not come up with a way to provide support services to seriously mentally ill people. We need to rethink and revamp our system of community-based treatment."

One challenge to that is the nationwide lack of funding for mental health care. Florida ranks 49th in funding. At the same time, the number of hospital beds in treatment facilities has declined, curtailing ongoing care for people who really need it, Pittman added.

That was illustrated last week when Austin "Gus" Deeds, the son of a Virginia state senator, stabbed his father and killed himself after local hospitals failed to find a bed in a psychiatric institute for him.

The stigma associated with mental illnesses also has made it hard to treat people, Pittman said.

"Part of the situation is recognizing that mental illness is no different than any other illness; if you have diabetes, people understand the need to treat," Pittman said.

The recent federal ruling on the implementation of the Mental Health Parity Act — requiring insurance companies to cover mental illness and substance abuse just as they cover physical illnesses — "is a step in the right direction," Kelley said.

Pittman agreed that the ruling is promising for a lot of people, but he said he's still concerned that many Floridians will fall through the cracks because the state government didn't opt to expand Medicaid under the federal health care overhaul, leaving a number of people with mental health conditions in the coverage gap.

While consistent outpatient care is what many experts say would work best to curtail Baker Acts, Kelley cautioned that in the wake of rampage shootings, "the pendulum is swinging the other way" toward more policing of the mentally ill.

The irony is that mentally ill people are more likely to be the victims rather than the perpetrators of crimes — unless they go untreated.

"There is maybe a small percentage of mentally ill people who should be institutionalized," Kelley said. "The vast majority, if they have access to medications, work and support groups, will be productive and law-abiding citizens."

Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.

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