HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 7021 PCB CFS 24-01 Mental Health and Substance Abuse
SPONSOR(S): Health & Human Services Committee, Health Care Appropriations Subcommittee, Children,
Families & Seniors Subcommittee, Maney and others
TIED BILLS: IDEN./SIM. BILLS: SB 1784
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
Orig. Comm.: Children, Families & Seniors 18 Y, 0 N Curry Brazzell
Subcommittee
1) Health Care Appropriations Subcommittee 14 Y, 0 N, As CS Fontaine Clark
2) Health & Human Services Committee 16 Y, 0 N, As CS Curry Calamas
SUMMARY ANALYSIS
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 statutory processes for mental
health and substance abuse examinations and treatment, respectively.
The bill amends the Baker Act in that it:
 Combines 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.
 Grants law enforcement officers discretion on initiating involuntary examinations.
The bill amends the Marchman Act in that it:
 Repeals existing provisions for court-ordered involuntary assessments and stabilization in the Marchman Act, and
creates a new 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.
The bill amends both acts in that it:
 Creates a more comprehensive and personalized discharge planning process.
 Requires the Louis de la Parte Florida Mental Health Institute to prepare and publish certain reports on its
website.
 Removes the 30-bed cap for crisis stabilization units.
The bill appropriates $50,000,000 to the Department of Children and Families to implement its provisions, and has no fiscal
impact on local government.
The bill provides an effective date of July 1, 2024.
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
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.
Current Situation - Behavioral Health Managing Entities
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 .6 The
implementation of the ME system initially began on a pilot basis and, in 2008, the Legislature
authorized DCF to implement MEs statewide.7 MEs were fully implemented statewide in 2013, serving
all geographic regions.
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 January 3, 2024).
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 January 3, 2024).
3 Id.
4 National Institute of Mental Health (NIH), Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last visited January
3, 2024).
5 Id.
6 Ch. 2001-191, Laws of Fla.
7 Ch. 2008-243, Laws of Fla
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 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.8
Current Situation - Coordinated System of Care
Managing entities are required to promote the development and implementation of a coordinated
system of care.9 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.10 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, DCF may award system improvement grants to managing entities. 11 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. 12 DCF must
use performance-based contracts to award grants.13
There are several essential elements which make up a coordinated system of care, including: 14
 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: 15
 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;
 Case management;
 Services for victims of sex offenses;
 Transitional services; and
8 DCF, Managing Entities, available at https://www.myflfamilies.com/services/samh/provIders/managing-entities, (last visited January 8,
2024).
9 S. 394.9082(5)(d), F.S.
10 S. 394.4573(1)(c), F.S.
11 S. 394.4573(3), F.S. The Legislature has not funded system improvement grants.
12 Id.
13 Id.
14 S. 394.4573(2), F.S.
15 S. 394.495(4), F.S
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  Trauma-informed services for children who have suffered sexual exploitation.
DCF must define the priority populations which would benefit from receiving care coordination. 16 In
defining priority populations, 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.17
The assessments must be submitted to DCF for inclusion in the state and district substance abuse and
mental health plan.18
Effect of Bill - Coordinated System of Care
Office of Children’s Behavioral Health Ombudsman
The bill creates the Office of Children’s Behavioral Health Ombudsman (Office) within DCF for the
purpose of being a central point to receive complaints on behalf of children and adolescents with
behavioral health disorders receiving state-funded services and to use this information to improve the
child and adolescent mental health treatment and support system. The bill requires the Office to:
 Receive and direct to the appropriate contact within the department, at the Agency for Health
Care Administration, or the appropriate organizations providing behavioral health services
complaints from children and adolescents and their families about the mental health treatment
and support system.
 Maintain records of complaints received and the actions taken.
 Be a resource to identify and explain relevant polices or procedures to children, adolescents
and their families about the child and adolescent mental health treatment and support system.
 Provide recommendations to the department to address systemic problems within the mental
health treatment and support system that are leading to complaints. The department shall
include an analysis of complaints and these recommendations in the report required under s.
394.4573, F.S.
 Engage in functions that may improve the child and adolescent mental health treatment and
support system.
DCF and managing entities must place contact information for the Office prominently on a webpage
related to children’s behavioral health services on their websites.
Behavioral Health Interagency Collaboration
The bill creates the Behavioral Health Interagency Collaboration. The bill requires DCF and AHCA to
work together to jointly establish regional behavioral health interagency collaboratives throughout the
state. DCF is responsible for defining the region to be served by each collaborative and for facilitating
meetings. The goal of the collaboratives are to identify and address ongoing challenges within the
behavioral health system at the local level to improve the accessibility, availability, and quality of
behavioral health services.
The regional collaborative membership shall, at a minimum, be composed of representatives from the
following serving each region:
 Department of Children and Families;
16 S. 394.9082(3)(c), F.S.
17 S. 394.9082(5)(b), F.S.
18 S. 394.75(3), F.S.
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  Agency for Health Care Administration;
 Agency for Persons with Disabilities;
 Department of Elder Affairs;
 Department of Health;
 Department of Education;
 School districts;
 Area Agencies on Aging;
 Community-based care lead agencies;
 Managing entities, as defined;
 Behavioral health services providers;
 Hospitals;
 Medicaid Managed Medical Assistance Plans;
 Police departments; and
 Sheriffs’ Offices.
All entities represented on the regional collaboratives must provide assistance as appropriate and
reasonably necessary to fulfill the goals of the regional collaboratives.
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. 19 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. 20
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, and FY 2020-2021, across all age groups.21
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 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. 22
Each patient entering treatment must be asked to give express and informed consent for admission or
treatment.23 If the patient has been adjudicated incapacitated or found to be incompetent to consent to
treatment, express and informed consent to treatment 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.24 In situations where emergency
medical treatment is needed and the patient or the patient’s guardian or guardian advocate are unable
19 The Baker Act is contained in Part I of ch. 394, F.S.
20 S. 394.459, F.S.
21 DCF, Agency Bill Analysis, (2023), on file with the House Children, Families, and Seniors Subcommittee.
22 Ss.394.459(3), and 394.459(5), F.S. Other patient 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 and personal 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
treatment facility; and participate in their treatment and discharge planning. See, s. 394.459 (1) -11), F.S. Current