Chapter 33-404 Mental Health Services
33-404.101 Mental Health Services Program -- Purpose and Scope. 🔗 📘
(1) Mental health services are those services and activities that are provided primarily by mental health staff and secondarily by other health care staff for the purposes of:
(a) Identifying inmates who are experiencing disabling symptoms of a mental illness that impair the ability to function adequately within the incarceration environment;
(b) Providing appropriate intervention to alleviate disabling symptoms of a diagnosed mental illness;
(c) Assisting inmates with a mental illness adjust to the demands of prison life;
(d) Assisting inmates with a mental illness to maintain a level of adaptive functioning; and
(e) Providing re-entry mental health planning to facilitate the inmate's continuity of care after release to the community.
(2) Inmates in the custody of the Department will be offered mental health services commensurate with their individualized needs as determined by qualified mental health staff. Such services will be provided in accordance with prevailing correctional standards of care. Inmates receiving mental health services will be offered the opportunity to participate in the development of their individualized treatment plan in accordance with Section 945.41, Florida Statutes.
(3) The Department will provide the following levels of mental health care:
(a) Outpatient;
(b) Infirmary; and
(c) Inpatient treatment services to include:
1. Transitional mental health care;
2. Crisis stabilization care; and
3. Corrections Mental Health Treatment Facility Care.
(4) Inmates are offered the least restrictive appropriate treatment and services based on their assessed mental health needs and best interests and consistent with the improvement of their assessed mental health condition and appropriate adjustment within the correctional environment.
33-404.102 Provision of Mental Health Services. 🔗 📘
(1) All inmates entering the Department must receive an intake screening and comprehensive mental health evaluation by a qualified mental health professional.
(2) Inmates will be assigned to the appropriate level of mental health services based upon individualized screening and evaluation.
(3) Inmates will move between levels of mental health care according to their level of adaptive functioning and treatment needs.
(4) An inmate's individualized treatment plan will be updated as clinically indicated.
(5) Inmates who are assigned to administrative confinement under Rule 33-602.220, F.A.C., disciplinary confinement under Rule 33-602.222, F.A.C., protective management under Rule 33-602.221, F.A.C., close management under Rule 33-601.800, F.A.C., or maximum management under Rule 33-601.820, F.A.C., and require necessary mental health services must be referred to mental health staff or to medical staff in the absence of mental health staff.
(6) The Department will establish a mental health classification system to identify any inmate with a mental illness that, in the clinical judgment of mental health staff, will adversely impact the inmate's ability to adapt to the incarceration environment. The classification system must identify inmates according to their level of mental and adaptive functioning and treatment needs.
(7) Before mental health evaluation and treatment are rendered to an inmate, the inmate must be asked to give express and informed written consent, after the limits on confidentiality are explained, unless such consent is already documented. The explanation must enable the inmate to make a voluntary decision without any element of fraud, deceit, duress, or any other form of constraint or coercion.
(8) If an inmate requires long-term involuntary treatment, the inmate must be referred to a corrections mental health treatment facility in accordance with section 945.44, F.S. and Rule 33-404.2095, F.A.C.
(9) Conditions and Privileges of Inmates Receiving Inpatient Mental Health Services. Notwithstanding Rule 33-602.101, F.A.C., and subject to the provisions of Rule 33-404.112, F.A.C., Mental Health Risk Assessment of Inmates in an Inpatient Setting, inpatient inmates will be managed in accordance with Form DC4-664B, Behavioral Management Progress System. Form DC4-664B, Behavioral Management Progress System is hereby incorporated by reference. Copies of this form are available from the Forms Control Administrator, 501 South Calhoun Street, Tallahassee, Florida 32399-2500, <http://www.flrules.org/Gateway/reference.asp?No=Ref-10013>;. The effective date of the form is 11/18.
