TREATMENT FOR THOSE WHO NEED IT MOST: BAKER ACT BRINGS HELP, HOPE TO FLORIDA'S UNTREATED MENTALLY ILL
Governor Bush signs landmark legislation initiated by Florida Sheriffs Association

Arlington, VA – Gov. Jeb Bush today signed HB 463/SB 700, the Florida Sheriffs Association's legislation to reform that state's mental illness treatment law, known as The Baker Act. The law will allow court-ordered outpatient treatment for people with severe mental illnesses, like schizophrenia and bipolar disorder, who have a history of noncompliance combined with either repeated Baker Act admissions or serious violence. Cosponsored by Representative David Simmons, Senator Durell Peaden, and Senator Rod Smith, the legislation becomes effective January 1, 2005. 

Before passage of this law, Florida was one of only nine states that did not allow court-ordered outpatient treatment for people with untreated severe mental illnesses who did not voluntarily accept treatment - inpatient commitment was the only choice. "Court-ordered outpatient treatment is a less restrictive, less expensive treatment alternative for people who need intervention but do not require inpatient hospitalization," said Treatment Advocacy Center Executive Director Mary T. Zdanowicz. The Treatment Advocacy Center is a national nonprofit dedicated to removing barriers to treatment of severe mental illnesses. "States with similar laws that implement them effectively have had well-documented successes in helping people whose brain diseases prevent them from making rational treatment decisions," said Zdanowicz. 

Recent statistics on the first three years of New York state's similar law revealed that for people placed in court-ordered outpatient treatment, 63 percent fewer were hospitalized, 55 percent fewer experienced homelessness, 75 percent fewer were arrested, and 69 percent fewer were incarcerated. Individuals in New York's Kendra's Law program were also more likely to regularly participate in services and take prescribed medication. The number of individuals exhibiting poor adherence to medication decreased 67 percent and those exhibiting poor engagement to services decreased 42 percent. Kendra's Law has also had a marked effect on individuals with co-occurring substance abuse problems: participation in substance abuse services doubled. 

Florida's reform focuses on a small subgroup of those meeting existing involuntary examination criteria, recidivists who disproportionately use mental health, criminal justice, and court resources. "Not only does a court order commit someone to treatment, but it commits the system to help the person," said bill sponsor Rep. David Simmons. "This law can ensure existing services are used more wisely, and scarce resources are not exhausted by people continually entering and exiting the system without gaining stability." 

In 2002, one person was Baker-Acted 41 times, at a cost of approximately $81,000 - not including court costs, law enforcement resources, or short-term treatment. Recidivists' Baker Act examinations increased 50 percent between 2000 and 2002; 540 individuals had eight or more Baker Act exams in one 24-month period (2000 to 2001), averaging at least one every three months. 

Seminole County Sheriff Donald Eslinger has witnessed how lack of treatment drains resources from law enforcement. "Law enforcement officers are not mental health professionals and yet our deputies are increasingly responding to crises involving people who need mental health treatment," he said. "In 2000, there were 34 percent more Baker Act cases than DUI arrests. Florida law enforcement officers initiate nearly 100 Baker Act cases each day. This legislation will no doubt enhance mental health intervention and treatment services that will ultimately result in improved public safety for our communities." 

Oftentimes the unwillingness to stay in treatment is due not to denial or stubbornness, but to lack of insight. "Anosognosia, the neurological term for lack of awareness of illness, is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications," said E. Fuller Torrey, MD, president of the Treatment Advocacy Center. "Caused by damage to specific parts of the brain, anosognosia affects about half of those with schizophrenia and bipolar disorder. People with anosognosia often will not accept medication unless they are court-ordered to do so. When asked retrospectively about their experience with court-ordered treatment, the majority of those ordered to treatment agreed that it was the right decision." 

This focus on the improved quality of life for consumers with untreated mental illnesses is an important point to everyone involved in passing this legislation, especially treatment providers. "Assisted treatment provides for early intervention to prevent a crisis, and, better still, empowers people with mental illnesses to take control of their symptoms and their lives," explains Wayne Dreggors, President of Act Corporation and Chair of the Florida Council for Community Mental Health. "Having that legal avenue available in Florida can only serve the good of the people we serve, their families, and the community." 

Linda Gregory and Alice Petree know well the pain that can come from the unintended consequences of failing to treat a severe mental illness. Deputy Gene Gregory, Linda's husband, and Alan Singletary, Alice's brother, were both killed in a standoff six years ago resulting from Alan's refusal to take medication for his schizophrenia. They worked together on passage of this legislation. "We want other families to be able to get help for the people they love, before disaster strikes," said Linda. "Alan didn't believe he was sick," said Alice. "If we could have gotten him the help he needed, he and Deputy Gregory might be with us today." 

July 8 is the six-year anniversary of their deaths. 

Baker Act reform was reviewed in 15 separate legislative committee hearings before passing the House 100-15 and the Senate 39-0.

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The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

For more on the Baker Act reform effort, visit www.bakeractreform.org.

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