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 Rules
BILL: CS/SB 914
INTRODUCER: Rules Committee and Senators Garcia and Book
SUBJECT: Suicide Prevention
DATE: April 11, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Favorable
2. Brown Brown HP Favorable
3. Delia Twogood RC Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 914 modifies statutory provisions governing confidentiality for peer support
communications between a first responder and a first responder peer. The bill allows certain first
responder organizations to designate first responder peers and clarifies that first responder peers
include active, volunteer, and retired first responders. The bill also permits diagnosis of post-
traumatic stress disorder in first responders via telehealth for the purposes of obtaining worker’s
compensation benefits.
The bill renames the Commission on Mental Health and Substance Abuse (the Commission),
adjunct to the Department of Children and Families (the DCF), as the Commission on Mental
Health and Substance Use Disorder, and directs the Commission to conduct a study examining
the following services and programs relating to suicide prevention:
 The 988 Suicide and Crisis Lifeline system (the 988 system);
 Crisis response services;
 Strategies to improve linkages between the 988 system infrastructure and crisis response
services;
 Available mental health block grant funds;
 Funding sources available through Medicaid; and
 Strategies to ensure that managing entities work with community stakeholders in furtherance
of supporting the 988 system and other crisis response services.
BILL: CS/SB 914 Page 2
The bill adds a representative of the statewide Florida 211 network appointed by the Governor to
the Commission membership. The bill also requires the Commission to evaluate and make
recommendations regarding skills-based training that teaches participants about mental health
and substance use disorder issues, including, but not limited to, Mental Health First Aid models.
The bill extends the statutory repeal date of the Commission from September 1, 2023, to
September 1, 2026.The bill also requires the Commission to submit interim reports, beginning
January 1, 2023, annually thereafter through January 1, 2025, and a final report due September 1,
2026, to the Governor; the President of the Senate; and the Speaker of the House of
Representatives. The bill requires the Commission to include the findings of the suicide
prevention study in the final report due September 1, 2026.
The bill is unlikely to have a significant negative impact on state government and may have an
indeterminate impact on certain affiliated first responder organizations as defined in the bill. See
Section V. Fiscal Impact Statement.
The bill is effective July 1, 2023.
II. Present Situation:
Suicide Prevention
Suicide is a major public health issue and a leading cause of death nationally.1 In 2020, 45,979
suicide deaths were reported across the U.S., while an estimated 12.2 million American adults
seriously thought about suicide, 3.2 million planned a suicide attempt, and 1.2 million attempted
suicide.2 Suicide rates increased every year from 2000 through 2018.3 After stable trends from
2000 to 2007, suicide rates for persons aged 10–24 increased 56 percent from 2007 to 2017,4
before declining two percent from 2018 to 2019.5 Provisional data indicate that both the number
and the rate of suicides nationally increased four percent from 2020 to 2021, after two
consecutive years of decline in 2019 and 2020.6
In 2020, 3,113 Floridians died by suicide, representing a 10-percent decrease from the number of
deaths in 2019.7 According to provisional data, approximately 3,325 Floridians died from suicide
in 2021, an increase of approximately seven percent from 2020.8
1
The Centers for Disease Control and Prevention (The CDC), Facts About Suicide, available at
https://www.cdc.gov/suicide/facts/index.html (last visited March 17, 2023).
2
Id.
3
Id.
4
Heron M., Curtin, S., Death Rates Due to Suicide and Homicide Among Persons Aged 10-24: United States, 2007-2017.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Health
Statistics, available at https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf (last visited March 17, 2023).
5
The CDC, Changes in Suicide Rates – United States, 2018-2019, available at
https://www.cdc.gov/mmwr/volumes/70/wr/mm7008a1.htm (last visited March 17, 2023).
6
The CDC, Suicide Increases in 2021 After Two Years in Decline, available at
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220930.htm (last visited March 17, 2023).
7
The DCF, 2022 Suicide Prevention Coordinating Council Annual Report, January 1, 2023, p. 11 (on file with the Senate
Committee on Children, Families, and Elder Affairs).
8
The Florida Department of Health, FLHealthCharts – Death Count Query System, available at
https://www.flhealthcharts.gov/FLQUERY_New/Death/Count (last visited March 17, 2023).
