HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 655 Suicide Prevention
SPONSOR(S): Health & Human Services Committee, Children, Families & Seniors Subcommittee, Trabulsy
TIED BILLS: IDEN./SIM. BILLS: SB 468
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee 18 Y, 0 N, As CS Curry Brazzell
2) Health & Human Services Committee 16 Y, 0 N, As CS Curry Calamas
SUMMARY ANALYSIS
First responders are often exposed to incidents of death and destruction that can result in the development of behavioral
health conditions, such as post-traumatic stress disorder (PTSD) and depression. However, studies have shown that first
responders experience positive benefits from mental health help and from receiving support and encouragement from
their peers. Current law authorizes first responder agencies to designate first responder peers, and makes
communications between peers and first responders confidential.
The bill amends s. 111.09, F.S., to allow an affiliated first responder organization to designat e peers to provide support to
first responders. Affiliated first responder organizations include, but are not limited to regularly organized volunteer
firefighting departments or volunteer ambulance services, or combination fire departments (as defined in current law). The
bill also specifies that a first responder peer includes active, volunteer, and retired responders.
The Commission on Mental Health and Substance Abuse (Commission) was created by the legislature in 2021.The
purpose of the Commission is to examine the current methods of providing mental health and substance abuse services
in the state; improve the effectiveness of current practices, procedures, programs, and initiatives in providing such
services; identify any barriers or deficiencies in the delivery of such services; and to recommend changes to existing laws,
rules, and policies necessary to implement the Commission’s recommendations.
The bill renames the Commission the Commission on Mental Health and Substance Use Disorder. The bill broadens the
purpose of the Commission, requiring it to assess the adequacy of the current infrastructure of Florida’s National Suicide
Prevention Lifeline (NSPL) system and other components of the state’s behavioral health crisis system. The bill also
expands the duties of the Commission to require the Commission to:
1. Work with the community stakeholders throughout the state to further support the NSPL system and other crisis
response services;
2. Conduct an overview of the current infrastructure of the NSPL system;
3. Analyze the current capacity of crisis response services throughout the state, including services provided by
mobile response teams and centralized receiving facilities.
4. Evaluate and make recommendation to improve linkages between NSPL and crisis response services in the state;
5. Identify available federal funding that can be used to support the NSPL infrastructure, Florida’s 211 Network, and
crisis response services within the state; and
6. In consultation with AHCA, identify sources of funding available through the Medicaid program , specifically for
crisis response services.
The bill requires the Commission to submit annual interim reports through January 1, 2025, and a final report by
September 1, 2026. Lastly, the bill repeals the Commission on September 1, 2026.
This bill has an insignificant fiscal impact on the Department of Children and Families which can be absorbed within
existing resources. This bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2023.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0655c.HHS
DATE: 3/26/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Mental Health
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
Suicide Prevention
Suicide is the act of taking one's own life by intentional self-harm or self-inflicted injury.6 It is a serious
public health problem that contributes to premature death, long-term disability, loss of productivity, and
significant healthcare costs.7 Suicide is among the leading causes of death in the country, making the
prevention of suicide a public health priority nationally and within Florida.8 The most recent data ranks
suicide as the 12th leading cause of death nationally in 2020 and the 8th leading cause of death in
Florida in 2019.9 The graph compares suicide data in Florida and nationally for 2015-2020.10
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 February 20, 2023).
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 February 20, 2023).
3
Id.
4 National Institute of Mental Health (NIH), Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last visited February
20, 2023).
5 Id.
6 Florida Department of Health, Suicide Prevention, available at https://www.floridahealth.gov/programs-and-
services/prevention/suicide-prevention/index.html (last visited February 24, 2023).
7 Center for Disease Control and Prevention, Suicide Prevention, available at https://www.cdc.gov/suicide/resources/prevention.html
(last visited February 24, 2023).
8 DCF Office of Substance Abuse and Mental Health (SAMH), Suicide Prevention Coordinating Council 2021 Annual Report, available
at https://www.myflfamilies.com/sites/default/files/2022-12/2021%20Suicide%20Prevention%20Coordinating%20Council%20Annual%
20Report%20-%20Final.pdf (last visited February 24, 2023). According the Center for Disease Control and Prevention WISQARRS
Leading Causes of Death Reports, suicide was the twelfth leading cause of death in the U.S. in 2020. See National Health Information,
Suicide, at https://www.nimh.nih.gov/health/statistics/suicide (last visited February 25, 2023).
9 Id. See also Florida Department of Health, FLHealthCHARTS.com Statistical Brief Suicide Deaths in Florida, 2019 , at
https://www.flhealthcharts.gov/Charts/documents/StatisticalBriefs/SuicideDeaths2019.pdf (last visited February 27, 2023).
10 DCF Office of Substance Abuse and Mental Health (SAMH), Suicide Prevention Coordinating Council 2021 Annual Report, available
at https://www.myflfamilies.com/sites/default/files/2022-12/2021%20Suicide%20Prevention%20Coordinating%20Council%20Annual%
20Report%20-%20Final.pdf (last visited February 24, 2023).
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Data Sources: Centers for Disease Control and Prevention National Center for Injury Prevention and Control (2021) Web-
based Injury Statistics Query and Reporting System (WISQARS); Florida Department of Health Bureau of Vital Statistics.
