This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0655.CFS
DATE: 3/7/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 655 Suicide Prevention
SPONSOR(S): Trabulsy
TIED BILLS: IDEN./SIM. BILLS: SB 468
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee Curry Brazzell
2) Health & Human Services Committee
SUMMARY ANALYSIS
Since 2004, the National Suicide Prevention Lifeline, currently known as the 988 Suicide & Crisis Lifeline (Lifeline),
has provided a national toll-free phone number that connects callers who are in suicidal crisis or emotional distress
to free and confidential emotional support. The Lifeline is comprised of a national network of over 200 local,
independent, and state-funded crisis centers. In 2020, Congress passed the National Suicide Hotline Designation
Act to designate 988 as the universal telephone number for the nation’s suicide prevention and mental health crisis
hotline. The 988 dialing code became available nationwide in July 2022.
In Florida, there are 13 local crisis call centers that are a part of the Lifeline network. Most of the state’s crisis
centers are affiliated with 2-1-1 United Way, while the other centers are housed in comprehensive non-profit or
county mental health centers. Florida’s 2-1-1 Network is authorized to serve as the single point of coordination for
information and referral for health and human services under s. 408.918, F.S.
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
Recommend changes to existing laws, rules, and policies necessary to implement the Commission’s
recommendations.
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:
Work with the community stakeholders throughout the state to further support the NSPL system and
other crisis response services;
Conduct an overview of the current infrastructure of the NSPL system;
Analyze the current capacity of crisis response services throughout the state, including services
provided by mobile response teams (MRT) and centralized receiving facilities.
Evaluate and make recommendation to improve linkages between NSPL and crisis response
services within the state;
Identify available mental health block grant funds that can be used to support the NSPL
infrastructure and crisis response services within the state, including any available funding through
the opioid settlements or through the American Rescue Act, The Coronavirus Aid, Relief, and
Economic Security (CARES) Act, or other federal legislation;
In consultation with AHCA, identify sources of funding available through the Medicaid program
specifically for crisis response services, including funding sources that may be available by seeking
approval of a Section 1115 waiver submitted to the Centers for Medicare and Medicaid Services.
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. STORAGE NAME: h0655.CFS PAGE: 2
DATE: 3/7/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSE D 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
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.
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
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 STORAGE NAME: h0655.CFS PAGE: 3
DATE: 3/7/2023
suicide as the 12
th
leading cause of death nationally in 2020 and the 8
th
leading cause of death in
Florida in 2019.
9
The graph compares the number and rate of suicide for Florida and nationally for
2015-2020.
10
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
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).
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. STORAGE NAME: h0655.CFS PAGE: 4
DATE: 3/7/2023
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.
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 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.
15
Supra, note 10.
16
Supra, note 6.
17
Id.
18
Supra, note 8. STORAGE NAME: h0655.CFS PAGE: 5
DATE: 3/7/2023
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 Receiving
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. STORAGE NAME: h0655.CFS PAGE: 6
DATE: 3/7/2023
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
department utilization.
26
Response teams are available statewide in all 67 counties to individuals in
need, regardless of their ability to pay, and must be ready to respond to any mental health
emergency.
27
Historically, MRTs generally focused on youth and young adults under 25 years old but
most teams have now increased their capacity to serve individuals of all ages.
28
Telehealth can be used
to provide direct services to individuals via video-conferencing systems, mobile phones, and remote
monitoring.
29
It can also be used to provide assessments and follow-up consultation as well as initial
triage to determine if an in-person visit is needed to respond to the crisis call.
30
SB 7026 (2018) funded additional mobile response teams to serve areas of the state that were not
being served by such teams at a total of $18.3 million.
31
In 2019, MRT reports showed an 80%
statewide average of diverting individuals from involuntary examination.
32
For Fiscal Year (FY) 2022-23,
DCF received additional funding allowing for the implementation of 12 new teams and the expansion of
30 existing teams.