(10) An inmate receiving inpatient mental health services must have access to the courts and legal materials as provided in Rule 33-501.301, F.A.C. However, if the psychologist, or a psychiatrist in the absence of the psychologist, determines that an inmate's access to the law library must be restricted in order to prevent injury or harm to the inmate or others, security and mental health staff must immediately notify the law librarian. The law librarian will coordinate with mental health and security staff to ensure that the inmate has access to necessary law library services, such as inmate law clerk visits, to ensure that the inmate meets any pending legal deadlines during the restriction.
(11) During hours other than 8 a.m. to 5 p.m., Monday through Friday, and on observed holidays, the shift supervisor of an inpatient unit, in the absence of a psychologist or psychiatrist, and after consulting with the on duty health care staff, may authorize the temporary restriction of any property being used to create an immediate threat to the security of the unit that prevents security staff from accomplishing required functions in the unit. Any property restrictions authorized by the shift supervisor must be limited to those items necessary to neutralize the threat. All restrictions must be reviewed for further disposition by the Multidisciplinary Services Team (MDST) on the next business day.
(12) An inmate's access to property or privileges will be restricted upon the recommendation of licensed mental health staff when access to the property or privilege poses a threat of self-injury to the inmate or to the health or safety of other inmates or staff. The restrictions, together with justifications for the restrictions, must be documented in the inmate's medical file. Restrictions imposed under this paragraph must be reviewed by the psychologist or psychiatrist not less than every 72 hours to determine whether the continuation or modification of the restriction is necessary. The review and any resulting action must be documented in the inmate's medical file.
33-404.103 Mental Health Services -- Definitions. 🔗 📘
(1) The definitions in this rule are applicable to all rules under Chapter 33-404, F.A.C.
(2) "Behavioral Management Progress System" (or "BMPS") -- refers to a structured system of performance-based behavioral incentives and consequences used to facilitate adaptive functioning; promote constructive goal-oriented behavior; develop coping skills; and provide opportunities to demonstrate self-care, self-control, appropriate interpersonal interactions, compliance with rules, and cooperation with the treatment regimen. The levels are sequentially organized for the provision of progressive incentives to encourage compliance with the prescribed treatment regimen, involvement in unstructured out of cell activities, proper care of personal property, and participation in psychoeducation groups and therapeutic activities. Placement, advancement, or recession within the levels is based on demonstrated inmate behavior, including prosocial behavior, compliance with prescribed treatment modalities, aggressive acts, disruptive outburst, or other maladaptive behaviors. Individualized modification to an inmate's assignment to a level in the BMPS is approved by the MDST and documented in the mental health record.
(3) "Business Day" refers to any calendar day except Saturday, Sunday, or a paid holiday as defined in Section 110.117, F.S.
(4) "Corrections Mental Health Treatment Facility" refers to an inpatient mental health unit within the corrections system that provides extended involuntary mental health evaluation and treatment in accordance with Sections 945.40 ‒ 945.49, F.S.
(5) "Court" refers to the Circuit Court.
(6) "Crisis Stabilization Care" means an impatient level of care that is less restrictive and intense than care provided in a Corrections Mental Health Treatment Facility, that includes a broad range of evaluation and treatment services provided within a secure and highly structured residential setting, and that is intended for inmates who are experiencing acute psychological distress and who cannot be adequately evaluated and treated in a transitional care unit or infirmary isolation management room. This treatment is more intense than treatment provided in a transitional care unit and is devoted principally toward rapid stabilization of acute symptoms and conditions.
(7) "Critical Event" -- Involvement of an inpatient inmate in one or more of the following events or behaviors: receipt of a disciplinary report, assignment to self-harm observation status after committing an act of self-injury, homicide, attempted homicide, escape, attempted escape, physical or sexual assault or battery, or attempted physical or sexual assault or battery.
(8) "Express and Informed Consent" refers to consent voluntarily given in writing, by a competent inmate, after sufficient explanation and disclosure of the subject matter involved to enable the inmate to make a knowing and willful decision without any element of force, fraud, deceit, duress, or other form of constraint or coercion.
