The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/SB 1784
INTRODUCER: Fiscal Policy Committee and Senator Grall
SUBJECT: Mental Health and Substance Abuse
DATE: February 29, 2024 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Hall Tuszynski CF Favorable
2. Hall Yeatman FP Fav/CS
I. Summary:
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. The bill modifies the Baker Act and makes significant changes to
the Marchman Act.
The bill amends the Baker Act by combining processes for courts to order individuals to
involuntary outpatient services and involuntary inpatient placement in the Baker Act, to
streamline the process for obtaining involuntary services, and providing more flexibility for
courts to meet individuals’ treatment needs. The bill also grants law enforcement officers
discretion on initiating involuntary examinations.
The bill substantially amends the Marchman Act to:
 Repeal existing provisions for court-ordered involuntary assessments and stabilization in the
Marchman Act, and creates a new consolidated involuntary treatment process.
 Prohibit 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.
 Revise 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.
 Authorize a witness to appear remotely upon a showing of good cause and with consent by
all parties.
 Allow 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.
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For both the Baker and Marchman Acts, the bill:
 Creates a more comprehensive and personalized discharge planning process.
 Requires the DCF to publish certain specified reports on its website.
 Removes limitations on advance practice registered nurses and physician assistants serving
the physical health needs of individuals receiving psychiatric care.
 Allows a psychiatric nurse to release a patient from a receiving facility if certain criteria are
met.
 Removes the 30-bed cap for crisis stabilization units.
The bill will have an indeterminate negative fiscal impact on state government.
The bill provides an effective date of July 1, 2024.
II. Present Situation:
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 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. More than one in five
adults lives with a mental illness.4 Young adults aged 18-25 had the highest prevalence of any
mental illness5 (33.7%) compared to adults aged 26-49 (28.1%) and aged 50 and older (15.0%).6
1
World Health Organization, Mental Health: Strengthening Our Response, available at: https://www.who.int/news-
room/fact-sheets/detail/mental-health-strengthening-our-response (last visited Jan. 26, 2024).
2
Centers for Disease Control and Prevention, Mental Health Basics, available at: http://medbox.iiab.me/modules/en-
cdc/www.cdc.gov/mentalhealth/basics.htm (last visited Jan. 26, 2024).
3
Id.
4
National Institute of Mental Health (NIH), Mental Illness, available at: https://www.nimh.nih.gov/health/statistics/mental-
illness (last visited Jan. 26, 2024).
5
Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from
no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness).
6
National Institute of Mental Health (NIH), Mental Illness, available at: https://www.nimh.nih.gov/health/statistics/mental-
illness (last visited Jan. 26, 2024).
BILL: CS/SB 1784 Page 3
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. SAM 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
In 2001, the Legislature authorized the DCF to implement behavioral health managing entities
(ME) as the management structure for the delivery of local mental health and substance abuse
services.7 The implementation of the ME system initially began on a pilot basis and, in 2008, the
Legislature authorized the DCF to implement MEs statewide.8 MEs were fully implemented
statewide in 2013, serving all geographic regions.
The DCF currently contracts with seven MEs for behavioral health services throughout the state.
These entities do not provide direct services; rather, they allow the department’s funding to be
tailored to the specific behavioral health needs in the various regions of the state. The regions are
divided as follows:9
7
Ch. 2001-191, Laws of Fla.
8
Ch. 2008-243, Laws of Fla.
9
DCF, Managing Entities, available at: https://www.myflfamilies.com/services/samh/providers/managing-entities (last
visited Jan. 26, 2024).
BILL: CS/SB 1784 Page 4
Coordinated System of Care
Managing entities are required to promote the development and implementation of a coordinated
system of care.10 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.11 A community or region provides a coordinated system of care for those with a
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, the DCF may award system
improvements grants to managing entities.12 MEs must submit detailed plans to enhance crisis
services based on the no-wrong-door model or to meet specific needs identified in the DCF’s
assessment of behavioral health services in this state.13 The DCF must use performance-based
contracts to award grants.14
There are several essential elements which make up a coordinated system of care, including:15
 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:16
 Prevention services;
 Home-based services;
 School-based services;
 Family therapy;
 Family support;
 Respite services;
 Outpatient treatment;
 Crisis stabilization;
 Therapeutic foster care;
 Residential treatment;
 Inpatient hospitalization;
10
Section 394.9082(5)(d), F.S.
11
Section 394.4573(1)(c), F.S.
12
Section 394.4573(3), F.S. The Legislature has not funded system improvement grants.
