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Kids need hospitalization under Baker Act but where to go?

BROOKSVILLE — A few months ago, two distraught parents showed up at Springbrook Hospital with their 7-year-old son.

The boy was physically lashing out and could not be consoled, recalled Vijaya Siddalingappa, director of clinical services for the 66-bed adult psychiatric hospital.

The private, for-profit facility on Grove Road is not licensed or designed to provide in-patient services to minors.

"We're not allowed to medicate children," Siddalingappa said. "The poor kid needed something to calm him down, and all we could do was talk to him, and it didn't help."

Springbrook staffers called Morton Plant North Bay Hospital Recovery Center in Lutz, 30 miles south, but the BayCare facility declined to take the boy, citing a lack of beds, Siddalingappa said. Springbrook finally convinced the Hernando Sheriff's Office to take the boy there anyway.

The case illustrates what mental health advocates call an unacceptable situation for Hernando residents — especially juveniles — who are involuntarily committed under the Baker Act. The state law allows people to be taken into custody for mental health examinations if they appear likely to cause serious injury to themselves or others.

In the short term, advocates agree, Springbrook needs help transporting Hernando's juvenile Baker Act patients to facilities outside the county. In the long run, Hernando needs its own crisis unit for children.

Last week, a committee of mental health professionals and advocates gathered at Springbrook for their monthly Baker Act meeting and agreed: It's time to meticulously document Hernando's needs and aggressively push for resources from the state.

"We have to get facts and figures down," said Maureen Soliman, a board member for the Hernando chapter of the National Alliance on Mental Illness. "And we have to be one voice."

• • •

NAMI has for years lamented the lack of mental health services in Hernando County. That concern grew on Jan. 31, 2012, when BayCare closed its 10-bed crisis stabilization unit at the Harbor, also located on Grove Road.

State law requires mental health facilities to accept Baker Act patients regardless of age. Under a local agreement in place for several years, Hernando deputies delivered patients up to 64 years old to the Harbor, and Springbrook took patients 65 and older.

Now Springbrook is Hernando's only crisis unit, so deputies bring all Baker Act patients there unless they require medical treatment.

Springbrook officials say state officials failed to prepare for the loss and have been slow to react since then.

"Who stepped in as patient advocates and said, 'We need to have continuity of services?' " Siddalingappa said. "No one did that."

An effort was made to help ease the transition, said Carolann Duncan, regional substance abuse and mental health director for the state Department of Children and Families.

"We worked very closely with Springbrook and BayCare," Duncan said.

State mandate requires Hernando County to give matching funds to the Harbor for crisis care and other services. When BayCare officials announced they would close the Harbor's crisis unit in order to focus on outpatient services, they agreed to work with Springbrook to place minor or indigent Baker Act patients at the Morton Plant North Bay facility.

"There weren't any beds lost," Duncan said. "They were moved from one facility to another."

But that has made for a rocky year, Springbrook officials said.

"When we first started it was really a battle" to get patients placed at North Bay, Siddalingappa said. "Change was not a comfortable thing on their end. But after meetings, they started to really help out. Every once in a while we get a lot of resistance."

Springbrook is not a Medicaid facility, so it absorbs the cost of treating indigent adults admitted under the Baker Act, said hospital administrator Mike Hogan. Over the last year, about 20 percent of patients could not pay.

Springbrook might seek permission from the state to add about 10 beds, which would help defray the cost of indigent adult care, Hogan said.

Children are another matter.

Evaluating young patients and holding them for a short amount of time is not a problem, Hogan said. But the average stay is seven or eight hours, and some children stay as long as 24.

That's too long, Hogan said, especially for a child like the agitated 7-year-old. "It's unsettling for a child to come into a Baker Act facility for adults."

The contract with the county requires BayCare to reserve four beds at its North Bay center for Hernando's indigent patients and one bed for the county's indigent minors. When that center is full, BayCare helps find a bed at one of its other facilities, such as Morton Plant Hospital in Clearwater or St. Joseph's Behavioral Health Center in Tampa, said Gail Ryder, BayCare's vice president of behavioral health.

"We're doing what we said we were going to do," Ryder said.

Finding a bed is only part of the problem. Springbrook devotes two mental health technicians and a driver to get the child to BayCare. When BayCare is full, Springbrook, which bears the responsibility of transferring the children, regularly travels as far as Ocala. Springbrook absorbs the transportation expenses as well as costs for holding the children.

The County Commission and DCF could allow law enforcement to take Baker Act patients to facilities outside of the county, but that would put the burden on the Sheriff's Office, which has its own budget and staffing concerns. Either way, the likely solution is more resources.

"We've taken the extra responsibility and done the right thing," Siddalingappa said, "but we need help."

• • •

As Springbrook has struggled to place and transport patients, two developments in the last year have reshaped the local mental health landscape, offering some hope.

DCF now funnels state dollars through managing entities that solicit bids from mental health service providers and oversee the contracts. Lutheran Services Florida, the managing entity over Hernando and 22 other counties, took over in July.

Lutheran Services is eager to meet with Hernando officials to talk about solutions, said Tina St. Clair, vice president of mental health and substance abuse. Funding will be a challenge, though, St. Clair said.

"Unfortunately, that's what you have throughout the state," she said.

The second development came last month, when the Hernando County Commission formed a mental health alliance that aims to give local mental health service providers a means to snag grant money to address specific issues.

That could help with the Baker Act problems, and also pay for a dedicated child psychiatrist to address mental health issues before they result in involuntary commitments, said David Welch, NAMI Hernando's president.

"We've made more progress in the last two months than we have in a couple years," he said.

Tony Marrero can be reached at

by the numbers

30 Juvenile Baker Act cases in Hernando in an average month.

802 Adults and children

taken into custody under the Baker Act by Her-

nando Sheriff's Office in 2012.

1,397 Total number of adult Baker Act cases in Hernando in 2012.

Source: Springbrook Hospital,

Hernando Sheriff's Office

Kids need hospitalization under Baker Act but where to go? 02/09/13 [Last modified: Saturday, February 9, 2013 12:36pm]
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