(9) "Incompetent to Consent Treatment" means a state in which an inmate's judgment is so affected by mental illness that he or she lacks the capacity to make a well-reasoned, willful, and knowing decision concerning his or her medical and/or mental health treatment and services. The term is distinguished from the term "incompetent to proceed," as defined in section 916.106, F.S., and only refers to an inmate's inability to provided express and informed consent for medical or mental health treatment and services.
(10) "Individualized Treatment Plan" -- A written description of an inmate's current problems, goals, and treatments.
(11) "Infirmary Mental Health Care" (IMH) is the first level of inpatient mental health care, and consists of brief admission to the institutional infirmary for patients residing in the general prison community.
(12) "Inpatient Level of Care" -- Mental health care provided at Corrections Mental Health Treatment Facilities, Crisis Stabilization Units, Transitional Care Units, and Infirmary Mental Health Care Units.
(13) "Inpatient Units" -- Includes the Corrections Mental Health Treatment Facilities (CMHTF), Crisis Stabilization Units (CSU), and Transitional Care Units (TCU).
(14) "Involuntary Examination" -- A psychiatric examination performed at a Corrections Mental Health Treatment Facility to determine whether an inmate will be placed in a Corrections Mental Health Treatment Facility for treatment and services.
(15) "In Need of Care and Treatment" has the same meaning as specified in section 945.42(7), F.S.
(16) "Isolation Management Room" -- A cell in an infirmary mental health care unit, transitional care unit, crisis stabilization unit, or a Corrections Mental Health Treatment Facility that has been certified as being suitable for housing those with acute psychological impairment or those who are at risk for self-injury.
(17) "Mental Health Treatment" -- Mental health screening, assessment, evaluation, or services that are delivered in inpatient or outpatient settings by mental health staff. Mental health treatment can include psychotropic medications prescribed by a medical practitioner licensed pursuant to chapter 458 or chapter 459, F.S., including laboratory tests and related medical procedures that are essential for the safe and effective administration of a psychotropic medication, and psychological interventions and services such as group and individual psychotherapy, activity therapy, recreational therapy, and music therapy. The term does not include forensic services for inmate defendants who are incompetent to proceed as defined in s. 916.106, F.S.
(18) "Mental Illness" or "Mentally Ill" refers to an impairment of the mental or emotional processes that exercise conscious control of one's actions or of the ability to perceive or understand reality, which impairment substantially interferes with the person's ability to meet the ordinary demands of living. However, for the purposes of transferring an inmate to a Corrections Mental Health Treatment Facility, the term does not include a developmental disability as defined in Section 393.063, F.S., simple intoxication, or conditions manifested only by antisocial behavior or substance abuse addiction. However, an individual who is developmentally disabled may also have a mental illness.
(19) "Multidisciplinary Services Team" (MDST) -- Staff representing different professions and disciplines, which has the responsibility for ensuring access to necessary assessment, treatment, continuity of care and services to inmates in accordance with their identified mental health needs, and which collaboratively develops, implements, reviews, and revises an individualized treatment plan, as needed.
(20) "Residential Continuum of Care" -- Specialized residential mental health units that provide augmented outpatient mental health treatment and habilitation services in a protective environment for inmates with serious psychological impairment associated with a historical inability to successfully adjust to daily living in the incarceration environment.
(21) "Structured Out of Cell Treatment and Services" (SOCTS): Weekly scheduled individualized treatment services, psychoeducational groups and therapeutic activities to ameliorate disabling symptoms of a diagnosed mental illness and improve behavioral functioning as identified in the individualized treatment plans.
(22) "Transitional Mental Health Care" means a level of care that is more intensive than outpatient care, but less intensive than crisis stabilization care, and is characterized by the provision of traditional mental health treatments and services such as group and individual therapy, activity therapy, recreational therapy, and psychotropic medications in the context of a secure, structured residential setting. Transitional mental health care is indicated for an inmate with chronic or residual symptomatology who does not require crisis stabilization care or acute mental health care but whose impairment in functioning nevertheless renders him or her incapable of adjusting satisfactorily within the general inmate population.
