The Baker Act - University Of South Florida
The Baker ActFlorida Mental Health ActFiscal Year 2017/2018Annual ReportPrepared for the Florida Department of Children and FamiliesBaker Act Reporting CenterLouis de la Parte Florida Mental Health InstituteDepartment of Mental Health Law & PolicyAnnette Christy, Ph.D.Sara Rhode, MSWKim Lersch, Ph.D.Daniel Ringhoff, Ph.D. Kevin Jenkins, AA3FQPSU 3FMFBTFE VOF
Table of Contents – Baker Act Reporting Center 17/18 ReportI. Introduction. 1II. Report Highlights . 2III. Involuntary Examinations . 3A. Technical Notes . 3B. Involuntary Examinations: State Level Analyses . 4C. Involuntary Examinations: Provider Level Analyses . 13D. Involuntary Examinations: Geographic Area Reporting . 20E. Involuntary Examinations: County Specific Analyses . 24Appendix A: Baker Act Receiving Facility List . 97Appendix B: County Level Indicators Detail . 102Appendix C: Deaths by Suicide in Florida: Additional Details. 103
I. IntroductionChapter 394, Florida Statutes (F.S.), The Florida Mental Health Act, also known as the “Baker Act,”includes several data reporting requirements. Specifics of data submission requirements aredescribed in Florida Administrative Code 65E-5, which includes directing providers to send forms tothe Baker Act Reporting Center at the University of South Florida. Forms must be submitted to theBaker Act Reporting Center within one working day after the person arrives at the receiving facility(Section 394.463 F.S.).Forms submitted to the Baker Act Reporting Center include:CF-MH 3052aReport of Law Enforcement Officer Initiating Involuntary ExaminationCF-MH 3052bCertificate of Professional Initiating Involuntary ExaminationCF-MH 3001Ex Parte Order for Involuntary ExaminationThe Cover Sheet (CF-MH 3118) was implemented in 1999 to systematically report clientdemographic and provider information. Designated Baker Act receiving facilities submit a CoverSheet (CF-MH 3118) on top of each initiation form and Ex Parte Order for Involuntary Examination(CF-MH 3052a, CF-MH 3052b, and CF-MH 3001 or its equivalent). Links to the statute,administrative code, forms, and other materials can be found on The Department of Children andFamilies (Department) Crisis Services – Baker Act web page.Section 394.463(2)(e) F.S. requires the Department of Children and Families (Department) to submitan annual report to the President of the Florida Senate, the Speaker of the House ofRepresentatives, and the minority leaders of the Senate and House of Representatives. This annualreport is published on the Department’s website.Staff at the Baker Act Reporting Center at the University of South Florida produced this report undercontract LH292 with the Department. Although this is considered the statutorily required annualreport for FY17/18, additional years of data were used for analyses. Staff at the Baker Act ReportingCenter can be reached at 813-974-1010 or bakeract@usf.edu. Additional information and resourcesare available at https://www.usf.edu/cbcs/baker-act/.Suggestions for additions or changes to the structure and content of future annual reports may beaddressed to Annette Christy, Director, Baker Act Reporting Center (achristy@usf.edu). Additionalresults may be released in between annual reports. Readers of this report are encouraged toperiodically check the Baker Act Reporting Center website for reports and updates.Baker Act Reporting Center FY17/18 Annual Report1
II. Report Highlights There were 205,781 involuntary (Baker Act) examinations in Fiscal Year 2017/2018 (FY17/18). Involuntary examinations increased 2.92% from FY16/17 to FY17/18, 16.26% from FY13/14 to FY17/18, and53.98% from FY08/09 to FY17/18. Involuntary examinations more than doubled (115.31% increase) in the 17years from FY01/02 to FY17/18. From FY13/14 to FY17/18, statewide involuntary examinations increased 18.85% for children, 14.04% for youngadults (18-24), and 12.49% for older adults. Three-quarters (73.55%) of involuntary examinations in FY17/18 were for adults aged 18 through 64, with17.53% for children, and 7.41% for people 65 and older. [Age was unknown for 1.51%.] 