HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 1447 Commission on Mental Health and Substance Abuse
SPONSOR(S): Children, Families & Seniors Subcommittee, Hunschofsky
TIED BILLS: IDEN./SIM. BILLS: SB 1888
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee 15 Y, 0 N, As CS Morris Brazzell
2) Health Care Appropriations Subcommittee 13 Y, 0 N Fontaine Clark
3) Health & Human Services Committee 21 Y, 0 N Morris Calamas
SUMMARY ANALYSIS
The Department of Children and Families (DCF) administers a statewide system of safety-net services for
substance abuse and mental health (SAMH) prevention, treatment, and recovery. It serves children and adults
who are otherwise unable to obtain these services. Individuals may also receive behavioral health services in
Florida through other systems, such as Medicaid, schools, and the corrections system.
In 2018, the Legislature enacted the “Marjory Stoneman Douglas High School Public Safety Act” (the Act) to
address school safety and security and establish the Marjory Stoneman Douglas High School Public Safety
Commission. The Act created the Office of Safe Schools within the Florida Department of Education and
requiring increased coordination among state and local agencies serving students with, or at-risk of, mental
illness. In 2019, the Florida Supreme Court convened a Grand Jury to study systemic school safety failures.
The Grand Jury investigated whether specific public entities failed to act or committed fraud that undermined
the school safety activities which the Act and subsequent legislation required. The Grand Jury recommended
the Legislature appoint a commission to specifically examine the provision of mental health services in the
state.
CS/HB 1447 creates a 19-member Commission on Mental Health and Substance Abuse (Commission),
adjunct to DCF, to examine the current methods of providing mental health and substance abuse services in
the state. The bill requires DCF to provide administrative staff and support services for the commission.
Commission members are appointed by the Governor, President of the Senate, and Speaker of the House of
Representatives and must convene by September 1, 2021. The bill requires state departments and agencies to
provide assistance in a timely manner if requested by the Commission.
The Commission must submit an initial report by September 1, 2022, and a final report by September 1, 2023,
to the Governor, President of the Senate, and Speaker of the House of Representatives on its findings and
recommendations on how to best provide and facilitate mental health and substance abuse services in this
state. The Commission is repealed on September 1, 2023, unless it is reenacted by the Legislature.
The bill has a significant, negative fiscal impact on DCF that can be absorbed within existing resources. The
bill has no fiscal impact to local governments.
The bill is effective upon becoming a law.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Mental Illness
Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope
with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or
her community.1 The primary indicators used to evaluate an individual’s mental health are:2
Emotional well-being- Perceived life satisfaction, happiness, cheerfulness, peacefulness;
Psychological well-being- Self-acceptance, personal growth including openness to new
experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality,
self-direction, and positive relationships; and
Social well-being- Social acceptance, beliefs in the potential of people and society as a whole,
personal self-worth and usefulness to society, sense of community.
Mental illness is collectively all diagnosable mental disorders or health conditions that are characterized
by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress or
impaired functioning.3 Thus, mental health refers to an individual’s mental state of well-being whereas
mental illness signifies an alteration of that well-being.
Mental illness affects millions of people in the United States each year. Nearly one in five adults (51.5
million people) live with a mental illness.4 An estimated 13.1 million adults aged 18 or older have a
serious mental illness.5 Many people are diagnosed with more than one mental illness. For example,
people who suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) tend to
co-occur with substance abuse and anxiety disorders.6
According to a 2019 assessment by the U.S. Department of Housing and Urban Development, 567,715
people were homeless on a given nights in the United States.7 At a minimum, 116,179, or 20% percent,
of these people were severely mentally ill.
Mental Health Safety Net Services
The Department of Children and Families (DCF) administers a statewide system of safety-net services
for substance abuse and mental health (SAMH) prevention, treatment and recovery for children and
adults who are otherwise unable to obtain these services. SAMH programs include a range of
prevention, acute interventions (e.g. crisis stabilization), residential treatment, transitional housing,
outpatient treatment, and recovery support services. Services are provided based upon state and
federally-established priority populations.
Behavioral Health Managing Entities
1
World Health Organization, Mental Health: Strengthening Our Response, https://www.who.int/news-room/fact-sheets/detail/mental-health-
strengthening-our-response (last visited April 12, 2021).