33
There are currently 51 MRTs serving all 67 counties in Florida.
34
Through the
expansion, it is estimated that an additional 14,743 individuals will be served statewide.
22
Eleven facilities are funded under the dedicated “Central Receiving Facility” appropriation in the annual General Appropriations Act.
The remaining four facilities are funded with nonrecurring proviso project appropriations this year. See DCF, Agency Bill Analysis HB
655 (2023), p. 3.
23
Department of Children and Families, Mobile Response Teams Framework, (August 29, 2018), p. 4
https://myflfamilies.com/sites/default/ files/2022-12/Mobile%20Response%20Framework.pdf (last visited Feb. 27, 2023).
24
Id.
25
Id.
26
Id. at 2
27
Id. Mobile response services are required to be available 24 hours per day, 7 days per week.
28
DCF, Agency Bill Analysis HB 655 (2023), p. 3.
29
Supra note, at 7.
30
Id.
31
See Chapter No. 2018-3, L.O.F.
32
Florida Department of Children and Families, Report on Involuntary Examination of Minors, 2019, (Nov. 2019), p. 4,
https://myflfamilies.com/sites/default/files/2022-12/Report%20on%20Involuntary%20Examination%20of%20Minors%202019.pdf (last
visited February 27, 2023).
33
DCF, Agency Bill Analysis HB 655 (2023), p. 3.
34
Id. STORAGE NAME: h0655.CFS PAGE: 7
DATE: 3/7/2023
During FY 2021-22, MRTs received 25,495 calls, where 28 percent of those calls originated in a school,
and 72 percent of those calls required an acute response (an in-person response). Of the calls
requiring an acute response, 84 percent of them were diverted from an involuntary examination, which
highlights the role MRTs play in reducing unnecessary psychiatric hospitalizations.
35
HB 945 (2020) required crisis response services to be provided through MRTs.
36
DCF must contract
with a managing entity to procure mobile response teams throughout the state to provide immediate,
onsite behavioral health crisis services to children, adolescents, and young adults ages 18-25,
inclusive, who:
37
Have an emotional disturbance;
Are experiencing an acute mental or emotional crisis;
Are experiencing escalating emotional or behavioral reactions and symptoms that impact their
ability to function normally within their environment; or
Are served by the child welfare system and are experiencing or are at high risk of placement
instability.
When procuring a MRT, the managing entity must, at a minimum:
38
Collaborate with local sheriff’s offices and public schools in the planning, development,
evaluation and selection processes;
Require that services be made available 24 hours per day, 7 days per week, with a response
time of 60 minutes;
Require that the provider establish response protocols with local law enforcement agencies,
CBC lead agencies, the child welfare system, and the DJJ;
Require access to board-certified or board-eligible psychiatrists or psychiatric nurse
practitioners; and
Require MRTs to refer children, adolescents, or young adults and their families to an array of
crisis response services that address their individual needs as necessary to address an
immediate crisis event.
The bill also established the minimum standards for MRTs. At a minimum, a MRT must:
39
Triage and prioritize requests, then, to the extent permitted by available resources, respond in
person within 60 minutes of prioritization;
Respond to a crisis in the location where the crisis is occurring;
Provide behavioral health crisis-oriented services that are responsive to the needs of the child,
adolescent, or young adult and his or her family and enable them to deescalate and respond to
behavioral health challenges through evidence-based practices;
Provide screening, standardized assessments, early identification, and referrals to community
services;
Provide care coordination by facilitating the transition to ongoing services;
Ensure a process for informed consent and confidentiality compliance measures is in place;
Promote information sharing and the use of innovative technology; and
Coordinate with the managing entity and other key entities providing services and supports to
the child, adolescent, or young adult and their family.
988 Suicide & Crisis Lifeline
35
Id.
36
See Chapter 2020-107, L.O.F.
