Florida Mental Health Act and the Practical Nurse

Abstract

This article includes information on the Florida Mental Health Act, also known as the Baker Act. It provides insight on what the Baker Act was created for, how it is implemented, and how it affects those suffering from mental illness, those caring for mentally ill patients, and the community in which they live. The Baker Act is strictly mandated only in the state of Florida, this compares the similarities and differences some parts of the country have when it comes to treating the mentally ill. It also sheds light on the implications of caring for a patient with a mental illness from a nursesnurse’s perspective, and current problems the health care community is facing.

Florida Mental Health Act and the Practical Nurse

The Florida Mental Health Act, more commonly known as the “Baker Act” was established in 1971. It was named afternamed after Florida State Representative, Maxine Baker, who supported the change in legislature to give more rights to patients and to separate the processes done for the mentally ill both medically and legally. Since it was initially introduced as a Florida Statute (FS394) multiple addendums have been added to ensure the legislature stays current. Upon researching the Florida Mental Health Act, there are questions regarding ethical conflicts for the patient, the role of the health care professional, and how it compares to the process other states have implemented providing care for the mentally ill.

What does the Baker Act Do?

The Baker Act was established to “authorize and direct the Department of Children and Families to evaluate, research, plan, and recommend to the Governor and the Legislature programs designed to reduce the occurrence, severity, duration, and disabling aspects of mental, emotional, and behavioral disorders.” (FS394.453, 2018). This act provides a multitude of services to patients including short and long term care for the patient. In the event of an emergency where one is a danger to themselves or others, this law allows for medical professionals to involuntarily admit them under a psychiatric evaluation lasting up to seventy-two hours. This process places the patient in a safe environment where a multi-speciality speciality team can properly evaluate, diagnosis, and treat the patient to the best of their abilities, while protecting their human rights in the least restrictive environment in hopes of discharge.

Implications of Caring for the Mentally Ill

The most important part of medical ethics, dating all the way back to Hippocrates is nonmaleficence, which is the physician’s duty to “do no harm.” Showing respect for autonomy (i.e., allowing a patient to make their own decision regarding their medical care and treatment) is a key component in maintaining the ethical code of nonmaleficence. In mental health cases, there is a very fine line between distinguishing if someone is of sound enough mind to make those decisions for themselves.

The Baker Act is being detained against one’s own will until they are further evaluated. While some may see this as an ethical violation, the foundation of this act is to ensure safety for the individual and others while temporarily revoking ones autonomy. These actions could potentially save one’s life and/or guide them to the treatment they need to live a more enriched lifestyle. A relevant observation when one is involuntarily committed, they are not allowed to bring contraband into a facility, but why are their own personal belongings taken from them in this stressful time (i.e. phones, watches etc.).

All this in addition to being forced into a physical exam, given psychotropic drugs and treatment, this is all extremely stressful for the patient. However, if temporarily acting on their behalf due to a patient not being in their right mindset can help them, then it is necessary. A nurse’s role is to maintain a therapeutic environment, maintain open communication, and provide a non-judgmental zone that leads to a nurturing relationship with the patient. It can be difficult to establish trust with a mentally ill patient so the nurse must practice patience and empathy in order to provide a higher quality of care. Nurses play a crucial role in being an advocate for the patient and are the last line of defense to ensure the patient is receiving the treatment they need within the scope of practice.

Legislature Across the United States

The Baker Act is confined to the state of Florida, but other states have similar laws and guidelines in place to care for the mentally ill. These guidelines are referred to as involuntary commitment. Most states require dangerousness (physical harm to self or to others) happening in the near future as a requirement to be admitted. There are a few states who have created their own parameters in how they address the institutionalization of the mentally ill. “Delaware requires only proof that a person is not able to make ‘responsible choices’ about hospitalization or treatment for that person to be committed.” (Testa & West, 2010) Another example of loosely based criterion is Iowa, who can also require that “a person is likely to cause severe emotional injury on family members who lack reasonable opportunity to avoid contact with the person.” (Iowa Judicial Court, 2018). There are two legal principles that are embedded into each states core interest in the process of civil commitment. The first of these is parens patriae that term means “parent of the country.” It dates back to English common law placing responsibility on the government to intervene in a situation where a person can no longer act in their own best interest. The second legal principle is police power, which requires states to protect its citizens. (Testa & West, 2010). Even though each state has a different set of guidelines on how to decide when involuntary commitment is necessary, the main focus is that if a person is a harm to themselves or society it is an ethical and moral responsibility to place them in a facility where they are safe until physicians can evaluate and determine the correct form of treatment if needed.

The Baker Act is a vital component in keeping those who suffer from mental illness and those who are around them safe. As with most things relating to mental illness, there are many ethical gray areas that can complicate the process. It is important to have a law in place protecting the patients and the medical professionals involved. Those who have witnessed someone suffering from a mental illness know that proper psychiatric treatment and a caring nursing staff is beneficial for the patient’s well-being. Unfortunately, there is still more to be done to overcome the stigma of caring for the mentally ill. “The bad news is that, at a time when public awareness of the need for mental health care reform continues to increase, funding for mental health services fell in more states than it grew.” (NAMI, 2015)

References

1. Commitments | Iowa Judicial Branch. (n.d.). Retrieved August 13, 2018, from https://www.iowacourts.gov/for-the-public/representing-yourself/committments
2. Florida Statute 394. (2018, August 13). Retrieved August 13, 2018, from http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0300-0399/0394/Sections/0394.453.html
3. State Mental Health Legislation 2015. (n.d.). Retrieved from https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/State-Mental-Health-Legislation-2015
4. Testa, M., & West, S. G. (2010, October). Civil Commitment in the United States. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392176/