Florida, USA – “The family is the nucleus of society.  When it is weakened or destroyed, we all pay,” says Jenny Jabril, a Chaldean nurse in Florida’s Orange County.  “We all pay when families break-down or fail.  We the people, deal with the dysfunction.  Our taxes go up to care for the abandoned or misguided children, our education system spins out of control, we pay more to prevent crimes, protect our families, or hospitalize these people.” 

Jabril is frustrated over the increased number of substance abuse.  In Florida law, citizens can be held against their will under the Marchman Act. Individuals whose substance abuse makes them a threat to themselves or others can be held at a mental-health facility for up to five days while physicians evaluate them.

Jerry Kassab, president and chief executive officer of Lakeside Alternatives, Orange County's receiving center, said his facility receives about 20 patients a day who are committed under the law.   There are three scenarios in which someone can be committed under the Marchman Act.

In Orange County, Kassab said, most patients are taken to Lakeside by law enforcement officers.  "The most common instance is when someone's out on the street who's acting up, or the police might be called by a store owner because someone's acting up or acting weird," Kassab said. "You also get instances when one family member calls the police because someone in their family is out of control."

That number has increased during the past five years, Kassab said, as law-enforcement culture has shifted toward the belief a hospital is better than a jail.  "This doesn't show up on their records," Kassab said. "It's a good thing to have them receive treatment rather than jail."

Patients can also be committed by a licensed mental-health counselor or physician. According to Kassab, family members sometimes come to Lakeside with patients who don't want to enter the facility voluntarily. If they meet the criteria for involuntary commitment, the center's staff can commit them.

A family member or friend also can seek a court order for someone to be committed. To do that, an individual fills out a petition form and signs it under oath at a county clerk's office. A judge then decides, based solely on the petition, whether the patient meets the criteria.  If the petition is persuasive, the judge enters an order and informs law enforcement officers, who take the patient to a receiving center.

The goal of the Marchman Act commitments is to evaluate patients and persuade them to enter an outpatient treatment program.  "We sit down with them and try to set up an appointment and a plan that they'll keep, but so many don't, and that's just a fact of it," Kassab said.

After the designated evaluation period has passed, physicians at the receiving center can petition the court to hold a patient longer, often just for a few days; but in a few instances, they may ask the court for permission to move the patient to a state-run hospital.

In both instances, the hearings usually take place right at the receiving center, and the patient is represented by a public defender.

"The public defender is very opposed many times, because they believe it's a violation of their civil rights," Kassab said. "Our doctors want to keep them because they believe it's in their best interest."

When the court does decide in the favor of the receiving center, the patient's lawyer often appeals the ruling -- and usually the appeals court will side with the patient, Lenderman said.

Jabril says, “It's a balancing act between a person's liberty and their safety and the safety of the community.  All of this has come about because of the family breaking down. Our healthcare costs have skyrocketed and it has forced other families to pay for the lack of personal responsibility by those who are alcoholic, using drugs, or becoming mentally ill due to a parents STD.”