BILL: CS/SB 914 Page 3
First Responders
Under ss. 111.09 and 112.1815, F.S., a first responder is a law enforcement officer,9 firefighter,10
or an emergency medical technician or paramedic11 employed by state or local government.12
Additionally, volunteer law enforcement officers, firefighters, and emergency medical
technicians and paramedics engaged by the state or a local government are considered first
responders of the state or local government.13
First responders are often exposed to incidents of death and destruction that can result in post-
traumatic stress disorder (PTSD), depression, and suicide. A study by the Ruderman Family
Foundation revealed that 35 percent of police officers have suffered from PTSD and 46.8 percent
of firefighters have experienced suicidal thoughts.14 Firefighters and police officers are both
more likely to die by suicide than in the line of duty.15 Further, according to a 2015 article
published in the Journal of Emergency Medical Services, a survey of 4,000 first responders
found that 6.6 percent had attempted suicide, which is more than 10 times the rate in the general
population.16
Volunteer Firefighters
A volunteer firefighter is an individual who holds a current and valid Volunteer Firefighter
Certificate of Completion issued by the Division of State Fire Marshal under s. 633.408, F.S.17
Approximately 12 million Florida citizens depend on volunteer firefighters to protect their
community.18 To keep these residents safe, it is important for individuals to volunteer for local
9
Section 943.10(1), F.S. defines the term “law enforcement officer” to mean “any person who is elected, appointed, or
employed full time by any municipality or the state or any political subdivision thereof; who is vested with authority to bear
arms and make arrests; and whose primary responsibility is the prevention and detection of crime or the enforcement of the
penal, criminal, traffic, or highway laws of the state. The term includes all certified supervisory and command personnel
whose duties include, in whole or in part, the supervision, training, guidance, and management responsibilities of full-time
law enforcement officers, part-time law enforcement officers, or auxiliary law enforcement officers but does not include
support personnel employed by the employing agency.”
10
Section 633.102(9), F.S. defines the term “firefighter” to mean “an individual who holds a current and valid Firefighter
Certificate of Compliance or Special Certificate of Compliance issued by the Division of State Fire Marshal within the
Department of Financial Services.”
11
Section 401.23(12), F.S. defines the term “emergency medical technician” to mean “a person who is certified by the
Department of Health to perform basic life support.” Section 401.23(18), F.S., defines the term “paramedic” to mean “a
person who is certified by the Department of Health to perform basic and advanced life support.”
12
Section 125.01045, F.S.
13
Id.
14
Miriam Heyman, Jeff Dill & Robert Douglas, The Ruderman White Paper on Mental Health and Suicide of First
Responders, at p. 12, available at
https://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/TrainingDocs/First%20Responder%20White%20Paper_Final%20(2)
.pdf (last visited March 17, 2023).
15
Id. at p. 7.
16
Fire Rescue News, Increasing Suicide Rates Among First Responders Spark Concerns, available at
https://www.firerescue1.com/fire-ems/articles/222673018-Increasing-suicide-rates-among-first-responders-spark-concern/
(last visited March 17, 2023).
17
See s. 633.408, F.S.
18
The Florida Department of Financial Services, Division of State Fire Marshal, Florida Volunteer Firefighter Information,
available at
https://www.myfloridacfo.com/division/sfm/volff#:~:text=More%20than%20200%20departments%20throughout%20Florida
%20utilize%20volunteers%20to%20sustain%20operations (last visited March 17, 2023).
BILL: CS/SB 914 Page 4
departments.19 More than 200 departments throughout Florida utilize volunteers to sustain
operations.20
First Responders Suicide Deterrence Task Force
In 2020, the Legislature created the First Responders Suicide Deterrence Task Force within the
Statewide Office of Suicide Prevention, which is housed within the DCF and coordinates
education and training curricula on suicide prevention efforts for veterans and service
members.2122
The most recent report of the task force, published on July 1, 2022, included the findings of a
survey conducted by the 2nd Alarm Project,23 a nonprofit organization established to offer
comprehensive, evidence-based resiliency initiatives in first responder communities. 24
According to the survey, upwards of 24 percent of first responders reported provisional diagnosis
of PTSD, 52.3 percent reported depression; 39.1 percent reported anxiety; 38.3 percent reported
harmful levels of drinking; and 15.1 percent are at higher risk for suicide. 25 The findings
indicated generally higher rates of these issues among respondents who are single certified
emergency medical services (EMS) professionals and among dual certified/combined Fire/EMS
personnel who serve as advanced life support/transport providers.26
Peer Support
Research has shown that social support provided by peers is beneficial to those in recovery from
substance abuse or mental illness. There are four primary types of social support provided by
peers:
 Emotional: where a peer demonstrates empathy, caring, or concern to bolster a person’s self-
esteem (e.g., peer mentoring or peer-led support groups).
