The Baker Act Process 

Disclaimer: I have not read the entirety of the Baker Act law. None of this should be taken as legal advice, and I shall not be deemed liable for any errors in this post. This is only intended to be educational and informative in nature.

What is a Baker Act? The Baker Act is a law in the state of Florida stating that a person can be evaluated by a psychiatrist and held at a hospital or crisis center for up to 72 hours in order to be stabilized.

In order to be placed under an involuntary Baker Act, a police officer, mental health professional,  or medical doctor determines that they believe that a person is likely to be an imminent threat of serious bodily harm to self or others or is unable to care for their self. This means that the only person that has the ability to lift/rescind this type of Baker Act is a doctor.

A voluntary Baker Act is different in that most of these criteria are met with the important exception that the patient is choosing and is deemed competent to choose to be evaluated and stabilized.

How do people get Baker Acted and how are they transported to the hospital? The police may find out by a health professional,  family member, friend, or other individual, that a person appears to be having a psychiatric issue. The police go to where the identified person is and typically they are the ones who take the person to the hospital. Many times they will put the person in handcuffs during transport, not to make them feel like a criminal, but rather to protect the person from harming self and others.

In some cases, an ambulance may transport the person. If a person determines for themselves that they need help, they may decide to arrange their own transportation to the hospital rather than calling the police.

What are the first couple hours at the hospital like? When someone gets to the hospital, they typically talk to a nurse who puts in triage notes and a registration person who gets the patient’s identifying information into the computer. Sometimes, when someone comes by police, they will bring them straight to an ER room rather than having to wait in the lobby.

Once the person is in an ER room, they will have their vital signs taken(blood pressure, pulse, etc.),be asked to change into a gown, provide a urine sample, have their blood drawn, and have their belongings collected, inventoried, and locked up securely. These tasks are typically done at our hospital by our Techs (which are like nursing assistants).

Patients also talk to their nurse and an ER doctor. At our hospital,  patients also talk to a counselor (myself or a coworker) as well. Often, we will consult with each other to see if we are on the same page in our impressions of the patient.

The doctor may decide to keep a involuntary Baker Act in place (which is most common), may place a patient under an involuntary Baker Act, may have a patient who is not yet under a Baker Act sign a voluntary Baker Act form, or may (rarely) decide that a person does not actually meet Baker Act criteria and discharge them.

Once the patient’s blood work and urine results come back, if they look well and any acute health issues (such as high blood pressure, sugar level, or alcohol level) are treated or are anticipated to respond to treatment, then the doctor will “medically clear” the patient.

What happens once a patient is medically cleared? When do they get admitted/assigned a room? A lot of how this process works depends on the individual hospital and whether the particular hospital currently has beds available on their psych unit. Let me explain how this process works in both scenarios at the hospital I work at.

If our hospital has beds, the patient goes to the Transitional Care Area (psych holding area). The patient goes through a skin assessment to make sure the patient does not have anything on them that could cause harm to self or others. They also go through an intake nursing assessment that has to be done when admitting patients. Belongings are gone through again and the patient is given any belongings they can have on the psych unit. Allowable belongings include wireless bras, shirts with sleeves, pants and jackets without strings. After this, the patient is transitioned to their assigned bed.

If our hospital doesn’t have psych beds available, we encourage our patients prior to going up to the Transitional Care Area to sign consent to transfer. This grants us permission to transfer the patient to another hospital or crisis stabilization center. Although most patients are not fond of this idea, we encourage it because not only is it helpful to us, but it saves patients’ time and money. The patient still goes to the Transitional Care Area, has a skin assessment, and sometimes goes through a nursing assessment as well.

Regardless of whether the patient signs consent to transfer or not, either staff at the hospital (in our case a counselor) faxes patient info to other hospitals to see if they can admit the patient or our bed placement team works on finding placement.  This process can take a while.  Once staff finds out that another hospital or crisis center is able to admit the patient, the patient is made aware of it. If they don’t refuse, we arrange transport via a medical transport company to take the patient to the hospital they are being admitted at.  If the patient refuses to transfer, then the patient waits until a bed becomes available at our hospital, which means more of the waiting game.

What happens once a patient is admitted to a hospital or crisis unit? The patient is assigned a psychiatrist and a social worker. The psychiatrist is supposed to try to see patients within 24 hours of medical clearance to determine if the patient needs to stay or can be discharged.  They are the ones that can prescribe and change medications if needed.

The social worker meets with the patient to do a thorough intake (biopsychosocial) assessment, as well as obtains information necessary to set up a discharge plan.  The social worker then contacts where the patient came from (home, ALF, etc.) to see if they are ok with the patient returning once they are discharged.  If the patient can’t return to where they came from, the social worker tries to find an appropriate place for the pt to go upon discharge.  The social worker and/or discharge planner set up outpatient counseling and psychiatrist appointments for the patient prior to discharge so that they can maintain the stabilization they gained in the hospital and continue to experience improvements in their mental health condition.

When does a patient get to leave? One, if the psychiatrist decides before the 72 hours are up that the patient is stable enough to discharge, then they will be discharged. Two, if a patient has stayed the full 72 hours and have not either signed voluntarily to continue the stay nor had the psychiatrist go before a judge to get the stay extended. Three, a patient who has signed voluntarily decides they no longer want to stay-but they must meet with the psychiatrist first prior to the discharge. Four, a patient had their stay extended via a judges approval and now the psychiatrist no longer feels the patient needs to stay.

It is also important to note that if the social worker or discharge planner has difficulty finding a safe place (even a homeless shelter) to discharge a patient to, this can affect how long it takes to be discharged.

What are a few words of advice for people going through (or having recently gone through) being Baker Acted? Know that being placed under a Baker Act is not intended to be a form of punishment but rather something done to protect people from hurting themselves or others.  Although nobody likes being held against their own will and going through the Baker Act process can be stressful, being very loud, aggressive, and belligerent will only make the situation worse. Know that being Baker Acted is not the end of the world, it won’t prevent you from doing most jobs, and your mental health information is required to be protected in compliance with HIPPA Laws and regulations.

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