What is Involuntary Commitment and when is it appropriate?
Involuntary commitment due to psychosis is a disturbing, yet common clinically indicated occurrence meaning patients with specific symptomology may require it for safety reasons. Although the thought of forcing an individual to receive treatment in a locked psychiatric hospital may sound like a horror film, when done with a clinically based approach and compassion, it can be a lifesaving event. If it were not for involuntary commitment, people disabled by chronic mental illness would most likely wonder the streets confused and vulnerable, completely unable to attain medication or desperately needed treatment.
While training as a student psychologist much of my clinical experience was with severe and chronic mental illness due to persistent thought disorders.
During my first internship, I was placed at a locked facility for severe mental illness. I was terrified and believed I would have to transfer practicums. As the weeks went by, I started to realize that the initial shock of seeing psychosis first hand dissipated. It became apparent to me that although this hospital may not be where I saw myself practicing psychology long-term, it was definitely an area that needed more professionals willing to help. From that point on, I made it my mission to learn as much about serious mental illness as I could.
Although there are many different mental disorders which can ultimately lead to psychosis (schizophrenia, bipolar disorder, and substance abuse), unfortunately, if left untreated, the end result is usually involuntary commitment. Being forced to come to a hospital on a locked until and receive medication can be devastating and even traumatizing for patients. Because this is often a necessary intervention, it is crucial to carry it out in the most humane and professional
way possible. I will now address different aspects of involuntary commitment in order to shed
light on possible strategies for helping those who need it the most.
In the state of Florida, when an individual is committed involuntarily, it is carried out via the Baker Act which was statue enacted in 1971.
“The Baker Act allows for involuntary examination (what some call emergency commitment). It can be initiated by judges, law enforcement officials, or mental health professionals. There must be evidence that the person a) has a mental illness (as defined in the Baker Act) and b) is a harm to self, harm to others, or self neglectful (as defined in the Baker Act). Examinations may last up to 72 hours and occur in 100+ Florida Department of Children and Families designated receiving facilities statewide (Wikipedia 2007). In essence, the Baker Act ensures that certain professionals will have the ability to authorize that an individual under their care go to a psychiatric hospital for immediate treatment.
Involuntary commitment is particularly relevant and useful to psychologists because it allows mental health professionals the ability to protect their patients when possible danger to themselves or others is a risk. It is also a way for psychologists to protect themselves legally. If a patient discloses that he or she is suicidal for instance, and plans to ingest a bottle of Tylenol, by
utilizing involuntary commitment, the therapist has done everything possible to ensure the
patient’s safety. Psychologists obviously cannot go home with patients and this is sometimes the
means to know their patient will be out of harms way for at least 72 hours. Finally, involuntary
commitment is particularly helpful to psychologists because it often catalyzes patients into
receiving more intensive treatment which may have been needed. Further more, because many
psychiatric issues are a direct result of the patient’s environment, being Baker Acted forces the
individual out of that specific environment which may be harmful and gives them an opportunity
to make necessary living changes. Although being Baker Acted may be a necessary intervention
for some people, there are many primary prevention strategies which can prevent it from ever
happening in the first place or not happening numerous times (Poland & McCormick 1999).
Primary prevention can either come from oneself or the local community.
Based on my own clinical experience, I believe that when prevention strategies are utilized across both areas, people who struggle with mental illness maintain the best prognosis. Personal primary prevention skills include but is not limited to attending weekly individual and group therapy, medication management (when prescribed), recognizing and reaching out to support systems, open communication and charting of particular triggers and symptoms. Many of these activities must be provided by the community itself, or the individual who needs help cannot find it even if they try. This is why the local community has responsibility to offer as many mental health services and resources as possible.
Secondary intervention is short term activities to manage and minimize a crisis (Poland
McCormick 1999). When involuntary commitment is necessary, it certainly does not mean that
the individual will have to be hospitalized forever. In other words, people are no longer locked
up and the key thrown away. In today’s society, people are hospitalized for up to 72 hours in
order to monitor and assess whether or not they are safe to go home and care for themselves or
be cared for by loved ones. In severe cases, some people do not recover right away with medication and therapy, in which case longer term treatment is necessary. Even in this case
though, patients are still assessed every month to six months to evaluate whether or not they are well enough to go home. Furthermore, it should be mentioned here that psychiatric hospitals are no longer places of where people are tortured and abused. The government has taken many steps now to ensure the wellbeing and safety of patients institutionalized. In any case, secondary
interventions after an involuntary commitment occurs are important, whether or not the patient is released from the hospital. While in the hospital these can include resources offered by the
hospital itself, for instance, short-term (crisis intervention oriented) individual and group therapy,
psycho-education classes, medication management and daily structured activities.