2
Centers for Disease Control and Prevention, Learn About Mental Health, http://www.cdc.gov/mentalhealth/basics.htm (last visited April 12,
2021).
3
Id.
4
National Institute on Mental Health, Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness.shtml, (last visited April 12, 2021).
5 Id.
6 John Hopkins Medicine, Mental Health Disorder Statistics, https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-
health-disorder-statistics (last visited April 12, 2021).
7 U.S. Department of Housing and Urban Development, 2019 CoC Homeless Populations and Subpopulations Report – All States,
Territories, Puerto Rico, and DC, https://www.hudexchange.info/programs/coc/coc-homeless-populations-and-subpopulations-reports/
(last visited April 12, 2021).
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In 2001, the Legislature authorized DCF to implement behavioral health managing entities (ME) as the
management structure for the delivery of local mental health and substance abuse services.8 The
implementation of the ME system initially began on a pilot basis and, in 2008, the Legislature
authorized DCF to implement MEs statewide.9 Full implementation of the statewide managing entity
system occurred in April 2013; all geographic regions are now served by a managing entity.10
DCF contracts with seven MEs.11
In FY 2019-2020, the network service providers under contract with the MEs served 274,560
individuals.12
Coordinated System of Care
Managing entities are required to promote the development and implementation of a coordinated
system of care.13 A coordinated system of care means a full array of behavioral and related services in
a region or community offered by all service providers, participating either under contract with a
managing entity or by another method of community partnership or mutual agreement.14 A community
or region provides a coordinated system of care for those suffering from mental illness or substance
abuse disorder through a no-wrong-door model, to the extent allowed by available resources. If funding
is provided by the Legislature, DCF may award system improvement grants to managing entities.15
MEs must submit detailed plans to enhance crisis services based on the no-wrong-door model or to
meet specific needs identified in DCF’s assessment of behavioral health services in this state.16 DCF
must use performance-based contracts to award grants.17
There are several essential elements which make up a coordinated system of care, including: 18
Community interventions;
Case management;
Care coordination;
Outpatient services;
Residential services;
Hospital inpatient care;
Aftercare and post-discharge services;
Medication assisted treatment and medication management; and
Recovery support.
A coordinated system of care must include, but is not limited to, the following array of services:19
Prevention services;
Home-based services;
School-based services;
Family therapy;
Family support;
Respite services;
8 Ch. 2001-191, Laws of Fla.
9 Ch. 2008-243, Laws of Fla.
10 The Department of Children and Families Performance and Accountability System for Behavioral Health Managing Entities, Office of
Program Policy Analysis and Government Accountability, July 18, 2014.
11 Department of Children and Families, Managing Entities, https://www.myflfamilies.com/service-programs/samh/managing-entities/
(last visited April 12, 2021).
12 Department of Children and Families, Substance Abuse and Mental Health Triennial Plan Update for Fiscal Year, (December 31,
2020) https://www.myflfamilies.com/service-programs/samh/publications/docs/2019-2020%20Triennial%20Plan%20Update.pdf (last
visited April 12, 2021).
13
S. 394.9082(5)(d), F.S.
14
S. 394.4573(1)(c), F.S.
15
S. 394.4573(3), F.S. The Legislature has not funded system improvement grants.
16
Id.
17
Id.
18
S. 394.4573(2), F.S.
19
S. 394.495(4), F.S.
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Outpatient treatment;
Crisis stabilization;
Therapeutic foster care;
Residential treatment;
Inpatient hospitalization;
Case management;
Services for victims of sex offenses;
Transitional services; and
Trauma-informed services for children who have suffered sexual exploitation.
Current law requires DCF to define the priority populations which would benefit from receiving care
coordination, including considerations when defining such population.20 Considerations include the
number and duration of involuntary admissions, the degree of involvement with the criminal justice
system, the risk to public safety posed by the individual, the utilization of a treatment facility by the
individual, the degree of utilization of behavioral health services, and whether the individual is a parent
or caregiver who is involved with the child welfare system.
