General Resources / Legal Resources / Medical Resources / Briefing Papers / State Activity    
Hospital Closures / Preventable Tragedies / Press Room / Search Our Site / Home

Miami Herald

December 10, 2001

Reprinted with permission of the author. Copyright 2001 Miami Herald. All rights reserved.

OPED
Reform Baker Act to Save Lives

By Steven Leifman, Associate Administrative Judge, Miami, Florida

Florida's Mental Health Act - the Baker Act - makes it difficult for law-enforcement officers and courts to help people who refuse treatment for severe mental illnesses. It permits courts to order in-patient treatment, but not outpatient care; also, there can be no intervention until people are a danger to themselves or others. The Baker Act was created 30 years ago when we knew less about mental illnesses and how to effectively treat people with these diseases. Florida should reform this antiquated law, and let courts order outpatient treatment. It also should allow courts to order assisted outpatient treatment (AOT).

Alberto Serrano, of Port St. Lucie, cycled in and out of hospitals 10 times in 10 years. When he finally was deemed ``dangerous'' enough to be hospitalized, he killed a nurse and three patients. If the court could have ordered AOT, he would have been monitored until he was capable of maintaining his own psychiatric care. Florida is one of only nine states that do not allow AOT. The most comprehensive study demonstrated that long-term AOT reduced the risk of arrest by 74 percent, the probability of violence by 50 percent and hospital admissions by up to 72 percent.

Let the standard be need for treatment, not the level of danger posed before courts can intervene. Then let mental health professionals, not law enforcement, manage patient care.

In 1998, at least 35 people with mental illness were killed in encounters with police. Eight of those shootings - about 20 percent - were in Florida, even though we have less than 6 percent of the U.S. population.

Nearly 750,000 adult Floridians have a severe mental illness; another 285,000 have a severe and persistent mental illness. Research indicates that about 40 percent of people with these illnesses are not receiving treatment at any given time.

This continues in part because of two myths: that people with untreated severe mental illness can always make decisions about their own care and that civil liberties are infringed by court-ordered treatment. However, untreated severe mental illness can affect someone's ability to recognize that they are ill. They often refuse medication and deteriorate.

People with severe mental illnesses undergoing treatment are no more dangerous than the rest of the population, but those who are left untreated are significantly more likely to become dangerous or suicidal. New York's AOT law is named after a woman who died after being pushed in front of a train by a person with untreated mental illness. Preliminary findings in New York show a 129 percent increase in medication compliance, a 26 percent decrease in harmful behavior and a 100 percent decrease in homelessness.

Do Floridians deserve any less?

[NOTE: Judge Leifman is a county judge in Florida's 11th Judicial Circuit and co-chairman of that circuit's mental health committee.]

general resources | legal resources | medical resources | briefing papers | state activity   
hospital closures | preventable tragedies | press room | search | home