Florida Mental Health Act, Ch 394 (7)

Question 1

Baker Act

Answer 1

Florida Mental Health Act, informally called Baker Act

Question 2

Baker Act / Florida Mental Health Act is for..

Answer 2

• Involuntary commitment
  -The person is mentally ill
• Refuses a voluntary mental health evaluation or doesn’t understand why one would be necessary.
• Threat to themself or others, or incapable of caring for themself
• needs expert evaluation

Question 3

Incapacitated definition

Answer 3

Incapacitated means that a person has been adjudicated incapacitated pursuant to part V
of chapter 744 and a guardian of the person has been appointed.

Question 4

Incompetent to consent to treatment definition

Answer 4

“Incompetent to consent to treatment” means a state in which a person’s judgment is so
affected by a mental illness or a substance abuse impairment that he or she lacks the capacity to make a well-reasoned, willful, and knowing decision concerning his or her medical, mental health, or substance abuse treatment.

Question 5

Mental health overlay program

Answer 5

mobile services

Question 6

no-wrong-door models

Answer 6

a model for the delivery of acute care services to persons who have mental health or substance use disorders, or both, which optimizes access to care, regardless of the entry point to the behavioral health care system

Question 7

Involuntary inpatients rights

Answer 7

• Not more than 5 days after admission to a facility, each patient shall have and receive an
  individualized treatment plan in writing which the patient has had an opportunity to assist in
  preparing and to review prior to its implementation
• informed consent from patient, or, if incapacitated or incompetent, guardian’s consent
• must allow patient contact with outsiders, including access to a telephone
• must allow access to family members, guardian
• if patient is restricted, must be reviewed every 7 days
• may question by writ of habeas corpus the reason for involuntary commitment: patient, a relative, friend, guardian, guardian advocate, representative, or attorney, or the department
• may file a petition in circuit court challenging commitment

Question 8

Voluntary Patients

Answer 8

At the time a patient is voluntarily admitted to a receiving or treatment facility, the identity and contact information of a person to be notified in case of an emergency shall be entered in the patient’s clinical record

Question 9

For Involuntary Patients 1)what must be in the clinical record and 2) where must the paper work be filed?

Answer 9

• Clinical record to include: the names, addresses, and telephone numbers of the patient’s GUARDIAN or guardian ADVOCATE , or representative if the patient has no guardian, and the patient’s attorney
• filed in circuit court

Question 10

If no guardian for involuntary patient…the facility can assign who (in order of preference)

Answer 10

Facility may assign by preference order:
a) health care surrogate
b) spouse
c) adult child
d) parent
e) adult next of kin
f) adult friend

Question 11

Guardian Advocate

Answer 11

• maintains legal authority to make decisions if patient unable to consent to treatment
• for purposes of adjudication
• if patient is indigent, public defender assigned
• order of preference:
  (a) The patient’s spouse.
  (b) An adult child of the patient.
  (c) A parent of the patient.
  (d) The adult next of kin of the patient.
  (e) An adult friend of the patient.
  (f) An adult trained and willing to serve as guardian advocate for the patient
• may NOT consent to:
  (a) Abortion.
  (b) Sterilization.
  (c) Electroconvulsive treatment.
  (d) Psychosurgery.
  (e) Experimental treatments that have not been approved by a federally approved irb
  -guardian advocate is discharged when patient no longer involuntarily committed

Question 12

Notice of Admission to Facility

Answer 12

• Voluntary: only by the patient
• Involuntary: notice must be given to patient, guardian, guardian advocate, health care surrogate or proxy, attorney, and representative
• orally and in writing, interpreter if needed
• notice of involuntary admission must be given within 24 hours
• if a minor is involuntarily admitted, try to give notice every hour for 12 hours, then 1x every 24 hrs
• 72-hour examination

Question 13

For Involuntary Outpatient Treatment what 3 things must be done and what is the person entitled if they choose ?

Answer 13

1) must file in circuit or criminal court
2) assigned public defender if needed
3)facility must notify within 1 working day of admission

• entitled to independent expert opinion

Question 14

Release of Information from Clinical Record for Involuntary patients is allowed to whom, or for what reasons?

Answer 14

• DUTY TO WARN: If threat of harm to identifiable person, patient has intent and means,
• administrator may release info as needed
• to a researcher if identity is protected
• aftercare treatment provider,
• employee or agent of Dept

Question 15

Release of information for Involuntary Outpatients

Answer 15

• for purposes of determining if involuntary outpt services are needed
• may be released to state attny, public defender, patient’s private attny, the court, appropriate mental health providers

Question 16

Release of Information Required if…

Answer 16

• threat to identifiable person
• administrator at facility may release info necessary
• law enforcement contacts intended victim

Question 17

Release of Information allowed for….