(23) "Unstructured Out of Cell Time" -- Out of cell activities monitored by security staff without involvement of mental health staff, including but not limited to, outdoor recreation, dayroom, visitation, telephone calls, and showers.
33-404.104 Mental Health Services -- Classification System (Repealed). 🔗 📘
33-404.105 Consent to Mental Health Evaluation and Treatment (Repealed). 🔗 📘
33-404.106 Admission to Infirmary Mental Health Care, Transitional Care, or Crisis Stabilization. 🔗 📘
(1) Inmates may not refuse placement in infirmary mental health care, crisis stabilization, or transitional care for inpatient treatment.
(2) Inmates retain the right to refuse mental health treatment except as provided in sections 945.43, 945.44, and 945.48, F.S.
(3) An inmate's refusal of mental health treatment or services must be documented in accordance with Rule 33-401.105, F.A.C.
33-404.107 Use of Force with Mentally Disordered Inmates (Repealed). 🔗 📘
33-404.108 Discipline of Inmates Diagnosed as Mentally Ill. 🔗 📘
(1) Inmates diagnosed as mentally ill shall be subject to the provisions of Rules 33-601.301-.314, F.A.C., Inmate Discipline, except as as provided in this rule and Rule 33-404.112, F.A.C.
(2) The Mental Health Program Office is authorized to provide written or verbal input to the disciplinary team prior to disciplinary action being taken against any inmate who has a diagnosed mental illness. The input shall be limited to whether the patient's mental illness may have contributed to the alleged disciplinary offense and, if so, a recommendation for disposition or sanction options or alternative actions.
(3) Prior to the issuance of a disciplinary report for an incident of maladaptive behavior occurring in a Florida Department of Corrections inpatient mental health unit or in the residential continuum of care units, the correctional officer shift supervisor shall discuss the incident and circumstances with the supervising psychologist or the psychological services director to determine whether a disciplinary report will be issued. The consultation will be documented in the inmate's mental health record.
(4) For inmates receiving any inpatient level of care who have been issued a disciplinary report, written input must be provided by a psychologist, or a psychiatrist in the absence of the psychologist. For inmates in outpatient settings who have been issued a disciplinary report, written input by a fully licensed clinician within the Mental Health Program Office, must be provided for those inmates that have a current diagnosis associated with documented psychotic features, autism spectrum disorder, dementia, or intellectual disability.
(5) For inpatient, the written input by the psychologist, or a psychiatrist in the absence of the psychologist, will be documented on Form DC6-1008, Disciplinary Team Mental Health Consultation, and will be the result of a record review, a review of a copy of the statement of facts, and a clinical interview with the inmate. For outpatient, the written input by the fully licensed clinician within the Mental Health Program Office will be documented on Form DC6-1008, Disciplinary Team Mental Health Consultation, and will be the result of a record review, a review of a copy of the statement of facts, and a clinical interview with the inmate. Form DC6-1008 will be completed and provided to the disciplinary team prior to the disciplinary hearing. The results of the clinical assessment shall also be documented in the inmate's medical file. The disciplinary team shall incorporate the written input by the the Mental Health Program Office, into their final decision. Form DC6-1008, Disciplinary Team Mental Health Consultation, is hereby incorporated by reference. Copies of this form are available from the Forms Control Administrator, 501 South Calhoun Street, Tallahassee, Florida 32399-2500, <http://www.flrules.org/Gateway/reference.asp?No=Ref-17153>;. The effective date of the form is 11/24.
(6) For inmates receiving any inpatient level of care who have been found guilty of a disciplinary charge, the disciplinary process shall proceed in accordance with Rules 33-601.301-601.314, F.A.C., except these inmates shall not receive a penalty of disciplinary confinement. In lieu of disciplinary confinement, as provided in Rule 33-602.222, F.A.C., the disciplinary team's findings shall be referred to the Multidisciplinary Services Team (MDST) for review and revision to the Individualized Services Plan, Form DC4-643A, as incorporated in Rule 33-601.800, F.A.C., and for consideration of adjustment of privileges in accordance with the Behavioral Management Progress System, Form DC4-664B.
