In 1971, Florida State Representative Maxine Baker, a dedicated mental health advocate from Miami, proposed legislation intended to protect the basic rights and treatment of individuals who were mentally ill. Her efforts resulted in a comprehensive body of law, so called The Baker Act in her honor.
The Baker Act provides that judges, law enforcement officers, physicians, and mental health officials can initiate a process to involuntary institutionalize individuals who 1) appear to be mentally ill, or 2) are likely to cause harm to themselves, harm to others, or are self-neglectful. Once “Baker Acted,” these individuals are taken for evaluation for a minimum of 72 hours at a state-authorized psychiatric center. Alzheimer’s and dementia, which many regard as disability rather than mental illnesses, fits criteria #2 of the Baker Act.
We do not have space here to describe the entire medical and legal processes provided under the Baker Act, but suffice to say that some of its provisions (transport, introduction to an alien environment, forced separation from family, possible placement in a population of people who are seriously mentally ill) can be extremely traumatic for an individual with Alzheimer’s or dementia. The internet is replete with testimony from caregivers about how their loved ones with dementia were harassed, traumatized, and left worse-off by the process.
Due to significant demographic changes over the last 40 years, one can argue that the Baker Act in now being forced to address a problem – dementia — for which it was not primarily intended. The numbers tell the story. In 1995, The St. Petersburg Times reported that in Pinellas County two-thirds of those involuntarily committed under the Baker Act were over the age of 65.
We cannot assume they all had dementia, but undoubtedly many did, and we can be assured that this demographic segment will only grow – numerically and proportionately – in the future. We do know that today, 20 percent of those involuntarily committed under the Baker Act in Citrus County have Alzheimer’s or dementia.
While we have concerns about the Baker Act even when properly applied to individuals with dementia, there is further evidence that in the elder care industry it has been willfully abused. The Florida Supreme Court Commission on Fairness reported in 1997, “Some facilities purposefully use the Baker Act to ‘dump’ residents who are disruptive or require mental health treatment.” I can tell you from my experience; it is not an uncommon practice.
Thanks to modern dementia care philosophy and methodology (e.g. Teepa Snow’s Positive Approach to Care), we now know that much disruptive behavior among dementia sufferers is actually provoked, but insufficiently trained caregivers simply don’t understand what they are doing to trigger such behavior. Most of these moments when a person with dementia is disruptive or even violent can be de-escalated, precluding any need for a reaction as desperate or traumatic as Baker Acting.
We are not condemning the Baker Act, but suggesting that there is dire need for improvement when it is applied to individuals with Alzheimer’s and dementia. This is the same conclusion drawn by the Florida Supreme Court Commission on Fairness.
Many of these concerns don’t require a change in the law, but can be addressed by providing more training based on recently developed understandings of the disease. This training, based on a compassionate and positive approach to care, should be made available or even required for law enforcement officers who are often the front-line decision makers for when Baker Acting is appropriate. They need not be given full caregiver training, but they certainly should benefit from a deeper understanding of the triggers that can cause combative behavior, and how to use that knowledge to de-escalate rather than resort to the Baker Act.
For the care personnel at the psychiatric centers there should be full dementia caregiver training to avoid further trauma, physical harm, and human suffering among individuals with Alzheimer’s or dementia. And such individuals should never be placed in a general population of drug addicts, psychotics, and suicidal patients. Today they are. Just imagine a frightened and confused elder with dementia being thrown into such an environment. For them, it is bedlam, and how can that help, either with assessment or treatment?
The business case for higher training requirements and dementia-segregated communities is obvious. It does not take a lot of imagination to see how fewer transports, less time in Centers, reduced trauma, and avoidance of much of the extensive legal process required by the Baker Act will save a lot of money for the State and its tax payers.
The mental health industry has aggressively fought proposals for modest changes in the Baker Act based on their belief it will be too expensive. I think they are being short-sighted in defending a status quo that will become more and more unacceptable as the percentage of our population with dementia grows.
We need changes in the Baker Act that will 1) better address the specific needs of individuals with Alzheimer’s and dementia, 2) thereby reduce the frequency the law is applied within our elderly population, and 3) provide more specific and appropriate treatment once an individual with dementia is Baker Acted.
In the mean time, what can I say to caregivers in Florida and other states with laws similar to the Baker Act? Beware! Take the time to learn about the whole process and the physical and psychological damage it can cause your loved one with dementia.
For example, the law requires that your loved one will be placed under observation for a minimum of 72 hours, during which you may not see or visit them. But, often the “72 hours” will coincide with a weekend, and you may not be able to see or communicate with them for four or five days. Think about how they will feel and react to this period of isolation in an alien environment.
Do not take the Baker Act lightly or as a convenient “tool” for dealing with disruptive behavior. My advice is to use it only as a last resort under circumstances where you or your loved one are under imminent threat of physical harm. And when you use it, do not expect your loved one to return home “better.”
Until next time remember: “We all deserve the best”
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© Debbie Selsavage, 2016