37
S. 394.495(7)(a), F.S.
38
S. 394.495(7)(c), F.S.
39
S. 394.495(7)(b), F.S. STORAGE NAME: h0655.CFS PAGE: 8
DATE: 3/7/2023
Since its inception in 2004, the National Suicide Prevention Lifeline (NSPL), currently known as the 988
Suicide & Crisis Lifeline (Lifeline), has provided a national toll-free phone number that connects callers
who are in suicidal crisis or emotional distress to free and confidential emotional support.
40
The Lifeline
is composed of a national network of over 200 local, independent, and state-funded crisis centers.
Vibrant Emotional Health (Vibrant) is the administrator of the service, which is funded by SAMHSA.
41
The Lifeline serves as a national mental health safety net for the public by routing callers to the nearest
of 180 local crisis call centers. In an effort to improve and streamline the Lifeline system, on October
17, 2020, Congress passed the National Suicide Hotline Designation Act of 2020, to designate 988 as
the universal telephone number for the nation’s suicide prevention and mental health crisis hotline.
42
This was done to simplify the existing 10-digit toll free number and to redirect mental health crises
currently coming into the nation’s 9-1-1 emergency system. The 988 dialing code became available
nationally in July 2022.
43
Florida’s National Suicide Prevention Lifeline System All NSPL/Lifelines nationwide must be fully
accredited by Vibrant to take 988 calls, texts, or chats. In Florida, there are 13 active NSPL/Lifeline or
local crisis call centers (Lifeline Member centers) that are a part of the Lifeline network.
44
Most of the
state’s Lifeline Member centers are affiliated with 2-1-1 United Way, while the other centers are housed
in comprehensive non-profit or county mental health centers.
45
Florida’s 2-1-1 Network is authorized to
serve as the single point of coordination for information and referral for health and human services
under s. 408.918, F.S.
46
In preparation for the transition to a three-digit number, Vibrant facilitated the issuance of privately
donated grant dollars to help states plan for the implementation of 988. In February 2021, DCF
received a planning grant from Vibrant to create a 988 grant team and a statewide planning coalition
that was tasked with preparing a 988 implementation plan for Florida.
47
Florida’s 988 Planning Coalition
was established, comprised of a diverse array of more than 50 behavioral health professionals and met
monthly to plan for the 988 implementation.
48
The 988 Coalition was also established. Members of the
Coalition include:
49
NSPL/988 Suicide and Crisis Lifelines
Regional managing entities
Law enforcement officials
Mental health advocacy groups
Florida Behavioral Health Association
Seminole Tribe representatives
911 public safety answering points leaders
Vibrant Emotional Health representatives
988 Capacity Building Grant
40
988 Suicide & Crisis Lifeline at https://988lifeline.org/about/ (last visited February 24, 2023). Also see DCF Office of 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).
41
Id.
42
National Suicide Hotline Designation Act of 2020 (Pub. L. No. 116-172).
43
SAMHSA, 988 America’s Suicide Prevention and Mental Health Crisis Lifeline, at https://www.samhsa.gov/sites/default/ files/988-
factsheet.pdf (last visited February 24, 2023).
44
DCF, Agency Bill Analysis HB 655 (2023), p. 2. Also see Prevention Coordinating Council 2021 Annual Report, supra at note 39.
45
Id.
46
DCF Office of 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).
47
Id.
48
After the 988 implementation, the planning coalition has continued to meet and actively recruit stakeholders. See DCF, Agency Bill
Analysis HB 655 (2023), p. 5.
49
DCF, Agency Bill Analysis HB 655 (2023), p. 3. STORAGE NAME: h0655.CFS PAGE: 9
DATE: 3/7/2023
The 988 Coalition created a strategic plan based on eight core considerations for infrastructure and
capacity building that was submitted to Vibrant. To address the Planning Coalition’s top concern of
funding to increase capacity, in Fiscal Year 2022-2023 DCF received $8,461,833 for 988
implementation in the annual General Appropriations Act under the Supplemental Community Mental
Health Block grant. In 2022, DCF also applied for and received the SAMHSA 988 State and Territory
Cooperative Agreement Capacity Building Grant (“988 Capacity Building grant”) and was awarded $5.2
million in April 2022, plus an additional $2 million as a supplemental award in December 2022.