33-404.112 Risk Assessment of Inmates in an Inpatient Setting. 🔗 📘
(1) When an inmate is admitted to an inpatient unit, any prior confinement or close management status shall be suspended until the inmate is discharged from the specialized care setting. Absent inmate behavior that constitutes an immediate and present danger to the safety of staff and inmates, the inmate's security restraint status shall not be changed before the completion of their initial assessment of risk for violence.
(2) The Risk Assessment Team (RAT) shall consist of a security representative with the level Major or above with responsabilities in the inpatient unit, who shall serve as the team leader, a psychologist, and classification officer who are all assigned to the inpatient unit where the inmate is admitted. The RAT shall complete an initial assessment of risk for violence as set forth in this chapter. The RAT shall be responsible for making a determination of the inmate's security restraint status for use anytime the inmate is out of his or her cell.
(3) The RAT leader will be responsible for scheduling the initial assessment for the risk of violence. These risk assessment meetings will occur within 3 business days of an inmate's admission to a crisis stabilization unit, or within 7 business days of an inmate's admission to transitional care unit or a corrections mental health treatment facility, an initial assessment of risk for violence shall be completed by a risk assessment team using Form DC6-2087, Risk Assessment for Inpatient Treatment. Form DC6-2087, Risk Assessment for Inpatient Treatment, is hereby incorporated by reference. Copies of this form are available from the Forms Control Administrator, 501 South Calhoun Street, Tallahassee, Florida 32399-2500, <http://www.flrules.org/Gateway/reference.asp?No=Ref-14011>;. The effective date of the form is 02/22. Decisions on the use of security restraints on the inpatient unit shall be individualized and made on a case-by-case basis and referenced in Form DC6-2087. The assessment of risk for violence shall include a review of all mental health and institutional records, the inmate's adjustment to incarceration, and the inmate's disciplinary or confinement status at the time of the referral for inpatient treatment and shall be documented in the medical file via a copy of Form DC6-2087.
(4) After the initial risk assessment, the Multidisciplinary Services Team (MDST), as defined in Rule 33-404.103, F.A.C., shall be responsible for modifications for housing and structured out-of-cell treatment and services via the Behavioral Management Progress System. Any such modifications shall be documented in the inmate's inpatient medical file.
(5) Subsequent periodic assessments of risk for violence shall be completed by a RAT using Form DC6-2087. The RAT leader will be responsible for scheduling a subsequent periodic risk for violence assessment within 90 days of the initial risk assessment and at least every 90 days thereafter. RAT reviews shall also be conducted within 3 business days after the occurrence of any critical event, as defined in Rule 33-404.103, F.A.C.
(6) At any time between the required intervals established in subsection (5), the psychologist, with the consent of the MDST, may request the risk assessment team to review and determine the necessity for the security restraints, or the level of security restraints, any time he or she is outside of his or her cell. The MDST's request will be documented by the psychologist in the inmate's inpatient medical file. The RAT's review will be documented on Form DC6-2087. An inpatient inmate whose conduct or behavior results in a Disciplinary Report shall be subject to the provisions of Rule 33-404.108, F.A.C.
(7) The psychologist will provide information to the other members of the RAT whether the recommended restraints are contraindicated by the inmate's current psychological/behavioral functioning. If the psychologist determines there is a contraindication, but security and/or classification team members determine the security restraints must be applied, the Warden and Florida Department of Corrections' Director of Mental Health Services or his or her designee will collaborate to make a final determination. Under no circumstances shall the psychologist decide whether an inmate shall be subjected to security restraints.
33-404.201 Operation, Administration, and Designation of Corrections Mental Health Treatment Facilities. 🔗 📘
(1) The Department is responsible for the operation and administration of Corrections Mental Health Treatment Facilities, which are established to provide for the extended treatment of inmates who have a mental illness requiring intensive mental health treatment at the hospital level.