51.67% of involuntary examinations were initiated by law enforcement, with 46.31% initiated by professionalcertificate, and 2.02% initiated via ex parte order. Physicians who are not psychiatrists (68.04%) were the most common health professional to initiate involuntaryexaminations, followed by psychiatrists (9.28%), licensed mental health counselors (9.29%), licensed clinicalsocial workers (5.33%), psychiatric nurses1 (2.02%), psychologists (1.27%), Physician Assistants ( 1%), andlicensed marriage and family therapists ( 1%). Children were more likely than other age groups to have theirinvoluntary examinations initiated by licensed mental health counselors and social workers. Evidence Type: Over half (56.83%) of involuntary examinations were based on evidence of harm only. Almostone-third (30.47%) were based on both harm and self-neglect. Less than ten percent (9.47%) were based onevidence of self-neglect only. Self-neglect only (no harm) was more common with increased age. [Evidence typewas not reported for 3.22%.] Harm Type: Harm can be further broken down into harm to self and/or harm to others. More than half(55.84%) of all involuntary examinations were based on evidence of harm to self only. One in five (21.52%)were based on both harm to self and harm to others. Harm to others only was the evidence for 5.55% of allinvoluntary examinations. Suicide and Self-Harm: Three-quarters (77.36%) of involuntary examinations were based evidence of harm toself (either by itself, or in combination with harm to others and/or self-neglect). Self-harm includes suicidalideation a suicide attempts. However, it is important to understand that self-harm is not synonymous withsuicide. Self-harm can also include behaviors such as cutting and bodily harm that does not have suicidal intent. Rates per 100,000 population for deaths by suicide and involuntary examinations over a ten year period werepositively and significantly correlated statewide for all ages (r .71, p .05), children (r .92, p .01) and olderadults (r .78, p .01). These correlational findings do not imply causation. Further, these significantcorrelations were not seen in all counties. These relationships will be explored in future years to understandthe dynamics related to them, including additional (“third”) variables that may be related to the correlationsand differences across counties. Rates of suicide are included in this report to provide additional context toreaders (see Appendix C). More than half (55%) of involuntary examinations in FY17/18 were at privately funded receiving facilities, with45% at publicly funded receiving facilities. New to the annual report are details about transition-aged young adults (aged 18-24). Figures 1 and 2 presentcounts for all ages of involuntary examinations year by year by age group. The percentage of change in thenumber of involuntary examinations from FY16/17 to FY17/18 is reported at the facility level for all ages (seeTable 7).“Psychiatric nurse” means an advanced practice registered nurse licensed under s. 464.012 who has a master’s or doctoraldegree in psychiatric nursing, holds a national advanced practice certification as a psychiatric mental health advanced practicenurse, and has 2 years of post-master’s clinical experience under the supervision of a physician.1Baker Act Reporting Center FY17/18 Annual Report2
III. Involuntary ExaminationsA. Technical NotesUnderstanding what the data are not is as important as understanding what they are when considering relatedpolicy decisions. The Baker Act data analyzed for this report are from examination initiation forms received bythe Baker Act Reporting Center. However, some individuals for whom forms were received were never admittedto the receiving facility because an examination by a physician or psychologist performed prior to admissiondetermined they did not meet admission criteria. The data also do not include information on what occurredafter the initial examination. For example, the data do not reveal how long individuals stayed at the facility,whether they remained on an involuntary or voluntary basis, or whether the involuntary (Baker Act) examinationwas converted to a Marchman Act assessment.Redaction: Cell sizes smaller than 25 Baker Act examinations were redacted from this report. The purpose of thisredaction is to prevent identification of people. Those interested in more information about the Baker ActReporting Center’s approach to redaction may contact Annette Christy, Center Director, to discuss(achristy@usf.edu).Terminology: Involuntary examinations occur at designated receiving facilities. Receiving facilities may includehospitals (licensed under 395 F.S.) and Crisis Stabilization Units (licensed under 394 F.S.).The Departmentdesignates all