50
As a requirement of the 988 Capacity Building grant, DCF engages in ongoing analysis of the current
988 system. This includes constant analysis of metrics on call volume, in-state answer rates, speed to
answer, duration of calls, and the following key performance indicators:
Workforce Development: The number of people in the mental health and related workforce
trained in mental health-related practices/activities that are consistent with the goals of the
grant.
Partnership/Collaborations: The number of organizations that entered into formal written
inter/intraorganizational agreements (e.g., Memorandums of Understanding/ Memorandums of
Association) to improve mental health-related practices/activities that are consistent with the
goals of the grant.
Screening: The number of individuals screened for mental health or related interventions.
Referral: The number of individuals referred to mental health or related services.
Access: The number and percentage of individuals receiving mental health or related services
after referral.
In addition, DCF holds regular monthly meetings with Lifeline Centers, quarterly meetings with the
broader 988 Coalition, and works with centers one-on-one to help troubleshoot challenges and provide
technical assistance. DCF also has regular meetings with federal project officers, Vibrant Emotional
Health representatives, and participates in all national meetings and calls.
Commission on Mental Health and Substance Abuse
The Marjory Stoneman Douglas High School Public Safety Commission
In response to the shooting at Marjory Stoneman Douglas High School on February 14, 2018, the
Florida Legislature passed SB 7026, the Marjory Stoneman Douglas High School Public Safety Act
(Act). The Act’s provisions addressed school safety and security by creating the Office of Safe Schools
(OSS) within the Florida Department of Education (DOE) and requiring increased coordination among
state and local agencies serving students with or at-risk of mental illness, among other provisions. The
Act also created the Marjory Stoneman Douglas High School Public Safety Commission (MSD
Commission), to investigate system failures in the Marjory Stoneman Douglas High School shooting
and prior mass violence incidents and develop recommendations for system-wide improvements.
The MSD Commission submitted its initial report on January 2, 2019, which contained numerous
school safety and security recommendations
51
that the Legislature addressed in SB 7030 (2019),
Implementation of Legislative Recommendations of the Marjory Stoneman Douglas High School Public
Safety Commission.
52
The MSD Commission’s second report, submitted on November 1, 2019,
provided recommendations related to safe-school officers, threat assessments, juvenile diversion
programs, and mental health, among other recommendations.
53
The MSD Commission is authorized to
issue annual reports and is scheduled to sunset on July 1, 2023.
54
50
Id.
51
Marjory Stoneman Douglas High School Public Safety Commission, Initial Report (Jan. 2, 2019),
http://www.fdle.state.fl.us/MSDHS/CommissionReport.pdf (last visited February 25, 2023).
52
Chapter 2019-22, L.O.F.
53
Marjory Stoneman Douglas High School Public Safety Commission, Second Report (Nov. 1, 2020),
http://www.fdle.state.fl.us/MSDHS/MSD-Report-2-Public-Version.pdf (last visited February 25, 2023).
54
Section 943.687(9), F.S. STORAGE NAME: h0655.CFS PAGE: 10
DATE: 3/7/2023
In February 2019, Governor Ron DeSantis requested, and the Florida Supreme Court convened, a
grand jury to study systemic school safety failures. The grand jury was tasked with investigating
whether specific public entities failed to act or committed fraud that undermined the school safety
activities that the Act and subsequent legislation required.
