This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0829c.HCA
DATE: 3/14/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 829 Operation and Administration of the Baker Act
SPONSOR(S): Silvers and others
TIED BILLS: IDEN./SIM. BILLS: SB 938
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee 18 Y, 0 N Brazzell Brazzell
2) Health Care Appropriations Subcommittee 15 Y, 0 N Fontaine Clark
3) Health & Human Services Committee
SUMMARY ANALYSIS
The Baker Act provides 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. The Baker Act governs voluntary and involuntary admissions for mental health care, among
other aspects of the state’s mental health program. The Baker Act has been amended by the Legislature
multiple times over the last decade.
However, a variety of other entities are involved in meeting the needs of individuals in a mental health crisis,
and many other state and federal laws and associated regulations govern the operation of and interaction
between these entities in the performance of their duties relating to behavioral health acute care.
Section 394.457, F.S., requires the Department of Children and Families (DCF) to publish and distribute an
information handbook to facilitate understanding of the Baker Act. DCF also seeks to educate professionals
and the public about the Baker Act, such as through webinars, presentations, and a frequently asked question
(FAQ) repository. The handbook (known as a user reference guide) was last updated in 2014, and some of the
FAQ’s were last updated in 2012 despite the multiple revisions to the Baker Act since then.
HB 829 requires DCF to annually update the Baker Act handbook and to maintain a FAQ repository.
The bill does not have a fiscal impact on DCF or local governments.
The bill provides an effective date of July 1, 2023.
STORAGE NAME: h0829c.HCA PAGE: 2
DATE: 3/14/2023
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
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.
Some of the services administered by DCF are part of the state’s behavioral health acute care system.
Behavioral Health Acute Care System
The behavioral health acute care system is extraordinarily complex. This graphic indicates some of 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.
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. STORAGE NAME: h0829c.HCA PAGE: 3
DATE: 3/14/2023
Source: Florida Mental Health Institute, USF, 2014 Baker Act User Reference Guide.
Various state and federal laws and associated regulations govern the operation of and interaction
between these entities in the performance of their duties relating to behavioral health acute care. For
example, the federal Emergency Medical Treatment and Active Labor Act
6
applies to all hospitals with
emergency service capacity, including freestanding psychiatric hospitals. The law prohibits the delay or
denial of emergency medical services, including psychiatric or substance abuse emergencies, due to
inability to pay.
7
Examples of state laws include:
Baker Act and other provisions of ch. 394, F.S., governing the operation of the mental health
system, including those governing transportation of clients, local match for mental health
services, and the managing entity system.
Marchman Act and other provisions of ch. 397, F.S., including those governing substance abuse
provider licensure.
Access to emergency services and care, s. 396.1041, F.S., which also prohibits the delay or
denial of emergency services by hospitals. It governs access to care and transfers from a
hospital.
Guardianship, ch. 744, F.S., through which an individual is adjudicated incompetent and a
guardian appointed.
Advance directives, ch. 765, F.S., which addresses advanced planning for incapacity and
surrogate health care decisionmakers and proxies.
Medicaid, ch. 409, which governs the operation of the state’s medical assistance program. For
example, managed care plans must offer at a minimum mental health services and substance
abuse treatment services.
8
Other laws, such as federal law regarding the Community Mental Health Services and Substance
Abuse Prevention and Treatment Block Grants, which fund safety-net services, and confidentiality of
client records govern behavioral health care generally and also affect the operation of the behavioral
health acute care system.
6
42 U.S.C. 1395dd.
7
2014 Baker Act: the Florida Mental Health Act User Reference Guide.
https://www.myflfamilies.com/sites/default/files/2023-03/2014%20Baker%20Act%20Manual_0.pdf (last accessed March 1,
2023).
8
S. 409.973(1)(q) and (bb), F.S. STORAGE NAME: h0829c.HCA PAGE: 4
DATE: 3/14/2023
Funding for services provided in this system comes from a variety of sources, including but not limited
to state general revenue, federal block grant funds, Medicaid, private insurance, and client fees
9
.
Baker Act
The Florida Mental Health Act, otherwise known as the Baker Act, was enacted in 1971 to revise the
state’s mental health commitment laws.
