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 Appropriations Committee on Health and Human Services
BILL: CS/SB 1394
INTRODUCER: Children, Families, and Elder Affairs Committee and Senator Gruters and others
SUBJECT: Community Mobile Support Teams
DATE: February 7, 2024
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Hall Tuszynski CF Fav/CS
2. Sneed McKnight AHS Pre-meeting
3. FP
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 1394 requires the Department of Children and Families to contract with managing entities
for community mobile support teams throughout the state to place crisis counselors from
community mental health centers in local law enforcement agencies. These crisis counselors are
to conduct follow-up contacts with children, adolescents, and adults who have been involuntarily
committed under the Baker Act by a law enforcement officer and provide follow-up care to
individuals in the community that law enforcement has identified as needing additional mental
health support.
The bill details what services the community mobile support team is required to offer and also
details the requirements of a community mental health center contracted by the managing entity.
The bill has an indeterminate, but likely significant, negative fiscal impact on state government.
See Section V., Fiscal Impact Statement.
The bill takes effect July 1, 2024.
REVISED: BILL: CS/SB 1394 Page 2
II. Present Situation:
Mental Health and Mental Illness
Mental Health is a state of well-being in which the individual realizes his or her own abilities to
cope with normal stresses of life, can work productively and fruitfully, and can 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, and
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. More than one in five
adults live with a mental illness.
4
Young adults between the ages of 18 to 25 had the highest
prevalence of any mental illness
5
(33.7 percent) compared to adults between the ages of 26 to 49
(28.1 percent) and adults age 50 and older (15 percent).
6
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.
Behavioral Health Managing Entities
In 2001, the Legislature authorized DCF to implement and pilot behavioral health managing
entities (MEs) as the management structure for the delivery of local mental health and substance
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 20, 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 20, 2024).
3
Id.
4
National Institute of Mental Health, Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last visited
January 20, 2024).
5
Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from
no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness).
6
National Institute of Mental Health (NIH), Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last
visited January 20, 2024). BILL: CS/SB 1394 Page 3
abuse services.
7
In 2008, the Legislature authorized DCF to implement MEs statewide.
8
MEs
were fully implemented statewide in 2013, serving all geographic regions.
DCF currently contracts with seven MEs for behavioral health services throughout the state.
These entities do not provide direct services; rather, they allow the DCF’s funding to be tailored
to the specific behavioral health needs of various regions of the state. The regions are as
follows:
9
Coordinated System of Care
Managing entities are required to promote the development and implementation of a coordinated
system of care.
10
A coordinated system of care means a full array of behavioral and related
7
Ch. 2001-191, Laws of Fla.
8
Ch. 2008-243, Laws of Fla.
9
DCF, Managing Entities, https://www.myflfamilies.com/services/samh/providers/managing-entities (last visited January 20,
2024).
10
Section 394.9082(5)(d), F.S. BILL: CS/SB 1394 Page 4
services in a region or community offered by all service providers, providing service under
contract with a managing entity or by another method of community partnership or mutual
agreement.
11
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. 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;
Respite services;
Outpatient treatment;
Crisis stabilization;
Therapeutic foster care;
Residential treatment;
Inpatient hospitalization;
Care management;
Services for victims of sex offenses;
Transitional services; and
Trauma-informed services for children who have suffered sexual exploitation.
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.
16
The Act includes legal procedures for mental
11
Section 394.4573(1)(c), F.S.
12
Section 394.4573(1)(c), F.S.
13
Id.
14
Section 394.4573(2), F.S.
15
Section 394.495(4), F.S.
16
The Baker Act is contained in Part I of Ch. 394, F.S. BILL: CS/SB 1394 Page 5
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.
17
Receiving Facilities
Individuals in an acute mental or behavioral health crisis may require emergency treatment to
stabilize their condition. Emergency mental health examination and stabilization services may be
provided on a voluntary or involuntary basis.
18
Individuals receiving services on an involuntary
basis must be taken to a facility that has been designated by DCF as a receiving facility.
Receiving facilities, often referred to as Baker Act receiving facilities, are public or private
facilities designated by DCF to receive and hold or refer, as appropriate, involuntary patients
under emergency conditions for mental health or substance abuse evaluation and to provide
treatment or transportation to the appropriate service provider.
19
A public receiving facility is a
facility that has contracted with a managing entity to provide mental health services to all
persons, regardless of their ability to pay, and is receiving state funds for such purpose.
20
Funds
appropriated for Baker Act services may only be used to pay for services diagnostically and
financially eligible persons, or those who are acutely ill, in need of mental health services, and
the least able to pay.
21
Crisis Stabilization Units
Crisis Stabilization Units (CSUs) are public receiving facilities that receive state funding and
provide a less intensive and less costly alternative to inpatient psychiatric hospitalization for
individuals presenting as acutely mentally ill. CSUs screen, assess and admit individuals brought
to the unit under the Baker Act, as well as those individuals who voluntarily present themselves,
for short-term services. CSUs provide services 24 hours a day, seven days a week, through a
team of mental health professionals. The purpose of the CSU is to examine, stabilize, and
redirect people to the most appropriate and least restrictive treatment settings, consistent with
their mental health needs.