 Informational: where a peer shares knowledge and information to provide life or vocational
skills training (e.g., parenting classes, job readiness training, or wellness seminars).
 Instrumental: where a peer provides concrete assistance to help others accomplish tasks (e.g.,
child care, transportation, and help accessing health and human services).
 Affiliation-based: where a peer facilitates contacts with other people to promote learning of
social skills, create a sense of community, and acquire a sense of belonging (e.g., recovery
centers, sports league participation, and alcohol- or drug-free socialization opportunities).27
19
Id.
20
Id.
21
Section 14.2019, F.S.
22
Chapter 2020-39, L.O.F.
23
The 2nd Alarm Project, Our Services, available at https://2ndalarmproject.org/ (last visited March 17, 2023).
24
The DCF, First Responder Suicide Deterrence Task Force 2022 Annual Report, available at
https://myflfamilies.com/sites/default/files/2022-
11/FINAL%202022%20First%20Responder%20Suicide%20Deterrence%20Task%20Force%20Report.pdf (last visited
March 17, 2023).
25
Id. at p. 8.
26
Id.
27
The Substance Abuse and Mental Health Services Administration (The SAMSHA), Center for Substance Abuse Treatment,
What Are Peer Recovery Support Services?, p. 2, available at https://store.samhsa.gov/system/files/sma09-4454.pdf; See also
the DCF, Florida Peer Services Handbook at p. 4-5, 2016, available at
https://www.myflfamilies.com/sites/default/files/2022-11/Peer%20Guidance_2016.pdf (all sites last visited March 17, 2023).
BILL: CS/SB 914 Page 5
First Responder Peer Support
A survey by the Journal of Emergency Medical Services revealed that first responders were less
likely to contemplate suicide when they felt supported and encouraged at work.28 One study
showed that while some firefighters reported positive experiences with professional mental
health help, others felt more distressed after such intervention.29 Alternatively, these firefighters
reported benefits from peer support, such as bonding with their fire crew after negative incidents,
which can reduce the stigma, scheduling difficulties, lack of access, lack of trust, and fear or
repercussions that may prevent first responders from seeking mental health care.30
In 2020, the Legislature recognized the need for mental health counseling for first responders by
adopting confidentiality provisions intended to encourage peer support programs for law
enforcement officers, firefighters, emergency medical technicians, paramedics, and 911 public
safety telecommunicators.31 A “first responder peer” is defined as a person who:
 Is not a health care practitioner as that term is defined in s. 456.001, F.S.;32
 Has experience working as or with a first responder regarding any physical or emotional
conditions or issues associated with the first responder’s employment; and
 Has been designated by the first responder’s employing agency to provide peer support and
has received training for this purpose.33
First responder peers are prohibited from divulging information from, or testifying about, a peer
support communication in a civil, criminal, administrative, or disciplinary proceeding, unless:
 The first responder peer is a defendant in a civil, criminal, administrative, or disciplinary
proceeding arising from a complaint filed by the first responder who was a party to the peer
support communication, in which case such information may be divulged but is limited to the
scope of the proceeding;
 The first responder who was a party to the peer support communication agrees, in writing, to
allow the first responder peer to testify about or divulge information related to the peer
support communications;
 Based on the peer support communications, the first responder peer suspects that the first
responder who was a party to the peer support communications has committed a criminal act
or intends to commit a criminal act. There is no liability on the part of, and no cause of action
of any nature may arise against, the first responder peer for disclosing relevant information;
or
28
Journal of Emergency Medical Services, Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide,
available at https://www.jems.com/2015/09/28/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-
suicide/ (last visited March 17 2023).
29
The SAMSHA, First Responders: Behavioral Health Concerns, Emergency Response, and Trauma, (May 2019) at p. 10
and 12, available at https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-
may2018.pdf (last visited March 17, 2023).
30
Id.
31
Chapter 2020-104, L.O.F.
32
Section 456.001, F.S., defines “health care practitioner” to mean “any person licensed under chapter 457; chapter 458;
chapter 459; chapter 460; chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; part I,
part II, part III, part V, part X, part XIII, or part XIV of chapter 468; chapter 478; chapter 480; part I, part II, or part III of
chapter 483; chapter 484; chapter 486; chapter 490; or chapter 491.”
33
Section 111.09(1)(b), F.S.
BILL: CS/SB 914 Page 6
 There are articulable facts or circumstances that would lead a reasonable, prudent person to
fear for the safety of the first responder who was a party to the peer support communication,
a