HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 1143 Mental Health and Substance Abuse
SPONSOR(S): Appropriations Committee, Children, Families & Seniors Subcommittee, Maney and others
TIED BILLS: HB 1157 IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee 15 Y, 0 N, As CS Rahming Brazzell
2) Criminal Justice & Public Safety Subcommittee 16 Y, 0 N Mathews Hall
3) Appropriations Committee 23 Y, 0 N, As CS Fontaine Pridgeon
4) Health & Human Services Committee
SUMMARY ANALYSIS
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.
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and
drugs. In Florida, the Baker Act provides a legal procedure for voluntary and involuntary mental health
examination and treatment. The Marchman Act addresses substance abuse through a comprehensive system
of prevention, detoxification, and treatment services. The Department of Children and Families (DCF) is the
single state authority for substance abuse and mental health treatment services in Florida.
CS/HB 1143 modifies the Baker Act and makes significant changes to the Marchman Act, the statutory
processes for mental health and substance abuse examinations and treatment, respectively. The bill:
 Grants law enforcement officers discretion on initiating involuntary examinations, and revises
requirements for how they transport individuals for an involuntary examination.
 Repeals all provisions for court-ordered involuntary assessments and stabilization in the Marchman
Act, and combines these procedures into a consolidated involuntary treatment process.
 Prohibits courts from ordering an individual with a developmental disability who lacks a co-occurring
mental illness to a state mental health treatment facility for involuntary inpatient placement.
 Revises the voluntariness provision under the Baker Act to allow a minor's voluntary admission after a
clinical review, rather than a hearing, has been conducted.
 Authorizes a witness to appear remotely upon a showing of good cause and with consent by all parties.
 Allows an individual to be admitted as a civil patient in a state mental health treatment facility without a
transfer evaluation and prohibits a court, in a hearing for placement in a treatment facility, from
considering substantive information in the transfer evaluation unless the evaluator testifies at the
hearing.
 Requires receiving and treatment facilities to inform specified persons, in writing, of services available
in their geographic area that would assist in their mental health or substance abuse recovery.
 Adds a community mental health center setting to the current law restrictions on when a psychiatric
nurse may release a patient from a receiving facility.
 Revises certain provisions relating to the Commission on Mental Health and Substance Abuse.
 Requires DCF to publish specified annual Baker Act reports on its website and creates the same
requirement in the Marchman Act, but delays implementation for such reports until 2023.
 Makes technical and conforming changes.
The bill provides an appropriation of $633,000 for the additional data reporting costs and per diem
reimbursement provisions of the bill.
The bill provides an effective date of July 1, 2022.
This docum ent 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 Health and 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 lives with a mental illness.4 During their childhood
and adolescence, almost half of children will experience a mental disorder, though the proportion
experiencing severe impairment during childhood and adolescence is much lower, at about 22%.5
The Baker Act
The Florida Mental Health Act, commonly referred to as the Baker Act, was enacted in 1971 to revise
the state’s mental health commitment laws. 6 The Act includes legal procedures for mental health
examination and treatment, including voluntary and involuntary examinations. It additionally protects
the rights of all individuals examined or treated for mental illness in Florida. 7
Rights of Patients
Current Situation
The Baker Act protects the rights of patients examined or treated for mental illness in Florida, including,
but not limited to the right to communicate freely and privately with persons outside a facility, unless the
facility determines that such communication is likely to be harmful to the patient or others.8 Currently, a
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 Feb. 8, 2022).
2
Centers for Disease Control and Prevention, Mental Health Basics, http://medbox.iiab.me/modules/en-
cdc/www.cdc.gov/mentalhealth/basics.htm (last visited Feb. 8, 2022).
3 Id.
4 National Institute of Mental Health (NIH), Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last visited Feb. 8,
2022).
5 Id.
6 The Baker Act is contained in Part I of ch. 394, F.S.
7 S. 394.459, F.S.
8 S. 394.459(5), F.S. Other patient rights include the right to dignity; treatment regardless of ability to pay; express and in formed
consent for admission or treatment; quality treatment; possession of his or her clothing and pe rsonal effects; vote in elections, if eligible;
petition the court for a writ of habeas corpus to question the cause and legality of their detention in a receiving or treatm ent facility; and
participate in their treatment and discharge planning. See, s. 39 4.459 (1)-11), F.S. Current law imposes liability for damages on those
who violate or abuse patient rights or privileges. See, s. 394.459 (10), F.S.
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 facility must provide immediate patient access to a patient’s family members, guardian, guardian
advocate, representative, Florida statewide or local advocacy council, or attorney, unless such access
would be detrimental to the patient or the patient exercises their right not to communicate or visit with
the person.9 If a facility restricts a patient's right to communicate or receive visitors, the facility must
provide written notice of the restriction and the reasons for it to the patient, the patient's attorney, and
the patient's guardian, guardian advocate, or representative. Under current law, a facility must review
patient communication restrictions weekly.10
Baker Act patients also have the right to receive treatment at a receiving or treatment facility,
regardless of ability to pay. However, current law does not require facilities to offer patients assistance
in accessing any post-discharge continuum of care.
Effect of the Bill
The bill requires facilities to review a patient’s communication restrictions every 72 hours, or no later
than the next working day if such period ends on a weekend or holiday, instead of every week.
The bill requires facilities to provide specified patients, in writing, information about services available in
the patient’s geographic area that would assist in the patient’s recovery.