(2) The assistant secretary for health services designates mental health treatment facilities at the following institutions:
(a) Lake Correctional Institution (males);
(b) Reception and Medical Center (males); and,
(c) Florida Women's Reception Center (females).
33-404.202 Mental Health Treatment Facilities -- Definitions (Repealed). 🔗 📘
33-404.203 Mental Health Treatment Facilities -- Care of Inmates (Repealed). 🔗 📘
33-404.204 Mental Health Treatment Facilities -- Use of Force (Repealed). 🔗 📘
33-404.205 Mental Health Treatment Facilities -- Inmate Discipline (Repealed). 🔗 📘
33-404.206 Mental Health Treatment Facilities -- Administrative Confinement (Repealed). 🔗 📘
33-404.207 Mental Health Treatment Facilities -- Restrictions of Inmate Privileges (Repealed). 🔗 📘
33-404.208 Mental Health Treatment Facilities -- Admissible Reading Material (Repealed). 🔗 📘
33-404.209 Mental Health Treatment Facilities -- Forms (Repealed). 🔗 📘
33-404.2095 Involuntary Examination, Placement, and Treatment in Mental Health Treatment Facilities. 🔗 📘
(1) An inmate must be considered for placement in a Corrections Mental Health Treatment Facility when he or she is mentally ill and in need of care and treatment as defined in Section 945.42, F.S.
(2) An inmate who appears to meet the criteria in section 945.44, F.S., for involuntary placement and treatment in a Corrections Mental Health Treatment Facility must be transferred to a Corrections Mental Health Treatment Facility for an involuntary examination in accordance with section 945.43, F.S.
(3) If it is determined that the inmate is in need of care and treatment after the evaluation, the psychiatrist must propose a recommended course of treatment, and the warden must initiate proceedings with the court for the involuntary placement and treatment of the inmate in the Corrections Mental Health Treatment Facility as specified in sections 945.43 and 945.44, F.S.
(4) A court order authorizing involuntary placement and treatment in a Corrections Mental Health Treatment Facility will authorize the placement and treatment for a period not to exceed six months following the date of the order.
(5) If inmate remains in need of care and treatment after the initial six months, the warden must file a notice with the court requesting a status hearing to authorize continued involuntary placement and treatment for another period not to exceed six months. This process must be repeated until the inmate is no longer in need of care and treatment and is discharged from the Corrections Mental Health Treatment Facility.
33-404.2096 Emergency Placement in Mental Health Treatment Facilities (Repealed). 🔗 📘
33-404.2097 Discharge from Mental Health Treatment Facilities. 🔗 📘
(1) When an inmate is no longer in need of care and treatment as defined in Section 945.42(7), F.S., he or she must be discharged from treatment in a Corrections Mental Health Treatment Facility and transferred to a lower level of care for the provision of appropriate mental health services.
(2) The warden of the mental health treatment facility must notify the court in writing when an inmate is discharged from the Corrections Mental Health Treatment Facility because he or she is no longer in need of care and treatment, has been transferred to another institution of the Department, or has been released from the Department's custody.
33-404.2098 Continued Placement in Mental Health Treatment Facilities (Repealed). 🔗 📘
33-404.210 Mental Health Treatment -- Consent to Treatment. 🔗 📘
(1) Inmates must be asked to give express and informed written consent for offered mental health treatment within the Department, in accordance with Section 945.41, F.S.
(2) For inmates placed in a mental health treatment facility in accordance with section 945.44. F.S., when the express and informed consent of the inmate cannot be obtained or the inmate is incompetent to consent treatment, the warden of the mental health treatment facility, or his or her designee, under the direction of the inmate's attending physician, may authorize nonpsychiatric, emergency surgical treatment or other routine medical treatment if such treatment is deemed lifesaving or if there is a situation threatening serious bodily harm to the inmate.