Baker Act receiving facilities regardless of type. Some receiving facilities are called CrisisStabilization Units (CSUs). CSUs are usually inpatient units of community mental health centers and receiveDepartment funds for Baker Act services. CSUs designated for children are referred to as Children’s CrisisStabilization Units (CCSUs). This means that while all CSUs/CCSUs are Baker Act receiving facilities, not all BakerAct receiving facilities are CSUs. The abbreviations CSU and CCSU are used throughout this report. Receivingfacilities that are provided funds from the Department are referred to later in this report as “public,” while thosenot receiving such funds are referred to as “private.” When the phrase “The Department” is used in this report, itis referring to the Florida Department of Children and Families.All analyses in this report used the County of Residence (see Table 7).There are complex reasons for the lower numbers of involuntary examinations in some areas and highernumbers in other areas. Readers of this report are urged to consider these factors when interpreting theresults. For example, the distribution of Baker Act receiving facilities statewide is not uniform. About half ofFlorida’s 67 counties have at least one Baker Act receiving facility, about half do not having a receiving facility.Areas of some counties are geographically distant from the nearest receiving facility. Additional factors mayinfluence the use of involuntary examination, such as: Number of people trained in Mental Health First Aid Law enforcement training, including Crisis Intervention Training (CIT) Availability of criminal justice system diversion programs at all sequential intercepts, including thosefunded by Criminal Justice, Mental Health, and Substance Abuse (CJMHSA) Reinvestment Grants Availability and quality of community-based behavioral health services, including mobile response teams Availability of a wide array of social services such as assistance with housing, coverage for health care,and existence of county funds for those who are underinsured or uninsured.Population statistics are provided in some tables to put counts of involuntary examinations in context.Population estimates were obtained from the Florida Office of Economic and Demographic Research. Countylevel characteristics were obtained from the Florida Department of Health, Division of Public Health Statisticsand Performance Management, and the Florida Health Charts. While this report focuses on counts by fiscalyears, estimates of population are available by calendar year. Logical calendar year spans are used to providecontext.Baker Act Reporting Center FY17/18 Annual Report3
B. Involuntary Examinations: State Level AnalysesThere were 205,781 involuntary examinations in FY 17/18. Three-quarters of involuntary examinations were for adults aged 18 through 64(n 151,345, 73.55%), with 17.53% (n 36,078) for those less than 18, and 7.41% (n 15,253) for people 65 and older. Young adults (age 1824) accounted for 12.79% of involuntary examinations statewide. There were 3,105 (1.51%) forms where age was unknown because a validdate of birth was not included on the Cover Sheet. Counts of involuntary examinations for the last 17 fiscal years are reported for all ages,children ( 18), transition-aged young adults (18-24), and older adults (65 ) (see Table 1. and Figure 1.).Table 1: Involuntary Examinations: FY 01/02 to 17/18 – All Ages, Children, and Older Adults2Fiscal Year2017-2018All Ages%Involuntary 5Children ( 2-2013163,85025.59%2011-2012154,6552010-2011Young Adults 18-24%InvoluntaryIncrease Rate PerExamsto100,000FY17/1826,328N/A1,445Older Adults (65 )%RateInvoluntary he population statistics used to compute involuntary examinations rates per 100,000 are age specific. For example, the denominators used to compute the rates per 100,000 for childrenwere for children 5 through 17, for young adults for the population 18 through 24, and for older adults for the population 65 and older. The age range 5 through 17 was used for childrenbecause including the population of children from birth through age 4 (who are not typically subject to involuntary examination) would incorrectly lower the rate per 100,000 for children.2Baker Act Reporting Center FY17/18 Annual Report4
