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 disorder that impair the ability to function adequately within the incarceration environment;

(b) Providing appropriate intervention to alleviate disabling symptoms of a mental disorder;

(c) Assisting inmates with a mental disorder with adjusting to the demands of prison life;

(d) Assisting inmates with a mental disorder 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) Access to necessary mental health services shall be available to all inmates within the department, shall be provided in a non-discriminatory fashion, and shall be provided in accordance with prevailing community and correctional standards of care. All inmates are eligible to receive mental health screening and evaluation as necessary.

(3) The department shall provide the following levels of mental health care:

(a) Outpatient;

(b) Infirmary;

(c) Transitional;

(d) Crisis Stabilization; and

(e) Corrections Mental Health Treatment Facility Care.

(4) Final medical responsibility and authority for mental health matters at the institutional level rest with the chief health officer or medical executive director, with support and oversight provided by the regional mental health consultant, director of mental health services and assistant secretary for health services.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.40, 945.49 FS. History–New 5-27-97, Formerly 33-40.001, Amended 3-1-11.

33-404.102 Provision of Mental Health Services.

(1) All inmates entering the department shall have access to necessary mental health services as established by this chapter.

(2) Inmates shall have access to mental health services commensurate with their needs as determined by health care staff.

(3) Inmates shall move between levels of care according to their level of adaptive functioning and treatment needs.

(4) All inmates who are receiving mental health services shall have an individualized services plan developed by mental health service providers.

(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 shall be referred to mental health staff immediately or to medical staff in the absence of mental health staff.

(6) The department shall establish a mental health classification system with which to identify inmates with a mental disorder that, in the clinical judgment of mental health staff, will adversely impact on the inmate’s ability to adapt to the incarceration environment. The classification system shall 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 provider of such services shall ask the inmate to give express and informed written consent, after the limits on confidentiality are explained, unless such consent is already documented. The explanation shall 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 shall be referred to a corrections mental health treatment facility in accordance with 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, Risk Assessment of Inmates in an Inpatient Setting, inpatient inmates shall 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 shall 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 shall 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 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 shall 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, shall be documented in the inmate’s medical file. Restrictions imposed under this paragraph shall 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 shall be documented in the inmate’s medical file.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.48, 945.49 FS. History–New 5-27-97, Formerly 33-40.002, Amended 3-1-11, 11-7-18.

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 that provides ongoing involuntary mental health treatment in accordance with Sections 945.40 ‒ 945.49, F.S.

(5) “Crisis Stabilization Care” means a level of care that is less restrictive and intense than care provided in a mental health treatment facility, that includes a broad range of evaluation and treatment services provided within a highly structured setting or locked residential setting, and that is intended for inmates who are experiencing acute emotional distress and who cannot be adequately evaluated and treated in a transitional care unit or infirmary isolation management room. Such treatment is also more intense than treatment provided in a transitional care unit and is devoted principally toward rapid stabilization of acute symptoms and conditions.

(6) “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.

(7) “Individualized Service Plan” – A written description of an inmate’s current problems, goals, and treatments.

(8) “Infirmary Mental Health Care” (IMH) is the first and least restrictive level of inpatient mental health care, and consists of brief admission to the institutional infirmary for patients residing in the general prison community.

(9) “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.

(10) “Inpatient Units” – Includes the Corrections Mental Health Treatment Facilities (CMHTF), Crisis Stabilization Units (CSU), and Transitional Care Units (TCU).

(11) “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.

(12) “Mental Health Care” – Mental health screening, assessment, evaluation, treatment, or services that are delivered in inpatient or outpatient settings by mental health staff.

(13) “Mentally Ill” means 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 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.

(14) “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 service plan, as needed.

(15) “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.

(16) “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 service plans.

(17) “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 such as group and individual therapy, activity therapy, recreational therapy, and psychotropic medications in the context of a structured residential setting. Transitional mental health care is indicated for a person with chronic or residual symptomatology who does not require crisis stabilization care or acute psychiatric care, but whose impairment in functioning nevertheless renders him or her incapable of adjusting satisfactorily within the general inmate population.

(18) “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.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.42, 945.49 FS. History–New 5-27-97, Formerly 33-40.003, Amended 10-19-03, 3-1-11, 11-7-18, 2-10-22.