55
The Grand Jury’s third report, issued in
December 2020, included an analysis of the state’s mental health infrastructure and found systemic
problems are impacting mental health:
56
The current mental health system is underfunded leading to an inability to diagnose and
properly treat mental health problems;
The system is too decentralized with national, state, and local entities providing parallel and
duplicative resources with little to no coordination;
Many of the entities involved work for different agencies with different goals; and
DCF is not currently equipped or empowered to exercise the degree of leadership and control
necessary to correct problems in the system.
To address such problems, the Grand Jury recommended the Legislature appoint a commission to
specifically examine the provision of mental health services in the state.
57
The Legislature should ensure that relevant stakeholders have an opportunity to participate in
and provide knowledge to the commission.
The commission should consider how to best provide and facilitate services in dual diagnosis
cases.
58
Additionally, the commission should be charged with structuring and staffing a permanent,
agency-level entity to manage mental health, behavioral health, and substance abuse and
addiction services throughout the state.
59
Lastly, a cabinet-level agency should be created and funded to administer disparate sources of
funding and services relating to the state’s mental health system.
60
Commission on Mental Health and Substance Abuse
In 2021, the legislature created the Commission on Mental Health and Substance Abuse
(Commission).
61
The Commission consists of 19 members, which include the Secretaries of DCF and
the Agency of Health Care Administration (AHCA). The remaining members are appointed by the
Governor, the President of the Senate, and the Speaker of the House of Representatives.
62
The Commission was created 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
Recommend changes to existing laws, rules, and policies necessary to implement the
Commission’s recommendations.
63
55
Ron DeSantis, Governor of Florida, Petition for Order to Impanel a Statewide Grand Jury, (Feb. 13, 2019), https://efactssc-
public.flcourts.org/casedocuments/2019/240/2019-240_petition_72393_e83.pdf (last visited February 25, 2023); In re Statewide Grand
Jury #20, No. SC19-240, 2019 WL 908518 (Fla. Feb. 25, 2019), https://efactssc-public.flcourts.org/casedocuments/2019/240/2019-
240_disposition_145442_d04i.pdf (last visited February 25, 2023).
56
Statewide Grand Jury # 20, Third Interim Report of the Twentieth Statewide Grand Jury, (Dec. 10, 2020), https://efactssc-
public.flcourts.org/casedocuments/2019/240/2019-240_miscdoc_365089_e20.pdf (last visited February 25, 2023).
57
Id. at p. 21
58
The Grand Jury describes “dual diagnosis” cases as cases that lie at the nexus of mental health, substance abuse, and law
enforcement interests.
59
Supra, note 56 at p. 23.
60
Id. at p. 24.
61
See Chapter 2021-170, L.O.F.
62
S. 394.9086(3), F.S.
63
S. 394.9086(2), F.S. STORAGE NAME: h0655.CFS PAGE: 11
DATE: 3/7/2023
Under current law, DCF is required to provide administrative and staff support services to the
Commission as it carries out its statutory functions.
64
State agencies are also required to assist the
Commission in a timely manner when needed.
65
The duties of the Commission include:
Conducting a review and evaluation of the management and functioning of existing publicly
supported mental health and substance abuse systems in DCF, AHCA, and all other relevant
state departments;
o At a minimum, such review must include a review of current goals and objectives,
current planning, service strategies, coordination management, purchasing, contracting,
financing, local government funding responsibility, and accountability mechanisms.
Considering the unique needs of people who are dually diagnosed;
Addressing access to, financing of, and scope of responsibility in the delivery of emergency
behavioral health care services;
Addressing the quality and effectiveness of current service delivery systems and professional
staffing and clinical structure of services, roles, and responsibilities of public and private
providers;
Addressing priority population groups for publicly funded services, identifying the
comprehensive delivery systems, needs assessment and planning activities, and local
government responsibilities for funding services;
Reviewing the implementation of ch. 2020-107, Laws of Fla.;
66
Identifying gaps in the provision of mental health and substance abuse services;
Providing recommendations on how managing entities may promote service continuity;
Making recommendations about the mission and objectives of state-supported mental health
and substance abuse services and the planning, management, staffing, financing, contracting,
coordination, and accountability of mechanisms best suited for the recommended mission and
objectives; and
Evaluating and making recommendations regarding the establishment of a permanent, agency-
level entity to manage mental health, behavioral health, substance abuse, and related services
statewide, including the:
o Duties and organizational structure;
o Resource needs and possible sources of funding;
o Impact on access to and the quality of services;
o Impact on individuals with behavioral health needs, and their families, who are currently
receiving services and those who are in need of services; and
o Relation to and integration with service providers, managing entities, communities, state
agencies, and provider systems.
