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South Florida Sun-Sentinel

April 24, 2004

Reprinted with permission. All rights reserved.

Reform of law badly needed

With only a week to go in its annual session, the Florida Legislature has still not passed an important reform of the state's mental health law. Lawmakers must not let the measure be overlooked or pushed aside in the mad dash that usually accompanies the last week before adjournment.

The law, informally known as the Baker Act, authorizes law enforcement officers, judges and mental health professionals to involuntarily commit for inpatient observation and stabilization a person who appears to be in crisis and suffering from mental illness. But they can do so only if the person is judged to be an imminent danger to himself or others, and only for a period of 72 hours.

After that time, the person must be re-evaluated and, if not charged with a crime and if deemed to be stabilized and no longer an immediate threat, released. In all too many cases, the mentally ill person, once on his or her own, fails to take prescribed medications or follow a therapeutic treatment regimen at an outpatient clinic. It isn't long before he or she has "decompensated," or relapsed, and is either in trouble with the law or "Baker Act-ed" again, or both.

This is a foolish system that wastes money, helps few and stimulates recidivism, which wastes more money. It places an enormous and unaffordable burden on the criminal justice system, as relapsed mental patients are repeatedly arrested and incarcerated, usually for relatively minor offenses such as loitering or disturbing the peace.

Florida must follow the example of 41 other states and give the law the power to involuntarily commit a mentally ill person for court-ordered outpatient treatment, including requiring him or her to take prescribed medications. This would prevent a relatively small group of recidivists from exhausting the resources of law enforcement, the courts and the taxpayers while getting little or no help for their mental illness.

The recidivism is staggering. In Florida in 2002, there was a 14 percent increase in the number of adults with multiple Baker Act examinations, and 919 people were Baker Act-ed four or more times. One mentally ill person alone accounted for 41 such examinations at a cost of about $81,000, not counting court costs, law enforcement resources and long-term treatment.

Studies show that when people with severe and persistent mental illness receive appropriate treatment, they are no more violent or dangerous than people who are not mentally ill. It is when they fail to comply with treatment that they become dangerous to themselves or others. Mental illness is chronic, so continuity of care is vital. Waiting until they reach the danger point before ordering them to comply often means waiting too long. Inevitably, someone gets hurt.

New York and dozens of other states have passed laws authorizing court-ordered outpatient treatment for the mentally ill. These laws work. New York's resulted in 83 percent fewer arrests, 85 percent fewer incarcerations, an 85 percent reduction in homelessness and a 77 percent reduction in hospitalizations of the mentally ill. And a nationwide Duke University study found that long-term outpatient care reduces the risk of arrest or hospitalization by 74 percent, and that patients under such care are half as likely to be involved in acts of violence.

Florida spends untold millions of dollars dealing with the mentally ill in the criminal justice system. Broward County alone spends about $65 million a year on this problem, yet the expenditure does nothing to reduce the problem or help the mentally ill get better. This exposes the public to unnecessary dangers, and subjects the families of the mentally ill to a deepening cycle of frustration and misery.

Whatever else happens in the hectic last week of the session, legislators must make sure to pass CS-SB 700 in the Senate and HB 463 in the House. The bills are carefully crafted to reduce the likelihood of abuse. They would establish a nine-part set of criteria a court must meet before ordering involuntary outpatient treatment. They recognize for the first time a clear interest on the part of both the state and the person with mental illness to see to it that the person receives the treatment he needs before he becomes a danger to himself or others.

The legislation has the support of, among others, the Florida Sheriffs Association, the National Sheriffs Association and the Treatment Advocacy Center, a national nonprofit organization "dedicated to eliminating legal and clinical barriers to timely and humane treatment" for the mentally ill.

It should have your support as well. It would protect and help the mentally ill while shielding the public from the costs and dangers associated with untreated mental illness. Its provisions are humane and sensible and strike the perfect balance between the interests of society and those of the mentally ill.