While in the hospital, support from family and friends is also important immediately after the crisis has occurred. If the individual is no longer hospitalized after a couple of days, all of the same things are necessary (therapy, education, medication, structure and support) only it is up to the family and patient to seek this type of intervention for themselves. Either way, the important message is that although primary prevention activities can help to keep someone from being hospitalized involuntarily in the first place, secondary interventions can help to make treatment and recovery more effective and lasting.
Finally, tertiary intervention is long term assistance for those most affected by the crisis
(Poland & McCormick 1999). It is important to understand that the person being involuntarily committed to a psychiatric hospital is usually not the only person to experience distress. It is upsetting and at times, traumatizing for loved ones as well. Tertiary intervention takes into account not only the patient, but their family and friends as well on a long-term basis. Types of intervention can include long-term individual and group therapy, psycho-education, support groups and learning the to intervene in early stages of relapse. These types of assistance are for the patient, family and friends.
The topic of involuntary commitment is relevant to South Florida living where so many
communities have high rates of chronic addiction, severe mental illness and homelessness.
Baker Act can by a means of preventing crises with permanent consequences from ever
happening. For instance, in the Jonesboro case, perhaps if the student’s teacher’s and loved ones had noticed that he needed help earlier on, they would have been able to intervene by getting him the treatment he so desperately needed. The same can be said for some of the suicide and self- injury cases that we discussed in class. If intervention had occurred earlier, their condition may not have worsened. Of course, no one can prevent natural disasters, but unfortunately, after one does occur, many people are in need of significant help. If prevention and planning takes place before the disaster does, then less people may have a psychological break down afterwards.
Furthermore, in the case of natural disasters, involuntary commitment can sometimes save
people’s lives. While completing my training in Fort Lauderdale and Miami, I worked with
several people displaced from Hurricane Katrina. At the time, the hospital was the only place
they had to go while they tried to cope with such a great loss and got back on their feet.
After investigating the topic of involuntary commitment and severe mental illness, I have
learned many things. Number one, being Baker Acted or forced to go to the hospital for
psychosis is not necessarily a bad thing. It can help people to finally get the treatment they
desperately need. I have also learned that it can be prevented by following certain primary
prevention activities such as therapy, medication, support and asking for help. The most important thing I have learned about this topic is that anyone can be involuntarily committed. People with severe mental illness are often committed to psychiatric hospitals at numerous times in their lives. Unfortunately, other people, for instance some going through a divorce or a death in the family can have an emotional breakdown which can result in drug abuse, violence and suicidal ideation. In these cases, even though the individual may have never even been in mental health counseling, it is important for family and friends to recognize the severity of their condition.
Many times people avoid involuntary commitment because of shame, fear of hurting their
loved one or even denial. Sometimes the kindest thing one can do for their loved one is recognize when the situation has gotten out of control. When people avoid necessary hospitalization because of cost, embarrassment or denial, too often one or even more people can wind up injured or dead. In reality, if a loved on is endangering themselves or others, the family and friends have an obligation to let somebody know.
Recommendations to psychologists are as follows:
Number one, psychologists need to have as much knowledge as possible about involuntary commitment or Baker Act for psychosis and severe mental illness. Although school and of course the licensing exam covers these issues, it is up to each psychologist as a professional to maintain up- to-date information regarding this topic so that they are helping people in the most appropriate way possible. Number two, family and friends are not the only people who avoid involuntary commitment. Psychologists too have some reservations about hospitalizing patients. The psychologists may feel that they are breaking confidentiality or causing more trauma for the patient. If carried out accordingly, the Baker Act is a tool for psychologists in Florida to better serve their patient’s needs, even if the patient is resistant or unaware of it at the time.
If you or someone you know has questions about when it is appropriate or necessary to
go to the hospital or request a Baker Act, please contact MorMindful Therapy & Psychiatry at
561-460-1885 and we will do our best to give you additional information about what options and
resources are available to you. After hospitalization, voluntary or involuntary, an aftercare
treatment plan should be created which the providers at MorMindful are equipped and ready to
do.
Blair H. Mor, Psy.D.
Supervising Licensed Psychologist
Owner at MorMindful Therapy & Psychiatry