Answer 17

• research if identity is protected
• Agency for Health Care Administration, Florida advocacy councils for monitoring facility
• if Medicaid patient, release okay to Medicaid Fraud

Question 18

Voluntary Admissions & Discharge

Answer 18

• 18 years or older, gives informed consent
• 17 years or younger, guardian consent
• The health care surrogate or proxy of a voluntary patient may NOT consent to the provision of
  mental health treatment for the patient.
• if patient cannot consent, then transfer to involuntary status
• Discharge: shows signifiant improvement or Revokes Admission
• voluntary admission may be revoked by: patient, relative, friend, attorney of patient, either orally or written; must be entered into patient’s clinical record
• must be d/c within 24 hours of request, may be extended but not to exceed 3 days, exclusive of holidays or weekends

Question 19

Transfer from Involuntary to Voluntary Status

Answer 19

• Involuntary patient who applies to be transferred to voluntary status shall be transferred to voluntary status immediately, unless the patient has been charged with a crime, or has been involuntarily placed for treatment and continues to need treatment

Question 20

Transfer from Voluntary to Involuntary Status

Answer 20

• request for discharge by voluntary patient must be communicated to physician, clinical psychologist, or psychiatrist
• must be communicated within 12 hrs
• if needs to be made Involuntary, Administrator of facility must file in court within 2 working days of when voluntary discharge was requested

Question 21

Involuntary Examination can be initiated if the Patient is… (criteria) and timeline

Answer 21

• If patient has refused voluntary examination after conscientious explanation and
  disclosure of the purpose of the examination; or
• If unable to determine for himself or herself whether examination is necessary;
• If, without care or treatment, the person is likely to suffer from neglect or refuse to care for
  himself or herself; such neglect or refusal poses a real and present threat of substantial harm to
  his or her well-being; and it is not apparent that such harm may be avoided through the help of
  willing family members or friends or the provision of other services
• There is a substantial likelihood that without care or treatment the person will cause serious
  bodily harm to himself or herself or others in the near future, as evidenced by recent behavior
• may be initiated by ex parte order, which becomes part of patient’s clinical record, valid for** 7 days** (unless otherwise specified)
• facility accepting pt must send order to Dept within 5 working days
• certified by a psychiatrist and a clinical psychologist

Question 22

Involuntary Exam & Admission Details
-time period
-who must do the evalutation

Answer 22

• Examination period must be 72 hours
• for a minor, exam must be initiated within 12 hrs (or next working day)
• Law enforcement officers may bring patient to involuntary admitting facility
• Can be made by a physician, a physician assistant, a clinical psychologist, a psychiatric nurse, an advanced practice registered nurse registered, mental health counselor, a marriage and family therapist, or a clinical social worker, so long as have examined within last 48 hours
• least restrictive tx must be considered first
• Involuntary removal from a program or residential program allowed under: ex parte order, a professional certificate, or a law enforcement officer’s report is first prepared
• patient must be examined by physician or a clinical psychologist, or by a psychiatric nurse within time frame
• release by psychiatrist or psychologist
• Not be a psychiatric nurse if it was initiated by a psychiatrist

Question 23

Confidentiality in case of court order

Answer 23

• confidential
• Court clerk can release records if request made by: by petitioner, his or her attny; respondent and/or attorney of
• can be released to guardian, guardian advocate, parent, legal custodian
• can be released to treating health care provider, health care proxy or surrogate
• can be released to Dept of Children and Family, Dept of Corrections
• can be released to person authorized under court order for good cause
• to law enforcement

Question 24

Involuntary Outpatient criteria

Answer 24

• patient is 18 years or older
• patient has mental illness
• clinically determined to be unable to survive in community without supervision
• history of lack of compliance with tx
• has been involuntarily admitted within past 36 months
• violence towards self or others within past 36 months
• bc of mental illness cannot voluntarily participate or refuses tx
• in view of tx history and current behavior, a danger to self or others
• likely will benefit from outpatient treatment
• must have a hearing
• written proposed tx provided to guardian or guardian advocate
• if had been involuntary outpatient, certification of invol. outpt by psychiatrist AND clinical psychologist who has examined patient within past 72 hrs
• The service provider must develop with the patient, or the patient’s guardian advocate, if appointed, a treatment or service plan that addresses the needs identified in the discharge plan.

Question 25

Petition for Involuntary Outpatient Services

Answer 25

• may be filed by Administrator of receiving or treatment facility
• certification of meeting criteria must be included
• petition cannot be filed if services are not available
• public defender must be appointed within 1 working day
• patient is entitled to 1 continuance of hearing for up to 4 weeks
• hearing must be held within 5 working days, patient present, but can be waived
• if court determines involuntary outpt services are needed: court order up to 90 days

Question 26

Continuance of Involuntary Outpatient Services

Answer 26

• must be filed at least 10 days prior to expiration of order
• certificate of justification for continuance must be attached
• develop tx plan with patient or guardian advocate
• public defender appointed within 1 working day

Question 27

Continuance of Inpatient Treatment

Answer 27

• Administrator of facility must request before end of ordered tx
• must be accompanied by a statement from the patient’s physician, psychiatrist, psychiatric nurse, or clinical psychologist justifying the request, a brief description of the patient’s treatment during the time he or she was involuntarily placed, and an individualized plan of continued treatment
• patient may waive appearance, if done knowing and voluntary
• The request must be accompanied by a statement from the patient’s physician, psychiatrist, psychiatric nurse, or clinical psychologist justifying the request, a brief description of the patient’s treatment during the time he or she was involuntarily placed, and an individualized plan of continued treatment

Question 28

Transfer Requests

Answer 28

• may be made by patient, family member, guardian, guardian advocate
• may request transfer from public to private facility, if has the means to pay for private
• private facility may request transfer to a public one, public must answer request within 2 working days