22
Individuals often enter the public mental health system through
CSUs.
Involuntary Examination
An involuntary examination is required if there is reason to believe that the person has a mental
illness and, because of his or her mental illness, has refused a voluntary examination, is likely to
refuse to care for him or herself to the extent that such refusal threatens to cause substantial harm
to that person’s well-being, and such harm is unavoidable through the help of willing family
members or friends, or will cause serious bodily harm to him or herself or others in the near
future based on recent behavior.
23
17
Section 394.459, F.S.
18
Section 394.4625 and 394.463, F.S.
19
Section 394.455(40), F.S. This term does not include a county jail.
20
Section 394.455(38), F.S.
21
Rule 65E-5.400(2), F.A.C.
22
Section 394.875, F.S.
23
Section 394.463(1), F.S. BILL: CS/SB 1394 Page 6
An involuntary examination may be initiated by:
A court entering an ex parte order stating that a person appears to meet the criteria for
involuntary examination, based on sworn testimony;
24
or
A physician, clinical psychologist, psychiatric nurse, autonomous advanced practice
registered nurse, mental health counselor, marriage and family therapist, or clinical social
worker executing a certificate stating that he or she has examined a person within the
preceding 48 hours and finds that the person appears to meet the criteria for involuntary
examination, including a statement of the professional’s observations supporting such
conclusion.
25
Unlike the discretion afforded to courts and medical professionals, current law mandates that law
enforcement officers must initiate an involuntary examination of a person who appears to meet
the criteria by taking him or her into custody and delivering or having the person delivered to a
receiving facility for examination.
26
Under the Baker Act, a receiving facility has up to 72 hours to examine an involuntary patient.
27
During those 72 hours, an involuntary patient must be examined to determine if the criteria for
involuntary services are met.
28
Within that 72-hour examination period, one of the following
must happen:
29
The patient must be released, unless he or she is charged with a crime, in which case, law
enforcement will assume custody;
The patient must be released for voluntary outpatient treatment;
The patient, unless charged with a crime, must give express and informed consent to be
placed and admitted as a voluntary patient; or
A petition for involuntary placement must be filed in circuit court for involuntary outpatient
or inpatient treatment.
III. Effect of Proposed Changes:
Section 1 amends s. 394.495, F.S., to require the Department of Children and Families to
contract with managing entities throughout the state for community mobile support teams to
place crisis counselors from community mental health centers within local law enforcement
agencies. These crisis counselors are to conduct follow-up contacts with children, adolescents,
and adults who have been involuntarily committed under the Baker Act by a law enforcement
officer.
The bill provides the goal of the partnership is to reduce recidivism of law enforcement Baker
Act commitments, reduce the time burden of law enforcement completing follow-up work with
individuals after they have been subject to treatment under the Baker Act, provide additional
crisis intervention services, engage individuals in ongoing mental health care, and provide a
source for mental health crisis intervention other than law enforcement.
24
Section 394.463(2)(a)1., F.S. The order of the court must be made a part of the patient’s clinical record.
25
Section 394.463(2)(a)3., F.S. The report and certificate must be made a part of the patient’s clinical record.
26
Section 394.463(2)(a)2., F.S.
27
Section 394.463(2)(g), F.S.
28
Section 394.463(2)(f), F.S.
29
Section 394.463(2)(g), F.S. BILL: CS/SB 1394 Page 7
The bill requires a crisis counselor to, at a minimum:
Provide follow-up care to individuals in the community that law enforcement has identified
as needing additional mental health support.
Conduct home visits to assist individuals in connecting with appropriate aftercare services in
his or her community following his or her discharge from a Baker Act receiving facility.
Provide support to aid a person during the transition period his or her release from
commitment under the Baker Act to connection with aftercare services.
Provide brief crisis counseling and assessment for additional needs.
The bill requires a community mobile support team to offer, at a minimum, the following
services:
Crisis assessment.
Community-based crisis counseling.
In-person, follow-up care after involuntary commitment under the Baker Act by a law
enforcement officer.
Assistance with accessing and engaging in aftercare services.
Assistance with obtaining other necessary community resources to maintain stability.
Coordination of safety planning.
The bill requires the community mental health center contracted by the managing entity to, at a
minimum:
Collaborate with local law enforcement offices in the planning, development, and program
evaluation processes.
Require that services are available seven days a week.
Establish independent response protocols and memoranda of understanding with local law
enforcement agencies.
Section 2 provides that the bill take effect July 1, 2024.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None. BILL: CS/SB 1394 Page 8
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
The bill may have a significant, negative fiscal impact on state government due to the
provision that requires contracts between the behavioral health managing entities and
community mental health centers to employ community mobile support team crisis
counselors in local law enforcement agencies to perform the duties detailed within the
bill. As of this writing, the Department of Children and Families has not submitted an
estimate of such fiscal impact.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 394.495 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Children, Families, and Elder Affairs on January 23, 2024:
The committee substitute makes the following changes:
Requires the community mobile support team crisis counselor to provide follow-up
care to individuals in the community that law enforcement has identified as needing
additional mental health support.
Details what services the community mobile support team is required to offer.
Details the requirements of a community mental health center contracted by the
managing entity. BILL: CS/SB 1394 Page 9
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.