MEs are required to conduct a community behavioral health care needs assessment once every three
years in the geographic area served by the managing entity, which identifies needs by sub-region.21
The assessments must be submitted to DCF for inclusion in the state and district substance abuse and
mental health plan.22
The Baker Act
In 1971, the Legislature adopted the Florida Mental Health Act, also known as the Baker Act.23 The
Baker Act authorizes treatment programs for mental, emotional, and behavioral health which are
designed to reduce the occurrence, severity, duration, and disabling aspects of mental, emotional, and
behavioral disorders.24 These treatment programs include, but are not limited to, comprehensive health,
social, educational, and rehabilitative services to persons requiring intensive short-term and continued
treatment to encourage them to assume responsibility for their treatment and recovery.25 The Baker Act
provides legal procedures, protections, and rights to individuals examined or treated for mental illness
and addresses legal procedures for examination and treatment including: voluntary admission;26
involuntary admission;27 involuntary inpatient treatment;28 and involuntary outpatient treatment.29
The Baker Act requires each county to designate a single law enforcement agency to transfer a person
in need of services.30 If a person is in custody based on noncriminal or minor criminal behavior, law
enforcement transports the person to the nearest receiving facility.31 If, however, the person is arrested
for a felony, the person must first be processed in the same manner as any other criminal suspect. Law
enforcement must then transport the person to the nearest facility, unless the facility is unable to
provide adequate security, in which case the person must be examined and treated wherever he or she
is held.32
Receiving Facilities
20
S. 394.9082(3)(c), F.S.
21
S. 394.9082(5)(b), F.S.
22
S. 394.75(3), F.S.
23 Ch. 71-131, Laws of Fla.; ch. 394, part I, F.S.
24 S. 394.453(1)(a), F.S.
25 S. 394.453(1)(b), F.S.
26 S. 394.4625, F.S.
27 Ss. 397.6772, 397.679, 397.6798, and 397.6811, F.S.
28 S. 394.467, F.S.
29 S. 394.4655, F.S.
30 S. 394.462(1)(a), F.S.
31 S. 394.462(1)(g), F.S.
32 S. 394.462(1)(f) and (g), F.S.
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A person experiencing severe emotional or behavioral problems often requires emergency treatment to
stabilize his or her situation before referral for outpatient services or inpatient services can occur.
Emergency mental health stabilization services may be provided to a person on a voluntary or
involuntary basis. Receiving facilities, often referred to as Baker Act facilities, are public or private
facilities designated by DCF for the purpose of receiving and holding or referring, as appropriate,
involuntary patients under emergency conditions for mental health or substance abuse evaluation and
to provide treatment or transportation to the appropriate service provider.33 A public receiving facility is
a facility that provides mental health services to all persons, regardless of their ability to pay, and
receives state funds for such purpose.34 Facilities may only use appropriated funds to provide services
to diagnostically and financially eligible persons, or those who are acutely ill, in need of mental health
services, and the least able to pay.35
Crisis Stabilization Units (CSUs) are public receiving facilities that receive state funding and provide a
less intensive and less costly alternative to inpatient psychiatric hospitalization for individuals
presenting as acutely mentally ill. CSUs screen, assess, and admit individuals under the Baker Act, as
well as those individuals who voluntarily present themselves, for short-term services.36 CSUs provide
services 24 hours a day, seven days a week, through a team of mental health professionals. The
purpose of the CSU is to examine, stabilize, and redirect people to the most appropriate and least
restrictive treatment settings, consistent with their mental health needs.
As of March 2021, there were 131 Baker Act receiving facilities in Florida, including 66 public receiving
facilities and 65 private receiving facilities.37 Of the 53 public receiving facilities, 47 also contract to
provide CSU services.38
Involuntary Admission
A person receiving services on an involuntary basis must be taken to a designated “receiving facility.”39
He or she cannot be involuntarily held in a receiving facility for examination for longer than 72 hours.40
Generally, within the 72-hour examination period, one of the following must occur:41
The patient must be released, unless he or she is charged with a crime, in which case law
enforcement resumes custody;
The patient must be released into voluntary outpatient treatment;
The patient must be asked to give consent to be placed as a voluntary patient if placement is
recommended; or
A petition for involuntary placement must be filed in circuit court for outpatient or inpatient
treatment
Under the Baker Act, a court must hold a hearing on involuntary inpatient or outpatient placement within
five working days after a petition for involuntary placement is filed.42 The petitioner