Changes in Population vs. Changes in Volume of Involuntary Examinations: Because populationestimates for fiscal years were not available, population increases were calculated for thecalendar years closest to the fiscal years reported. Population estimates were obtained from theOffice of Economic and Demographic Research. The increase in the number of involuntaryexaminations was greater than the Florida population increase for all ages and the three agegroups from FY 07/08 to FY 17/18 (see columns A and B in Table 2). Over the last fiscal year (FY16/17 to FY 17/18) involuntary examination increases exceeded population increases, except foryoung adults (18-24) (see Columns C and D in Table 2).Table 2: Comparison of Change in Population to Change in Involuntary ExaminationsAge CategoriesAll AgesChildren ( 18)Young Adults (18-24)Older Adults (65 )Column APopulationChange2007 to 2017 11.32%-0.81% 7.95% 24.61%Column BInvoluntaryExaminationsFY 07/08 to FY 17/18 60.79% 83.09% 58.39% 69.70%Baker Act Reporting Center FY17/18 Annual ReportColumn CPopulationChange2016 to 2017 0.99% 0.32% 2.57% 1.58%Column DInvoluntaryExaminationsFY 16/17 to FY 17/18 2.92% 10.12% 0.32% 6.31%5
The increase over time for all three age groups is shown in Figure 1. Figure 2 shows counts for children, young adults, and older adults, but doesnot show the counts for all ages. This allows the scale of Figure 2 to be from 0 to 40,000, which allows us to see the pattern of increase in theage groups that is not possible in Figure 1 given the scale that is needed to show the count for all ages.Figure 1: Involuntary Examinations for 17 Fiscal Years for All Ages, Children, Young Adults, and Older AdultsInvoluntary Examinations by Fiscal Year250,000200,000150,000100,00050,0000All AgesChildren ( 18)Baker Act Reporting Center FY17/18 Annual ReportYoung Adults 18-246Older Adults (65 )
Figure 2: Involuntary Examinations by Age GroupsInvoluntary Examinations by Fiscal 00Children ( 18)Baker Act Reporting Center FY17/18 Annual ReportYoung Adults 18-24Older Adults (65 )7
The percent change in involuntary examinations from one year to the next is shown in Table 3 and Figure 3.Table 3: Year to Year Percentage Change of Involuntary Examinations by Age Groups% Change from One FiscalYear to the Next Fiscal YearAll AgesChildren( 18)Young Adults18-24Older Adults(65 )01/02 to 02/037.85%12.32%10.17%3.92%02/03 to 03/044.49%8.55%7.20%0.80%03/04 to 04/056.49%4.26%10.91%0.55%04/05 to 05/063.51%-0.24%3.70%0.78%05/06 to 06/071.15%1.15%0.86%0.13%06/07 to 07/086.58%2.43%1.45%3.23%07/08 to 08/094.42%2.81%5.89%5.76%08/09 to 09/105.72%4.29%8.36%7.72%09/10 to 10/112.84%2.95%2.85%6.05%10/11 to 11/126.45%14.18%4.99%7.77%11/12 to 12/135.95%7.94%5.68%6.96%12/13 to 13/148.03%13.23%6.08%8.31%13/14 to 14/156.21%7.56%5.98%1.98%14/15 to 15/163.38%-0.54%5.70%0.01%15/16 to 16/172.88%0.89%1.48%3.75%16/17 to 17/182.92%10.12%0.32%6.31%Baker Act Reporting Center FY17/18 Annual Report8
Figure 3: Year to Year Percentage Change of Involuntary Examinations by Age Groups3% Chang in Involuntary Examnations from Year to Year15105001/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17totototototototototototototototo02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17 17/18-5All Ages3Children ( 18)Young Adults 18-24Older Adults (65 )Note that the scale of Figure 3 is from slightly less than zero (to account for the few years with slight decreases) up to a max of a 15% change from one year to the next.Baker Act Reporting Center FY17/18 Annual Report9
Counts of involuntary examinations by age group are presented in Table 4. The percentage of totalexaminations and the percentage within each age group are both included. For example, involuntaryexaminations for adults aged 65 to 74 accounted for 4.71% of all involuntary examinations during thefiscal year and 62.56% of involuntary examinations for older adults (65 and older).Table 4: Involuntary Examinations by Age Groups for FY17/18% of Involuntary ExaminationsTotalWithin Each Age 4%11.78%15.77%7.41%4.71%62.56%2.05%27.23% 1.00%10.21%Involuntary ge GroupsChildren ( 18)10 and der Adults65-7475-8485 Initiation Type, Evidence Type, and Harm Type: Initiation type, evidence type, and harm type forinvol
Staff at the Baker Act Reporting Center at the University of South Florida produced this report under contract LH292 with the Department. Although this is considered the statutorily required annual . licensed mental health counselors (9.29%), licensed clinical social workers (5.33%), psychiatric nurses1 (2.02%), psychologists (1.27% .
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