Involuntary Examination and Receiving Facilities
Current Situation
Individuals in an acute mental or behavioral health crisis may require emergency treatment to stabilize
their condition. Emergency mental health examination and stabilization services may be provided on a
voluntary or involuntary basis.11 An involuntary examination is required if there is reason to believe that
the person has a mental illness and, because of his or her mental illness, has refused voluntary
examination, is likely to refuse to care for him or herself to the extent that such refusal threatens to
cause substantial harm to their well-being and such harm is unavoidable through help of willing family
members or friends, or will cause serious bodily harm to him or herself or others in the near future
based on recent behavior.12
An involuntary examination may be initiated by:
 A court entering an ex parte order stating that a person appears to meet the criteria for
involuntary examination, based on sworn testimony; 13 or
 A physician, clinical psychologist, psychiatric nurse, an autonomous advanced practice
registered nurse, mental health counselor, marriage and family therapist, or clinical social
worker executing a certificate stating that he or she has examined a person within the preceding
48 hours and finds that the person appears to meet the criteria for involuntary examination,
including a statement of the professional’s observations supporting such conclusion. 14
Unlike the discretion afforded courts and medical professionals, current law mandates that law
enforcement officers initiate an involuntary examination of a person who appears to meet the criteria by
taking him or her into custody and delivering or having the person delivered to a receiving facility for
examination.15 However, officers are not currently required to restrain the person in the least restrictive
manner available and appropriate under the circumstances.
9 S. 394.459(5)(c), F.S.
10 Id. Every seven days.
11 Ss. 394.4625 and 394.463, F.S.
12 S. 394.463(1), F.S.
13 S. 394.463(2)(a)1., F.S. The order of the court must be made a part of the patient’s clinical record.
14 S. 394.463(2)(a)3., F.S. The report and certificate shall be made a part of the patient’s clinical record.
15 S. 394.463(2)(a)2., F.S. The officer mus t execute a written report detailing the circumstances under which the person was taken into
custody, and the report must be made a part of the patient’s clinical record.
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 Involuntary patients must be taken to either a public or a private facility that has been designated by the
Department of Children and Families (DCF) as a Baker Act receiving facility. The purpose of receiving
facilities is to receive and hold or refer, 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.16 A public receiving facility is a facility that has contracted with a managing
entity to provide mental health services to all persons, regardless of their ability to pay, and is receiving
state funds for such purpose.17 Funds appropriated for Baker Act services may only be used to pay for
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.18
Under the Baker Act, a receiving facility has up to 72 hours to examine an involuntary patient. 19 During
that 72 hours, an involuntary patient must be examined by a physician or a clinical psychologist, or by a
psychiatric nurse performing within the framework of an established protocol with a psychiatrist at a
facility, to determine if the criteria for involuntary services are met.20 Current law does not indicate when
the examination period begins for an involuntary patient. However, if the patient is a minor, a receiving
facility must initiate the examination within 12 hours of arrival. 21
Within that 72-hour examination period, or, if the 72 hours ends on a weekend or holiday, no later than
the next business day, one of the following must happen: 22
 The patient must be released, unless he or she is charged with a crime, in which case law
enforcement will assume custody;
 The patient must be released for voluntary outpatient treatment;
 The patient, unless charged with a crime, must give express and informed consent to be placed
and admitted as a voluntary patient; or
 A petition for involuntary placement must be filed in circuit court for involuntary outpatient or
inpatient treatment.
The receiving facility may not release an involuntary examination patient without the documented
approval of a psychiatrist, or a clinical psychologist. However, if the receiving facility is owned or
operated by a hospital or health system, the release may also be approved by a psychiatric nurse
performing within the framework of an established protocol with a psychiatrist, or an attending
emergency department physician with experience in the diagnosis and treatment of mental illness who
has completed an involuntary examination. A psychiatric nurse may not approve a patient’s release if
the involuntary examination was initiated by a psychiatrist unless the release is approved by the
initiating psychiatrist.23 Because of the current setting restrictions on where psychiatric nurses may
approve Baker Act releases, there are about 30 nationally accredited community mental health
providers in Florida that operate receiving facilities licensed under chapter 394, F.S., but cannot allow
their psychiatric nurses to discharge a Baker Act patient under the protocol of their psychiatrists.24
Current law requires DCF to prepare and provide annual reports to the agency itself, the President of
the Senate, the Speaker of the House of Representatives, and the minority leaders of the Senate and
the House of Representatives. The annual reports analyze data obtained from involuntary orders
issued under the Baker Act, professional certificates, and law enforcement officers’ reports.25
Current law does not require a receiving facility to inform DCF about patients who have been examined
or committed multiple times under the Baker Act.
Effect of the Bill
16 S. 394.455(40), F.S. This term does not include a county jail.
17 S. 394.455(38), F.S
18 R. 65E-5.400(2), F.A.C.
19 S. 394.463(2)(g), F.S.
20 S. 394.463(2)(f), F.S.
21 S. 394.463(2)(g), F.S.
22 Id.
23 S. 394.463(f), F.S.
24 Email from Melanie Brown-Woofter, President and CEO, Florida Behavioral Health Association, Re: HB 1143 - FCBH (Jan. 17, 2022).
25 S. 394.463(e). F.S.
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 The bill authorizes, rather than requires as in current law, law enforcement officers to transport those
who appear to meet Baker Act criteria to receiving facilities. This gives law enforcement officers the
same discretion that courts and medical professionals have to initiate an involuntary examination. By
removing the legal mandate to initiate a Baker Act, there could be a reduction in involuntary
examinations, especially in cases involving minors and schools. This may lead to greater use of
alternatives to transport for involuntary examination, such as mobile response teams. The bill also
requires law enforcement officers to restrain a person in the least restrictive manner available and
appropriate under the circumstances.
The bill specifies that a receiving facility must examine an adult involuntary patient within 72 hours of
arrival at the facility.
The bill amends the restriction requiring a receiving facility to be owned or operated by a hospital or
he