13
Id.
14
Id.
15
Section 394.4573(2), F.S.
16
Section 394.495(4), F.S.
BILL: CS/SB 1784 Page 5
 Case management;
 Services for victims of sex offenses;
 Transitional services; and
 Trauma-informed services for children who have suffered sexual exploitation.
The DCF must define the priority populations which would benefit from receiving care
coordination.17 In defining priority populations, the DCF must consider 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.18 The assessments must be submitted to the DCF for inclusion in the state and district
substance abuse and mental health plan.19
The Baker Act
The Florida Mental Health Act, commonly referred to as the Baker At, was enacted in 1971 to
revise the state’s mental health commitment laws.20 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.21
The Department of Children and Families (DCF) is responsible for the operation and
administration of the Baker Act, including publishing an annual Baker Act report. According to
the Fiscal Year (FY) 2021-2022 Baker Act Annual Report, over 170,000 individuals were
involuntarily examined under the Baker Act; of those, just over 11,600 individuals were 65 years
of age or older. This age group is the most likely to include individuals with Alzheimer’s disease
or related dementia. It is important to note the number of Baker Acts per year decreased during
FY 2018-2019, FY 2019-2020, FY 2020-2021, across all age groups.22
Rights of Patients
The Baker Act protects the rights of patients examined or treated for mental illness in Florida,
including, but not limited to, the right to give express and informed consent for admission or
treatment and 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.23
17
Section 394.9082(3)(c), F.S.
18
Section 394.9082(5)(b), F.S.
19
Section 394.75(3), F.S.
20
The Baker Act is contained in Part I of Ch. 394, F.S.
21
Section 394.459, F.S.
22
DCF, Agency Bill Analysis (2023), on file with the Senate Children, Families, and Elder Affairs Committee.
23
Sections 394.459(3), F.S. and 394.459(5), F.S. Other patients’ rights include the right to dignity; treatment regardless of
ability to pay; express and informed consent for admission or treatment; quality treatment; possession of his or her clothing
BILL: CS/SB 1784 Page 6
Each patient entering treatment must be asked to give express and informed consent for
admission or treatment.24 If the patient has been adjudicated incapacitated or found to be
incompetent to consent to treatment, express and informed consent must be obtained from the
patient’s guardian or guardian advocate. If the patient is a minor, consent must be requested from
the patient’s guardian unless the minor is seeking outpatient crisis intervention services.25 In
situations where emergency medical treatment is needed and the patient or the patient’s guardian
or guardian advocate are unable to provide consent, the administrator of the facility may, upon
the recommendation of the patient’s attending physician, authorize treatment, including a
surgical procedure, if such treatment is deemed lifesaving, or if the situation threatens serious
bodily harm to the patient.26
Currently, a 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.27 If a facility restricts a patient’s right to
communicate or restrict 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.28 A qualified professional29 must document the restriction within 24 hours, and
a record of the restrictions and the reasons for the restrictions must be recorded in the patient’s
clinical record. Under current law, a facility must review patient communication restrictions at
least every three days.30
Clinical Records
Clinical records maintained by mental health facilities, which can include medical records,
progress notes, charts and admission and discharge data, and all other information recorded by
facility staff pertaining to the patient’s hospitalization or treatment,31 are confidential and exempt
from public disclosure by law.32 A patient’s clinical records and other information may be
released if authorized by the patient or the patient’s guardian. The patient’s guardian or guardian
advocate must be provided access to the appropriate information and clinical records of the
patient and may authorize the release of such information and records to the appropriate persons
to ensure the continuity of the patient’s health care or mental health care.33 Current law does not
and personal effects; vote in elections, if possible; petition the court for a writ of habeas corpus to question the cause and
legality of their detention in a receiving or treatment facility; and participate in their treatment and discharge planning. See, s.
394.456(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.
24
Section 394.459(3), F.S.
25
Section 394.4784, F.S.
26
Section 394.459(3)(d), F.S.
27
Section 394.459(5)(c), F.S.
28
Section 394.495(5)(d), F.S.
29
A qualified professional is a physician or a physician assistant, a psychiatrist, a psychologist, or a psychiatric nurse. See s.
394.455(39), F.S.
30
Section 394.459, F.S.
31
Section 394.455(6), F.S.
32
Section 394.4615, F.S.
33
Id.
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grant a patient’s legal custodian access to the patient’s information and clinical records or permit
the legal custodian to authorize the release of a patient’s clinical records and informat