BAKER ACT TRAINING Laura Gailey, LMHC

Should I Take Their Rights Away?

Voluntary Admissions Adults Minors Must have a mental illness Must be competent to provide express and informed consent Minors Must have a mental illness. Guardian applies for express and informed consent for minor’s admission

Express and Informed Consent What does that mean? Client is able to make knowing and willful decisions There has been no element of force, fraud, deceit, duress or coercion. Judgment is not affected by mental illness

Voluntary Criteria You have reason to believe the person has a mental illness (wanting to die due to end stage illness is not criteria for admission). Without care or treatment, the person is likely to suffer from neglect to self care and such neglect poses a real and present threat of substantial harm to one’s well-being There is substantial likelihood that without treatment, in the near future person will cause serious bodily harm to self or others, as evidenced by recent behavior Client is willing to sign self in voluntary Client is competent to sign self in voluntary Client must also sign Right to Request Discharge form

Who can sign in a person on a Voluntary? Has a minimum of a bachelor degree in a health related field Registered Nurse Physician Most agencies will not allow an “outsider” to sign a person in voluntarily

Involuntary Criteria Reason to believe person has a mental illness and because of mental illness, person has refused or is unable to determine whether examination is necessary (wanting to die due to end stage illness is not criteria for admission). and either: Without care or treatment, is likely to suffer from neglect or refuse to care for self, and such neglect or refusal poses a real and present threat of substantial harm to one’s well-being and it is not apparent that such harm may be avoided through the help of willing family members, friends, or the provision of other services; or There is substantial likelihood that without treatment will cause in the near future serious bodily harm to self or others, as evidenced by recent behavior.

Who Can Baker Act? Licensed professionals Law Enforcement LMHC LCSW LMFT MD ARNP Law Enforcement

Referring to Lakeside/Aspire Paperwork required Baker Act 3102 (if coming from a hospital) Labs Presenting problem (Medical and Psychiatric) Current vitals signs Medications (what the client is taking and what the hospital/Doctor has administered) Insurance Precertification Face Sheet (demographics)

I am going to baker act, now what From an area hospital – Contact your psych intake department or transfer coordinator From a Private Office Setting – Call your local law enforcement agency, request a CIT officer. Provide the officer with the original baker act form. The officer will bring the client to a receiving center.

Lakeside/Aspire Contact Information Contact Information Liaison – 407-875-3700 ext 5038 24/7 availability Fax – 407-532-1070

Central Florida Baker Act Receiving Facilities Central Receiving Center* Lakeside Behavioral Healthcare* Florida Hospital University Behavioral Center Central Florida Behavioral Hospital Seminole CMHC/CSU* South Seminole Hospital Park Place Behavioral Health* Circles of Care* Wuesthoff Medical Center *Public Receiving Facility

Exclusionary Criteria The following conditions ALONE are not appropriate for an admission to a crisis unit per FL Statute. Pervasive Developmental Disability Antisocial Personality Disorder Mental Retardation Dementia Alzheimers Homeless Seeking Shelter No DSM-IV diagnostic criteria Absence of immediate risk of harm to self or others due to a psychiatric illness; or absence of risk of not being able to care for self due to psychiatric illness

Exclusionary Criteria Exclusionary for Inpatient Units or lengthy stay at CRC. Acute medical condition that would prohibit treatment of the psychiatric condition Patients in need of the following: Continuous oxygen Continuous monitoring Cardiac monitoring Continuous medically ordered bed rest Traction Continuous skilled nursing care Complex Dressings Blood transfusions, IV’s, Catheters, etc Methadone Maintenance (client can remain at CRC for less than 4 hours if a transfer to the CFDFL will occur and the client remains medically stable).

Exclusionary Criteria Uncontrolled or Unmanageable Seizure Disorders Substance toxicity or severe withdrawal that cannot be safely treated with standard detox protocols. (Cocaine, Benzo, PCP, Morphine, Heroin).

Exclusionary Criteria BAL of .3 or above Clients with a BAL below .3 can be transferred from an ED to Lakeside as long as the following conditions have been met: The client must be able to “walk and talk”. The client cannot be so intoxicated that they are stumbling, have an unsteady gait or have slurred speech. The hospital must show that the client’s BAL is decreasing, by having at least two BAL checks completed to show this is decreasing, unless the client has been in the ED for a minimum of 10 hours (Then a 2nd BAL is not needed). The client must have stable vital signs as evidenced by checking vitals every 30 minutes for a two-hour period. If withdrawal symptoms are present, a client can only be accepted after a detox protocol has been initiated at the hospital. Clients with other serious medical conditions in addition to intoxication will be decided on a case-by-case basis.

Exclusionary Criteria Suggestions: Obtain a copy of your Receiving Facility’s Exclusionary Criteria If in doubt, you could contact EMT’s to evaluate the medical condition. Call your local Receiving Facility case by case to determine if the client should be sent to the ER first.

Forms All baker act forms can be found on the DFC website at: http://www.myflfamilies.com/service-programs/mental-health/baker-act-forms

Forms Voluntary - CF - MH 3040 Feb. 2005: Application for Voluntary Admission (Receiving Facility) This form may be altered Baker Act - CF - MH 3052b Sept. 2006: Certificate of Professional Initiating Involuntary Examination This form may not be altered Ex Parte - CF - MH 3001 Jan. 1998: Ex Parte Order for Involuntary Examination

Suggestions & Final Thoughts Find out who your local Receiving Facility is and their contact information Find out of your communicate has CIT Trained Officers Build a Relationship with the Receiving Facility and the Officers that patrol your area. Take this decision seriously. Consider if your decision will keep you up at night or not.

Questions?