33-404.106 Admission to Infirmary Mental Health Care, Transitional Care, or Crisis Stabilization.

(1) The right to refuse health care is inherent for all inmates committed to the custody of the department, except in cases in which refusal of care poses a serious threat to the inmate’s health or safety or the health or safety of other inmates or staff.

(2) Admission to infirmary mental health care, crisis stabilization, or transitional care may not be refused.

(3) An inmate’s refusal of evaluation or treatment and all observations and assessments regarding the refusal shall be properly documented in the inmate’s health record.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.48, 945.49 FS. History–New 5-27-97, Formerly 33-40.006, Amended 3-1-11.

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.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.49 FS. History–New 5-27-97, Amended 7-9-98, Formerly 33-40.008, Amended 7-9-12, 11-7-18, 11-12-24.

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.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.49 FS. History–New 11-7-18, Amended 2-10-22.

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 treatment of inmates who have a mental disorder 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) Suwannee Correctional Institution (males);

(c) Reception and Medical Center (males); and,

(d) Florida Women’s Reception Center (females).

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.41, 945.42, 945.49 FS. History–New 11-3-85, Formerly 33-23.01, Amended 10-9-96, Formerly 33-23.001, Amended 10-19-03, 3-1-11, 10-6-14, 12-22-15, 7-27-16.

33-404.2095 Placement in Mental Health Treatment Facilities.

(1) An inmate shall be considered for placement in a corrections mental health treatment facility when he or she is in need of care and treatment as defined in Section 945.42, F.S.

(2) Placement in a corrections mental health treatment facility can only be made from a crisis stabilization unit and, except for emergencies as described in Rule 33-404.2096, F.A.C., all placements must be accompanied by a court order obtained in accordance with Section 945.43, F.S.

(3) The warden of the institution in which the crisis stabilization unit is housed shall recommend placement of an inmate in a corrections mental health treatment facility in accordance with Section 945.43, F.S.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.43 FS. History–New 3-1-11.

33-404.2096 Emergency Placement in Mental Health Treatment Facilities.

An inmate who has a mental disorder and is in immediate need of care and treatment as defined in Section 945.42(5), F.S., that cannot be provided at the institution where the inmate is currently housed may be placed in a corrections mental health treatment facility in accordance with Section 945.44, F.S.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.44 FS. History–New 3-1-11.

33-404.2097 Discharge from Mental Health Treatment Facilities.

When an inmate is no longer in need of care and treatment as defined in Section 945.42(6), F.S., he or she shall be discharged from a corrections mental health treatment facility to a transitional care unit for at least thirty days prior to being transferred to a less restrictive setting.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.47 FS. History–New 3-1-11.

33-404.2098 Continued Placement in Mental Health Treatment Facilities.

(1) An inmate may be retained in a corrections mental health treatment facility if he or she has a mental disorder and continues to be in need of care and treatment as defined in Section 945.42(6), F.S.

(2) In accordance with Section 945.45, F.S., the warden of the institution where the corrections mental health treatment facility is located shall file a petition with the Division of Administrative Hearings for an order authorizing continued placement of an inmate in the facility prior to the expiration of the period during which the facility is authorized to retain the inmate.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.45 FS. History–New 3-1-11.

33-404.210 Corrections Mental Health Treatment Facilities – Consent to Treatment.

(1) Before treatment is initiated within a corrections mental health treatment facility as defined in Rule 33-404.103, F.A.C., the inmate shall be asked to give express and informed written consent for such treatment in accordance with Section 945.48, F.S.

(2) If the inmate is placed in a corrections mental health treatment facility by order of a court and refuses treatment deemed necessary for the appropriate care and safety of the inmate or others, the warden shall petition the circuit court serving the county in which the corrections mental health treatment facility is located for an order authorizing the treatment of the inmate in accordance with Section 945.48, F.S.

(3) When the consent of the inmate cannot be obtained, the warden or designee, with the concurrence of the inmate’s attending physician, may authorize emergency surgical or non-psychiatric medical treatment if such treatment is deemed lifesaving or if there is a situation threatening serious bodily harm to the inmate.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.48 FS. History–New 4-30-91, Formerly 33-23.026, Amended 3-1-11.