Suicide-related thoughts and behaviors can impact anyone, of any gender, age, race, or socioeconomic
background. However, specific groups experience higher rates. 11 Nationally, there is a higher rate of
death by suicide among men, non-Hispanic Whites, non-Hispanic American Indians or Alaska Natives,
youth who are of diverse gender expressions and sexual orientations, and individuals aged 45– 64
years and 85 years and older.12 In 2020, suicide was the second leading cause of death for people
ages 10-14 and 25-34 , the third leading cause of death among individuals between the ages of 15-24,
and the fourth leading cause of death among individuals between the ages of 35 and 44.13
Suicide is associated with several risk and protective factors. As with other human behaviors, suicide
does not have a single determining cause. Instead, it occurs in response to multiple biological,
psychological, interpersonal, environmental, and societal influences that coincide, often over time.
Therefore, a combination of situations could lead someone to consider suicide. 14
Suicide is preventable if risk factors associated with suicide are diminished while protective factors are
increased.15 Risk factors increase the possibility of suicide (but may not be direct causes), while
protective factors help lessen risk factors. Known risk factors include:
Individual: history of depression and/or other mental illnesses, hopelessness, substance abuse,
certain health conditions, previous suicide attempts, violence victimization and perpetration,
genetic/biological determinants.
Relationship: high conflict or violent relationships, sense of isolation, lack of social support,
family/loved one’s history of suicide, financial and/or work stress.
11 Id.
12 Id.
13 National Health Information, Suicide, at https://www.nimh.nih.gov/health/statistics/suicide (last visited February 25, 2023).
14 Id.
15 Supra, note 10.
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Community: inadequate community connectedness, barriers to health care (e.g., lack of access
to providers and medications).
Societal: availability of lethal means of suicide, unsafe media portrayals of suicide, stigma
associated with help-seeking and mental illness.16
Protective factors include:
Coping and problem-solving skills.
Cultural and religious beliefs that discourage suicide.
Connections to friends, family, and community support.
Supportive relationships with care providers.
Availability of physical and mental health care.
Limited access to lethal means.17
Support services are available to those who are experiencing suicide-related thoughts and behaviors.
These services, such as the National Suicide Prevention Lifeline, provide a safety net in moments of
crisis and connections to ongoing mental health support.18
Behavioral Health Acute Care System
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.
The behavioral health acute care system is a complex system that includes a variety of entities and
integrated components that are essential for providing a public health safety net and comprehensive
crisis response system for those with mental health and substance use disorders. This graphic
indicates the entities involved in the system regarding mental health specifically. Additional entities are
involved regarding substance abuse, such as addictions receiving facilities and detoxification units.
16 Supra, note 6.
17 Id.
18 Supra, note 8.
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Source: Florida Mental Health Institute, USF, 2014 Baker Act User Reference Guide.
Crisis Response System
The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) identifies three
components to an ideal crisis response system; someone to talk to, someone to respond and
somewhere to go. Florida has various crisis support services that address the different components.
The 988 Suicide & Crisis Lifeline helps to ensure that an individual has someone to talk to. Mobile
response teams respond to the crisis and the centralized receiving facilities, crisis stabilization units,
and hospitals provide some place to go.
As the single state authority for mental health and substance abuse, DCF administers the Statewide
Office for Suicide Prevention and facilitates the development of strategies for preventing suicide. The
agency also oversees and sets policy for Mobile Response Team services, Centralized Rec eiving
Facilities, Crisis Stabilization Units, Baker and Marchman Acts, as well as other crisis services. 19
Central Receiving Facilities
Florida’s “No-wrong-Door-Model” is a model for the delivery of acute care services to persons who
have mental health or substance use disorders, or both, that optimizes access to care, regardless of
the entry point to the behavioral health care system.20 A central receiving facility supports the no-
wrong-door-model by providing a central point of entry or intake for assessment and referral of
individuals experiencing a mental health or substance abuse crisis.
Central receiving facilities are capable of providing assessment, evaluation, and triage or treatment or
stabilization of persons with mental health or substance use disorders, as well as co-occurring
disorders.21 Through the assessment process at the central receiving facility, each individual is referred
to the most appropriate level of care (inpatient and/or outpatient) and to the appropriate service
provider that can meet the individual’s identified needs.
19 DCF, Agency Bill Analysis HB 655 (2023), p. 2.
20 S. 394.5473((1)(d), F.S.
21 Id.
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Central receiving facilities serve specific geographic areas. However, an area may be served by one or
more facilities. As of July 1, 2022, there are 15 central receiving facilities.22 Central receiving facilities
serve the following counties:
Alachua Hernando Marion
Brevard Hillsborough Orange
Broward Jefferson Osceola
Citrus Lake Sarasota
Collier Leon Sumter
Duval Liberty Taylor
Franklin Madison Volusia
Gadsden Manatee Wakulla
Mobile Response Teams
A mental health crisis can be an extremely frightening and difficult experience for both the individual in
crisis and those around him or her. It can be caused by a variety of factors at any hour of the day. 23
Family members and caregivers of an individual experiencing a mental health crisis are often ill-
equipped to handle these situations and need the advice and support of professionals. 24 All too
frequently, law enforcement or EMTs are called to respond to mental health crises and they often lack
the training and experience to effectively handle the situation. 25 Mobile response teams (MRT) can be
beneficial in such instances. MRTs support the no-wrong-door-model as these teams travel to the acute
situation or crisis to provide assistance and meet the level of need of individuals in crisis, wherever the
crisis occurs.
MRTs provide readily available crisis care in a community-based setting and increase opportunities to
stabilize individuals in the least restrictive setting to avoid the need for jail or hospital/emergency