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LANDMARK LEGISLATION FOR FLORIDA'S MENTALLY ILL
Baker Act reform offers compassion and hope for those too sick to help themselves: Florida becomes 42nd state to authorize assisted outpatient treatment

Arlington, VA – Gov. Jeb Bush’s signature on Baker Act reform is the first important step in halting the relentless revolving door of repeated arrests, short-term hospitalizations, and homelessness for thousands of people in Florida with severe untreated mental illnesses, like schizophrenia and bipolar disorder. The new legislation, effective January 1, 2005, will allow court-ordered outpatient treatment for people with severe mental illnesses who refuse medication because their illness impairs their ability to make rational decisions.

The Treatment Advocacy Center congratulates the Florida Sheriffs Association, led by Seminole County Sheriff Donald F. Eslinger, for three years of hard work to ensure the bill’s passage. Thanks to their efforts, and the support of Governor Jeb Bush, Representative David Simmons, Senator Durell Peaden, Senator Rod Smith, mental health advocates, and families across the state, Florida becomes the 42nd state to allow this proven treatment mechanism.

Baker Act reform will be a tremendous improvement for individuals suffering from the untreated symptoms of severe mental illnesses. This legislation closes a gap in current law that forces people who are severely ill to be repeatedly brought in for assessment under the Baker Act without guaranteeing sustained treatment. The problem was with followup – there was no mechanism in the law to ensure that someone leaving a treatment facility would stay on medications. And with the rapid and continued reduction of hospital beds for inpatient care, far too many people end up back on the streets, only to repeat the cycle again.

Involuntary outpatient placement saves lives. Involuntary outpatient placement, also called assisted outpatient treatment (AOT), is a less restrictive, less expensive treatment alternative for people who need intervention but do not require inpatient hospitalization. It is also a well-documented success. Recent statistics on the first three years of New York state’s similar law revealed that for people placed in assisted outpatient treatment, 63 percent fewer were hospitalized, 55 percent fewer experienced homelessness, 75 percent fewer were arrested, and 69 percent fewer were incarcerated.

Assisted outpatient treatment has also been shown to be effective in increasing treatment compliance. In New York, poor medication adherence dropped significantly, from 67 percent to 22 percent, after six months of assisted outpatient treatment. In North Carolina, only 30 percent of patients on AOT orders refused medication during a six-month period compared to 66 percent of patients not on AOT orders.

New law focuses on small subpopulation of sickest people. Florida’s new law focuses on those with a history of noncompliance combined with a history of either repeated Baker Act admissions or serious violence—a small subgroup of the people who meet existing criteria for involuntary examination. Although their numbers are small, these recidivists use a disproportionately high share of mental health, criminal justice, and court resources. In Florida in 2002, one individual alone accounted for 41 Baker Act examinations at an approximate cost of $81,000 – not including court costs, law enforcement resources, or short-term treatment. The number of Baker Act examinations for recidivists increased 50 percent between 2000 and 2002. There were 540 individuals who had eight or more Baker Act emergency examinations in one 24-month period (2000 to 2001), averaging at least one every three months.

This new law will help prevent tragic outcomes for many Floridians with severe mental illnesses. It is especially important for the 15,000 homeless on Florida’s streets and the 8,000 to 10,000 inmates in Florida’s jails and prisons, which hold more people with severe mental illnesses than the state’s remaining psychiatric hospitals.

Bill is a result of a broad coalition of support. For the past three years, the Baker Act reform bill, championed by the Florida Sheriffs Association, has been revised and improved by numerous stakeholders across the state, from the Florida Council on Behavioral Healthcare to the Department of Children and Families. It was reviewed in 15 separate legislative committee hearings and then passed with overwhelming support in both chambers: the House passed HB 463 100-15 and the Senate passed SB 700 39-0.

A unique coalition of family members, mental health professionals, mental health advocates, and law enforcement personnel orchestrated a statewide movement for reform that was backed by a slew of supportive editorials from Florida’s newspapers.

• The Orlando Sentinel, in one of three extraordinary editorials supporting the sheriffs’ bill, notes that the reform was critical “because Florida's severely mentally ill now are on a cruel merry-go-round. They bounce in and out of hospitals or jails, at great cost to society, themselves and their loved ones. Amending the Baker Act would open the door to a more effective, humane approach.”
• The Miami Herald, which also wrote three editorials supporting the bill, called the proposed reforms “humane, practical steps that would put the dollars that Florida spends on mental health to more effective use by placing these troubled individuals where they belong - in treatment rather than in jail.”
• The St. Petersburg Times noted that “[I]t makes sense to reform the law now. It would give judges one more option in dealing with repeat Baker Act cases, and if the process works, there will be even more motivation for lawmakers to expand mental health services.”
• And the South Florida Sun Sentinel said that the bill will “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.”

Sheriffs’ activism inspired by professional experiences and personal tragedies. Treating severe mental illnesses should be a medical issue, but Florida’s sheriffs know too well that law enforcement officers are increasingly becoming the first point of contact for people needing treatment. More than 100 times a day, law enforcement officers initiate the Baker Act for people with severe mental illnesses – in fact, in 2002, law enforcement handled more Baker Acts than burglaries. In nearly one-third of Florida counties in 2001, mental health professionals did not initiate a single Baker Act psychiatric evaluation, with law enforcement filling the void.

Nationally, conservative estimates show that people with mental illnesses are killed in altercations with law enforcement at a rate four times greater than the general population, and law enforcement officers are killed by people with mental illnesses 5.5 times more often than they are killed by the general population.

Those sobering statistics were clearly evident six years ago, in July 1998. Alan Singletary killed Deputy Eugene Gregory during a landlord-tenant dispute that evolved into a 13-hour standoff between Singletary, Seminole County sheriff's deputies, and SWAT team members. Singletary also wounded two other law enforcement officers before being killed himself during the ensuing gunbattle. Singletary's family had been frustrated for years in their efforts to get him treatment for his paranoid schizophrenia.

Seminole County Sheriff Don Eslinger, Deputy Gregory’s widow Linda, and Alice Petree, Alan Singletary's sister, joined together in a unique alliance to advocate for passage of Baker Act reform. Today’s bill signing is not only a tribute to them and their tenacity, but the new law is also a living legacy for Deputy Gregory and Alan Singletary. If Alan’s family had been able to place him in assisted outpatient treatment, he might have been saved from psychosis, and he and Deputy Gregory might be alive today.