IDEAS IN ACTION—It is Well Past Time to Modernize Florida's Baker & Marchman Acts
Guest Column by State Representative Patt Maney
One year ago, Johnny Lee Akins of Crestview, Florida sought treatment for severe mental health issues at a hospital with a psychiatric receiving facility, and despite his wife’s desperate pleas, the facility released him because he apparently did not meet commitment criteria.[i] Two days later, he was charged with the murder of his friend and neighbor,[ii] a scenario that repeats itself more often than it should. Equally alarming, in November 2021, the National Center for Health Statistics at the Centers for Disease Control and Prevention estimated that 100,306 overdose deaths occurred in America between April 2020 and April 2021—a nearly 29% increase from the prior year.[iii] These and many other similar stories illuminate how much we are systematically failing to assist people struggling with serious mental illnesses and drug addictions.
In Florida, the two laws that respectively govern these topics are commonly known as the Baker and Marchman Acts. Unfortunately, while revolutionary when enacted fifty years ago, these acts no longer reflect legal, medical, and scientific advances in the field. Additionally, these acts contain numerous procedural inefficiencies that limit access to services, threaten public safety, and waste state resources. For instance, it can take nearly twelve weeks for one person to be admitted into drug treatment under the Marchman Act. We would never tolerate this treatment timeline for a cancer or heart disease diagnosis. Likewise, with no post-discharge continuum of care, the Baker Act has become a “revolving door” for those with the most severe mental illnesses.[iv] More specifically, in 2019, there were over 210,000 involuntary assessments—a 120.76% increase since 2002—and 21% of these cases typically involved people with two or more evaluations, accounting for 44% of the year’s total examinations.[v] Moreover, the commitment criteria of these laws are more narrow than that of 27 other states and the 1983 model code of American Psychiatric Association.[vi] Outside factors have also changed dramatically while these laws have remained relatively static. Florida, after all, is now home to approximately 21.3 million people as opposed to 6.8 million in the 1970s, yet we only have 2,600 treatment facility beds, 69% of which are occupied by individuals from the criminal justice system.[vii]
By needlessly limiting the availability of care for those with the most severe mental illnesses and addictions, inefficiencies in Florida’s civil commitment laws have contributed to the criminal justice system inappropriately becoming the state’s de facto mental health and drug treatment system. Miami-Dade County jail, for example, contains more beds serving inmates with mental illnesses than all Florida state civil and forensic mental health hospitals combined.[viii] In fact, because the intervention process under Florida’s involuntary treatment laws is so disjointed, a Baker or Marchman admission is ironically “associated with a 12% increase in the risk of arrest,” and that probability jumps to 50% if a person has four admissions in a year.[ix] The criminal justice system, though, is poorly equipped to handle the special needs of these individuals, and many of them consequently leave jail or prison in worse shape than when they entered, which makes them highly likely to return or end up dead.[x] Modernizing the Baker and Marchman Acts would thus help keep individuals with serious mental illnesses and addictions from rotating between homelessness, incarceration, and hospitalization.
The human costs of this vicious cycle are obviously enormous, and the fiscal impact to taxpayers is just as astronomical. Miami-Dade County alone spends $636,000 per day—which is $232 million a year—on roughly 2,400 inmates with serious mental illness and co-occurring disorders.[xi] By comparison, Florida as a state annually allocates only $47.3 million to provide around 34,000 people in Miami-Dade and Monroe counties with mental health services.[xii]The impact of failing to provide adequate community-based treatment is even more considerable over time as a study revealed that in a five-year period, 97 individuals with serious mental illnesses in Miami-Dade County accounted for 2,200 bookings into the county jail, 27,000 days in jail, and 13,000 days in crisis units, state hospitals, and emergency rooms.[xiii] The cost to taxpayers was estimated at nearly $17 million with little impact on reducing recidivism, return on investment, or other measurable positive outcomes.[xiv]
Continuing to spend more money to incarcerate rather than treat people with mental illnesses or drug addictions is wasteful and in many ways the definition of insanity. Furthermore, as evidenced by the Conference of Chief Justices and Conference of State Court Administrators recently passing a unanimous resolution recommending major changes on how we respond to people with mental illnesses and co-occurring disorders, there is widespread agreement between stakeholders and members of both political parties that the existing system does not work well and can sometimes make matters worse.[xv] The Florida Legislature must therefore update the Baker and Marchman Acts to reflect modern medicine and science and to stop the revolving door into the criminal justice and civil commitment systems.
Accordingly, in an effort to save lives, help heal Florida families, improve public safety, save critical tax dollars, and enable countless Floridians achieve a life of recovery with hope and opportunity, I will be sponsoring a comprehensive reform of Florida’s outdated civil commitment system during the 2023 legislative session that will remove the many structural inefficiencies preventing vulnerable Floridians from accessing care.
* Patt Maney is a retired brigadier general and former county court judge who has represented District 4 (Part of Okaloosa) in the Florida House of Representatives since 2020. Reforming Florida’s civil commitment laws was one of his primary motivators for seeking legislative office because as a judge, he presided over Baker Act hearings and witnessed the law’s various shortcomings.
[i] Sierra Rains, ‘I begged’: Wife says murder suspect was refused mental health treatment days before slaying, Northwest Florida Daily News, Aug. 26, 2011; https://www.nwfdailynews.com/story/news/2021/08/26/ crestview-murder-suspect-sought-treatment-mental-illness-wife-says/5586636001/.
[iii] Centers for Disease Control and Prevention, Drug Overdose Deaths in the U.S. Top 100,000 Annually, Nov. 17, 2021; https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm.
[v] Baker Act Reporting Center, Fiscal Year 2018/2019 Annual Report, https://www.usf.edu/cbcs/baker-act/documents/ba_usf_annual_report_2018_2019.pdf; John M. Robst et al., Association of Involuntary Psychiatric Examination With Probability of Arrest of People With Serious Mental Illness, Psychiatric Services, Sept. 2011; ps.psychiatryonline.org.
[vi] Treatment Advocacy Center, State Standards for Civil Commitment (Updated: Sept 2020) available at: https://www.treatmentadvocacycenter.org/storage/documents/state-standards/state-standards-for-civil-commitment.pdf; Clifford D. Stromberg & Alan A. Stone, Statute—A Model State Law on Civil Commitment of the Mentally Ill, 20 Harv. J. on Legis. 275 (1983); Craig v. State, 804 So. 2d 532 (Fla. 3d DCA 2002) (urging the Legislature to revise the commitment criteria because current law enables a person with mental illness to stalk or harass others and not be hospitalized unless said person causes or threatens physical harm). Florida’s Baker and Marchman Acts have the same commitment criteria. §§ 394.467(1); 397.675, Fla. Stat. (2022).
[vii] Florida Department of Health, Statewide Drug Policy Advisory Council: 2021 Annual Report.
[viii] Jackson Health System & Correction Health Services (Miami), CHS Operational Statistics (Unpublished 2021 Data); Florida Department of Children and Families, State Mental Health Treatment Facilities, https://www.myflfamilies.com/service-programs/mental-health/state-mental-health-treatment-facilities.shtml.
[ix] See Robst et al, supra note v.
[xiii] Florida Mental Health Institute, Miami-Dade County Heavy User Data Analysis (Unpublished 2010 data).
[xv] National Judicial Task Force to Examine State Courts’ Response to Mental Illness, CCJ-COSCA Resolution in Support, June 29, 2022.