The Commission is required to submit an interim report and a final report, to the Governor and the
legislature of its findings and recommendations on how to best provide and facilitate mental health and
substance abuse services in Florida.
67
The interim report was submitted on January 1, 2023.
68
The final
report is due September 1, 2023.
Effect of the Bill
64
S. 394.9086(1), F.S.
65
S. 394.9086(4)(b), F.S.
66
2020 House Bill 945 (Silvers) requires managing entities to implement of a coordinated system of mental health care for children and
expands the use of mobile response teams (MRT) across the state. It requires the Florida Mental Health Institute within the University
of South Florida to develop a model protocol for school use of MRTs. The bill also requires AHCA and DCF to identify children and
adolescents who are the highest users of crisis stabilization services and take action to meet the needs of such children. Lastly, the bill
requires AHCA to continually test the Medicaid managed care provider network databases to ensure behavioral health providers are
accepting enrollees and confirm that enrollees have access to behavioral health systems.
67
S. 394.9086(5), F.S.
68
The Commission on Mental Health and Substance Abuse Legislative Report, January 1, 2023, available at
https://img1.wsimg.com/blobby/go/04dad2ad-e4b1-42e4-b8b4-
42d4f2bb4407/downloads/Mental%20Health%20Commission%20Interim%20Report%201.1.20.pdf?ver=1673462392875 (last visited
February 24, 2023). STORAGE NAME: h0655.CFS PAGE: 12
DATE: 3/7/2023
The bill broadens the purpose of the Commission to require the Commission to assess the adequacy of
the current infrastructure of Florida’s National Suicide Prevention Lifeline system and other components
of the state’s behavioral health crisis system.
The bill also expands the duties of the Commission. The bill requires the Commission to:
Work with the community stakeholders throughout the state to further support the NSPL system
and other crisis response services;
Conduct an overview of the current infrastructure of the NSPL system;
Analyze the current capacity of crisis response services throughout the state, including services
provided by mobile response teams (MRT) and centralized receiving facilities. The analysis
must include:
o Information on the geographic area and total population served by each MRT and the
average response time to each call made to the MRT;
o The number of calls that a MRT was unable to respond to due to staff limitations, travel
distance, or other factors; and
o The veteran status and age groups of individuals served by the MRTs.
Evaluate and make recommendation to improve linkages between NSPL and crisis response
services within the state;
Identify available mental health block grant funds that can be used to support the NSPL
infrastructure and crisis response services within the state, including any available funding
through the opioid settlements or through the American Rescue Act, The Coronavirus Aid,
Relief, and Economic Security (CARES) Act, or other federal legislation;
In consultation with AHCA, identify sources of funding available through the Medicaid program
specifically for crisis response services, including funding sources that may be available by
seeking approval of a Section 1115 waiver submitted to the Centers for Medicare and Medicaid
Services.
B. SECTION DIRECTORY:
Section 1: Amends s. 394.9086, F.S., relating to Commission on Mental Health and Substance
Abuse.
Section 2: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
This bill has an insignificant fiscal impact on the Department of Children and Families which can be
absorbed within existing resources.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None
2. Expenditures:
None
STORAGE NAME: h0655.CFS PAGE: 13
DATE: 3/7/2023
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not Applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill does not require rulemaking to implement its provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES