Mental Health Commitment Essay

Mental health commitment is a sometimes necessary measure enacted presumably in the best interest of the patient, to secure their personal safety and well-being in times of emotional crisis, and to also provide helpful assessment and treatment of mental illness. The current mental health commitment process consists of legally defined and regulated procedures to be used as a guideline for intervention in emergency situations of mental health crises, and was designed in regards to protecting the civil rights of mental health patients. This paper will explore the legal processes involved in mental health commitment, and will reflect upon the morality and overall effectiveness of this process in treating mental illness in committed individuals.

In the state of Florida, mental health commitment is also referred to as “Baker Acting.” The Baker Act is a Florida Statute, formally known as the Florida Mental Health Act. The Baker Act protects the rights of all mental health patients in the state of Florida. Specifically, the Baker Act provides the legal procedures for emergency mental health assessment and treatment, including voluntary and involuntary placement in either an outpatient program or an inpatient program, and also monitors and regulates crisis stabilization units and short term treatment facilities (Department of Children and Families, 2013).
Today, mental health patients can rely on the protection of the Mental Health Act, but this law wasn’t enacted until 1972. The passing of this act brought about dramatic changes in Florida’s mental health laws and protected the civil rights of mental health patients. Before the Baker Act went into effect, all that was needed for a person to be placed in a state hospital was an affidavit signed by three individuals and the approval of a county judge. Once an individual was placed in a state hospital, there was no holding time limit until they were granted a hearing for a judge to reconsider their confinement. Also, the committed patients were limited to only one person with whom they could communicate with, outside of the hospital (State of Florida Department of Children and Families Mental Health Program Office, 2002).
For a person to be committed to a state hospital or other mental health facility, they can either submit themselves for assessment and treatment voluntarily, or certain authorized professionals can initiate an involuntary emergency commitment. The only professionals legally allowed to initiate involuntary commitment include; judges, law enforcement officials, physicians, clinical psychologists, licensed clinical social workers, some psychiatric nurses, licensed mental health counselors, and licensed marriage and family therapists (Christy, Handelsman, Hanson, & Ochshorn, 2010).
In order for professionals to initiate an involuntary exam, certain criteria must be met such as; there is sound reason to believe this person has a mental illness and has refused voluntary examination after being described the purpose of the exam, or they are unable to determine the necessity of the exam; There is a real and present threat of self neglect and substantial harm, without treatment; There is a great chance that without intervention the individual will purposely harm themselves or others, as evidenced by previous behavior (Florida Mental Health Act, 2015).
Documentation is required for involuntary examination such as; an ex parte order, which is only valid 7 days after the original order was signed, a professional certificate issued by a qualified physician within 48 hours of initial examination, and a written report compiled by the law enforcement officer who initiated the emergency exam. All documentation has to detail the situations and circumstances that led to the professional’s decision to initiate emergency mental health interventions; this becomes part of the patient’s clinical record and must be sent to the Agency for Health Care Administration (Florida Mental Health Act, 2015).
Once the patient arrives at a receiving facility, they cannot legally be held at that specific facility for longer than 72 hours. If an individual is examined at the receiving facility and is found to not meet the criteria for involuntary placement, they will then be asked to voluntarily submit to treatment and unless they are charged with a crime, they must be cleared for release by a physician. If the individual is found to meet the criteria for inpatient treatment, then the facility administrator can make a recommendation to retain the patient. This recommendation must be supported by the opinions of a psychiatrist and an additional clinical psychologist or psychiatrist, after they have personally examined the patient within the preceding 72 hours. If the recommendation is supported, then it must be documented on an involuntary inpatient placement certificate, authorizing detainment or transfer to another treatment facility until a hearing occur (Florida Mental Health Act, 2015).
After the recommendation is certified, the facility administrator must file a petition for involuntary inpatient placement with the court, and a hearing shall be conducted within 5 days. Within one business day after filing, a public defender shall be appointed to represent the patient, and a state attorney for the circuit court represents the state, rather than the facility. Instead of a judge, a general or special magistrate will preside at the hearing, and a psychiatrist involved with the issuance of the involuntary placement certificate will be a witness. The patient’s attendance at the hearing may be waived if their presence is determined to not be in their best interests. Although, the patient has the right to be examined by an independent expert, and one may be provided by the court if the patient is unable to afford services. If it is determined by the court that the patient meets the requirements for involuntary commitment, then the court will order that the patient receive inpatient treatment for a period of up to 6 months and will provide documentation to the receiving facility, including any advanced directives and evaluations performed by mental health professionals. This commitment ruling can be enforced legally and physically. If a patient leaves the treatment facility without permission or clearance, then the administrator can enlist the help of a law enforcement agency to conduct a search and return of the patient (Florida Mental Health Act, 2015).
While the decision to commit an individual to emergency examination cannot be contested, being involuntarily placed in a facility for holding and treatment can be contested. Although, the only way to successfully contest involuntary placement is have a mental health examination performed by an independent physician, and subsequently have that physician bear witness during the hearing. But, if the state’s attorney is still able to provide clear and convincing evidence that the individual meets criteria for inpatient placement and the magistrate orders that the individual in question be committed, then essentially the patient has no other options to contest the hold. That being said, the timeline for involuntary commitment specified on the order cannot exceed 6 months, and if at any time the patient does not meet criteria for involuntary holding, then they must sign into the facility voluntarily, or they must be released. If the order is about to expire and the patient still meets criteria for continued treatment, then a continuance for involuntary inpatient treatment must be filed containing a statement by the psychiatrist, justifying the continuance of the order. If a continuance is granted, this too cannot be longer than 6 months (Florida Mental Health Act, 2015).
Looking at the surface of this Act, I both agree and disagree with certain aspects. Overall, this process of examination and commitment appears to provide a fair process of intervention during a time of emotional crisis for a potentially mentally unstable individual, in theory. Although once the process is put in motion, I believe many situations could arise where an individual’s personal freedoms could be infringed upon.
Specifically, I do not agree with the process for involuntary examination, because I believe the criteria set forth is too general.

Essentially, anybody could be detained against their will for 72 hours if there is even the slightest bit of doubt or reason to believe a person is mentally ill or capable of harm towards themselves or others, and ironically, having a mental illness could serve as justification of the belief that somebody is a danger to themselves. Also, if an individual is asked to consent to exam, whether or not there is sound reason for the exam, if they refuse then this automatically counts as meeting one of the criteria. I do not believe a person should be held against their will based on a single belief and I propose that a professional should have to show evidence of trying to de-escalate the situation and enlist the help of another professional, and if that has failed then I believe it would be appropriate to enact emergency intervention. It would be assumed that de-escalation techniques would be employed before resorting to such drastic measures, but there could be a few situations where this does not occur. It seems to me this process for involuntary examination based on only the beliefs of one professional, resulting in an individual being falsely imprisoned and held against their will for 72 hours, is a gross violation of the individual’s civil liberties. Although, I understand that the law was written in this way to allow professionals to act quickly in true emergencies, but this general language of the law can leave a majority of individuals vulnerable to unjust

confinement.

So to answer the question of whether I agree or disagree with the legal process of commitment, requires one to take a closer look at the outcomes and determine if these are keeping in line with the purpose of the Act.