The measure would let judges order outpatient care for the mentally ill, such as forcing them to take their medication.
By JENNIFER LIBERTO
Published February 28, 2004
TALLAHASSEE - Seminole County Sheriff Donald Eslinger took up the battle cry for mental health reform six years ago.
Two of his deputies were shot and a third was killed in a 13-hour standoff with a schizophrenic who refused treatment and collected guns for years.
This year, Eslinger says he hopes lawmakers finally will retool mental health laws to stop the untreated mentally ill from moving between jails and mental health crisis centers.
He has in mind people like Alan Singletary, whose family tried to get him help before he pulled a gun on a landlord threatening to evict him, sparking a stand-off. The 43-year-old Singletary shot and killed Seminole Deputy Gene Gregory, who was among the first to arrive at Singletary's home in Geneva. Police shot and killed Singletary.
"He had a past history of a stand-off, several Baker Act admissions, and we knew that he was collecting guns, weapons and ammunition," said Singletary's sister Alice Petree who has been lobbying for mental health reforms for three years. "Yet, there was nothing we could do."
The Florida Mental Health Act, known as the Baker Act, allows law enforcement officers, judges or doctors to detain people deemed to be a threat to themselves or others at a psychiatric facility for an evaluation for up to three days. Once evaluated, the person can be commited to a state hospital or released.
Since Florida has drastically cut funding for beds at state hospitals and at mental health crisis centers over the years, most Baker Act admissions are released within days - no longer an immediate threat but not necessarily much better.
Those who walk away with prescriptions for stabilizing medications often stop taking them once they feel better, mental health advocates say. Others refuse to take the medications at all, because they aren't aware that they have a mental illness, a symptom of some forms of schizophrenia and bipolar disorders.
Hundreds of Baker Act admissions are longtime veterans of the state's mental health system. Over the past three years, 21 percent of adults examined as a Baker Act admission had been through the system at least once before, according to a state data recently analyzed by the Florida Mental Health Institute. One Florida man has gone through the Baker Act system 43 times over a two-year period.
A proposed bill would allow a judge to order outpatient treatment for those mentally ill who have had one violent episode or have been admitted for at least two Baker Act evaluations in three years. To qualify, they also must be diagnosed with "acute mental illness," have refused voluntary treatment in the past and seem likely to deteriorate again, according to mental health professionals.
The bill would give judges authority to order some mentally ill persons to take their medications. Proponents say it would affect fewer than 1,000 people statewide.
"It focuses on a small group of recidivists who are cycling in and and out of the mental system as well as the criminal justice system," said Eslinger, who in the past has lobbied the Legislature for increased funding for mental health services. "It only attaches itself to the most severe cases."
The law has no criminal penalties for those mentally ill who don't follow a judge's orders. And some who refuse treatment could still end up cycling back through the system again. But some states, including New York, have found that when faced with a court order, people listen, even if they've ignored a doctor or a family member in the past.
Forty-one states already have court-ordered involuntary outpatient mental health laws.
Last week, the legislation sailed through the Senate Committee on Children and Families, where it had stumbled last year. Gov. Jeb Bush told the Florida Sheriff's Association earlier this month that he supports the bill. A similar bill passed the House last year in a vote of 113 to 2, but it died in a Senate committee.
"It's a fairness topic," said Sen. Durell Peaden, R-Crestview, who has sponsored the bill for three years. "You've got poor people in the correctional system who have got underlying psychiatric disease, and you can't adequately prove that they didn't have the intent to commit a crime."
The proposal is not without critics.
The National Alliance for the Mentally Ill Florida is neutral because its own membership is split on the issue, said NAMI Florida president Michael Mathes. But they are concerned about the lack of financial support for mental health services.
"Unless we have a comprehensive mental health system, these people are still going to cycle in and out of the mental health centers and in and out of jails, because just medicine isn't going to do it," Mathes said.
Counties share that sentiment. Some social service directors said they support the concept but oppose the bill because it lacks dollars to implement the measure. Several counties, like Citrus and Hernando, already are strapped for mental health dollars to provide enough inpatient crisis beds, which serve Baker Act admissions during that three-day evaluation period.
"We're not against changing the Baker Act laws, but let's make sure the infrastructure is in place before we do all these changes," said Joe Anne Hart, spokeswoman for the Florida Association of Counties.
Advocates say the bill doesn't need funding because it works within the framework of the existing Baker Act system. Also, the bill says outpatient treatment cannot be ordered in areas where mental health services don't exist.
The measure is intended to save counties money by freeing up inpatient crisis beds and police officers who had been arresting the mentally ill and taking them to Baker Act receiving facilities, because fewer people will be recycling through the Baker Act system.
"It does give an alternative in keeping beds open to those who are truly in need of a bed, and with the shortage we have around the state, we need to look for every avenue we can," said Sen. Mike Fasano, R-New Port Richey, who is co-sponsoring the bill, because he hopes it will ease bed shortages in Citrus and Hernando counties. Those counties are asking for more state funding for crisis beds this year.