10
The Baker Act is the short title for part I of ch. 394. The Act
provides 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.
11
The Baker Act governs voluntary and involuntary admissions for mental
health care, among other aspects of the state’s mental health program.
Involuntary Exams under the Baker Act
Children, adults, and seniors are all potentially subject to the Baker Act. During FY 20-21, 194,680
involuntary exams were performed on 121,921 individuals. In FY 20-21, these exams, by group, were
as follows:
Children under 18: 38,447 exams.
Adults 18-64: 115,359 exams.
Adults 65 and over: 13,288 exams.
12
There are three approaches in law for initiating an involuntary exam under the Baker Act, as follows,
with the percent of exams initiated through that approach in FY 20-21:
Law enforcement—52% of exams.
Licensed clinicians and other professionals—45% of exams.
Ex parte order through the courts—2% of exams.
13
Individuals can move from a variety of settings into an involuntary exam under the Baker Act. For
example, in FY 20-21:
For adults 65+, 6.19% of exams were initiated from an assisted living facility, and 1.76% from a
nursing home.
For children, 11.12% were in a school setting when the exam was initiated.
14
Education and Training on Mental Health for Law Enforcement and School Personnel
As of 2021, there were 43,876 law enforcement officers in Florida’s police departments, sheriffs’
offices, schools and ports who could initiate an involuntary exam under Baker Act.
15
Some portion of
these officers receive training on working with individuals with mental illness through approaches such
as Crisis Intervention Team training.
16
Of the state’s law enforcement agencies, 94% initiated at least
one involuntary exam in FY 20-21.
9
S. 394.674(3), F.S.
10
Ss. 394.451-394.47892, F.S.
11
S. 394.459, F.S.
12
Annette Christy, Ph.D., et al; The Baker Act: Florida Mental Health Act FY 2020/2021 Annual Report, (2022), Tampa, FL: University
of South Florida, Department of Mental Health Law and Policy, Baker Act Reporting Center, at pg. 3.
13
Id.
14
Id. at pg. 11.
15
Florida Department of Law Enforcement, Criminal Justice Agency Profile (CJAP) Report-Statewide Ratios;
https://www.fdle.state.fl.us/CJSTC/Publications/CJAP/Statewide-Ratios.aspx (last accessed March 3, 2023).
16
See generally Florida Sheriff’s Association, Crisis Intervention Team Training, https://www.flsheriffs.org/law-enforcement-
programs/crisis-intervention-team (last accessed March 3, 2023). STORAGE NAME: h0829c.HCA PAGE: 5
DATE: 3/14/2023
In FY 2022-23, there were 343,238 full-time staff in Florida’s public schools.
17
Many receive training
through Youth Mental Health First Aid, which helps school personnel identify and understand the signs
of mental health concerns and substance use disorders, and provide such personnel with the next
steps to find help for a person who is developing or experiencing mental health concerns or a
substance use disorder.
18
Education and Training on the Baker Act by DCF
DCF is tasked in law with providing information about the Baker Act. DCF reports that it has created
webinars on the Baker Act and will provide community presentations.
19
A Baker Act user reference
guide and frequently asked question repository are other sources of information maintained by DCF.
Webinars on the Baker Act
The department has worked with a contracted vendor to produce four webinars regarding the Baker
Act
20
21
Introduction to the Baker Act (revised effective 2016).
Law enforcement and the Baker Act
Minors and the Baker Act (revised effective 2016).
Long-term Care and the Baker Act.
Community Presentations
DCF staff also make presentations on the Baker Act to community stakeholder groups upon request.
22
Baker Act Handbook
Section 394.457, F.S., requires DCF to publish and distribute an information handbook to facilitate
understanding of the Baker Act. DCF last published an updated version of the handbook, known as the
Baker Act User Reference Guide, in 2014.
23, 24
Since then, the Baker Act has been amended by the
Legislature multiple times.
25
The 2014 volume is 496 pages long and includes:
Overviews and historical background;
Maps of judicial circuits, DCF regions, and managing entity service areas;
Contact information for managing entities;
Statutes linked to associated rules;
Flow charts;
17
Florida Department of Education, PK-12 Public School Data Publications and Reports:Staff,
https://www.fldoe.org/accountability/data-sys/edu-info-accountability-services/pk-12-public-school-data-pubs-reports/staff.stml (last
accessed March 3, 2023).
18
Florida Department of Education, Youth Mental Health Awareness Training, https://www.fldoe.org/schools/k-12-public-
schools/sss/ymhat.stml (last accessed March 3, 2023). Rule 6A-1.094120, F.A.C., requires an annual certification that at least 80% of
school personnel in required job codes in a school district, including school personnel at charter schools, have completed the approved
training (last accessed March 1, 2023).
19
Department of Children and Families, Agency Analysis of 2023 HB 829, at pg. 2 (February 21, 2023).
20
Id.
21
Department of Children and Families, Baker Act On-Line Training Courses, https://www.myflfamilies.com/crisis-services/baker-
act/baker-act-training/baker-act-line-training-courses (accessed March 1, 2023).
22
Supra note 19
23
Supra note 7.
24
Email from Chad Corcoran, Deputy Legislative Affairs Director, Department of Children and Families, RE: Where is Baker Act
manual on DCF's website?--PS (March 1, 2023).
25
For example, 2016 (SB 12), 2019 (SB 1418), and 2022 (SB 1262, SB 1844). STORAGE NAME: h0829c.HCA PAGE: 6
DATE: 3/14/2023
Quick reference guides;
Charts depicting authority granted to various mental health professionals under different
situations;
Comparison of the Baker and Marchman Act provisions;
Resources, such as information about helplines, service providers, patient groups, and online
training; and
Forms.
Frequently Asked Questions Repository
DCF maintains a repository of frequently asked questions and responses on its website.
26
These FAQs
address issues that arise in the field in the day-to-day administration of the Baker Act by the hundreds
of thousands of individuals working in law enforcement, schools, mental health providers, hospitals,
nursing homes and ALF’s, and jails, as well as individual clinicians, who may come in contact with
someone who might meet criteria for an involuntary exam under the Baker Act. All of these individuals
must comply with the Baker Act’s provisions regarding involuntary exams.
Topics in the DCF FAQ list with accessible content include the following, with the date of last revision
noted:
Baker Act Forms—2020.
Long-term Care Facilities—2012.
Clinical Records and Confidentiality--2012
Marchman Act—2012.
Discharge Planning—2012.
Minors—2012.
Emergency Medical Conditions—2012.
Several other topics are listed, but as of March 6, 2023, the content was temporarily inaccessible due to
DCF’s website redesign in progress. It is unknown when the last revision to these topics occurred:
27
Professional Credentials.
Emergency Treatment Orders.
Receiving Facilities.
Express and Informed Consent.
Involuntary Examination.
Involuntary Inpatient Placement.
Transportation.
Involuntary Outpatient Placement.
Voluntary Admissions.
Weapons & Contraband.
Law Enforcement.
Telehealth.
Effect of Proposed Changes
The bill requires DCF to publish its information handbook on the Baker Act online by October 1 of each
year. It also requires DCF to maintain and publish on its website a repository of answers to frequently
asked questions.
The bill has an effective date of July 1, 2023.
26
Department of Children and Families, Baker Act Frequently Asked Questions, https://www.myflfamilies.com/crisis-services/baker-
act/baker-act-frequently-asked-questions (visited March 3, 2023).
27
Email from John Paul Fiore, Legislative Affairs Director, Department of Children and Families, RE: Where is Baker Act manual on
DCF's website?—PS—any information? (March 6, 2023). STORAGE NAME: h0829c.HCA PAGE: 7
DATE: 3/14/2023
B. SECTION DIRECTORY:
Section 1: Amends s. 394.457, F.S., relating to operation and administration.
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:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
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:
DCF has sufficient rulemaking authority to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
To the degree that conflicting DCF rules have not been revised to align with statutory changes, or that
new DCF rules have not been adopted to implement statutory changes, a revised handbook including
DCF rules would not provide accurate guidance to those involved in implementing the Baker Act
without DCF engaging in the rulemaking process first. STORAGE NAME: h0829c.HCA PAGE: 8
DATE: 3/14/2023
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CH ANGES