Navigating Mental Health Emergencies, Involuntary Holds, and Conservatorship
Kaitlyn (Kait) Oudt
Employee Benefits Specialist providing group benefits analysis & consultation to insurance professionals ? Mental Health Guru ? Digital Media Specialist, Content Creator, Strategist
In the realm of mental health, there are topics that seldom surface in everyday conversations. Among these are mental health hospitalizations, involuntary holds, and various types of conservatorship. These topics still carry a great deal of stigma in today's evolving mental & behavioral health climate. Let's talk about it.
Today, we'll be covering:
If you or someone close to you is experiencing a crisis due to a mental health challenge and may be a danger to themselves or others, you should call 988 or 911. Always?call 911 first?if you or someone you love is experiencing a life-threatening medical emergency or may be a danger to someone else. If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the 988 Lifeline network is available 24/7 across the United States.
DHCS collects data on a quarterly basis from each county on the number of involuntary detentions that occurred. In the California Involuntary Detentions Data Report for the 2020 - 2021 fiscal year, California reported the following:
When assessing California jails:
These numbers do not reflect data limitations.
Involuntary Treatment Information
First, it's important to understand what an involuntary hold is and why someone would be considered for involuntary mental health treatment. There are three key reasons someone can be considered for an involuntary hold:
There are several types of involuntary mental health holds in California. The most common is a 72-hour hold, often referred to as a 5150. If an individual requires additional treatment time or care, treating providers and state officials may consider lengthier holds to care for the patient in question adequately. We'll get into 5250, 5260, 5270.15, 5300 et al., and temporary conservatorship later.
What is a 72-hour hold or "5150"?
"5150" is the number of the section of the Welfare and Institutions Code, which allows an adult who is experiencing a mental health crisis to be involuntarily detained for a 72-hour psychiatric hospitalization when evaluated to be a danger to others or to himself or herself or gravely disabled.
In California, only specific professionals are authorized to initiate a 72-hour hold. These individuals can include police officers, members of mobile crisis teams, or other county-authorized mental health professionals. For someone to be placed on a 72-hour hold, one of three conditions must be met due to a mental disorder: the individual poses a danger to themselves, poses a danger to others, or is gravely disabled and unable to meet basic personal needs like food, clothing, or shelter.
What happens at the beginning of a 5150?
When someone is placed on a 72-hour hold, they must be informed of their rights. The responsible authority or facility must document the situation, detailing how the individual's condition came to their attention, the probable cause for believing the individual is a danger or gravely disabled, and the specific facts supporting this probable cause. General statements without factual backing are not adequate.
According to the LPS Act, when a person is taken into custody:
... [They] shall be provided, by the person who takes him or her into custody, the following information orally in a language or modality accessible to the person. If the person cannot understand an oral advisement, the information shall be provided in writing. The information shall be in substantially the following form:
My name is [name of professional]. I am a [peace officer/mental health professional] with [name of agency]. You are not under criminal arrest, but I am taking you for an examination by mental health professionals at [name of facility]. You will be told your rights by the mental health staff.
What happens during an involuntary hold?
When an individual is detained for up to 72 hours, the emergency facility or hospital completes a comprehensive evaluation of that person's overall well-being. This includes evaluating their medical, psychological, educational, social, financial, and legal conditions.
Upon review, if medical staff believes that a psychiatric hold is unnecessary and the patient no longer needs evaluation, they have the authority to release the individual before 72 hours have elapsed.
Once the 72-hour mark hits, one of three things must happen:
Extended Involuntary Holds
What's a "5250" or 14-day Certification for Intensive Treatment?
A "5250" is a 14-day certification for Intensive Treatment. If a patient is detained for 72 hours and has received an evaluation, they may be certified for no more than 14 days of intensive treatment related to a mental disorder or an impairment by chronic alcoholism under the following conditions:
If a patient is kept in the hospital for more than 72 hours, they have the right to choose to stay at the hospital for voluntary treatment. If the patient does not want to stay voluntarily, the facility must hold a certification review hearing within four days after the end of the 72-hour hold. During this hearing, the facility must provide evidence of why the patient requires additional treatment.
The patient has the option to seek assistance from a patients' rights advocate to explain why they believe there is no need for a further hospital stay. A hearing officer, court-appointed commissioner, or referee will determine whether there is probable cause to keep the patient involuntarily for 14 days. If they decide to hold the patient and the patient disagrees with the decision, they have the right to request a writ of Habeas Corpus and have a hearing in the county's Superior Court where they are being held. If the hearing officer determines that there is no probable cause to hold the patient, the patient can choose to stay in the hospital voluntarily.
Are there additional holds that can be carried out after a 5250?
Yes, there are several additional involuntary holds that can be executed after a 5150 and 5250. Additional levels of intensive treatment are dedicated to patients who are gravely disabled or who have threatened, attempted, or carried out self-harm during their hospitalization.
"5260" or Re-Certification for Intensive Treatment
If, during the initial 14-day certification period, a patient attempts or threatens to take their own life or continues to be at risk for doing so, the person's doctor may extend the hold for an additional 14 days. This is called re-certification or "5260". Patients have the right to request a writ of habeas corpus; however no hearing will take place for this extended hold. This recertification relates to Welfare and Institutions Code Section 5260.
Additional 30-Day Hold or "5270.15"
In some counties, after completing a 14-day treatment, individuals may be required to stay for an additional 30 days if their doctor determines that they are still gravely disabled and unwilling to accept voluntary treatment. During this period, a certification hearing will be scheduled automatically. Patients have the right to have a patients' rights advocate assist them at the hearing, and they can also request a writ of habeas corpus at any time with the support of a patients' rights advocate or attorney. The name "5270.15" comes from Welfare and Institutions Code Section 5270.15.
Post Certification for Dangerousness or "5300 et. al."
If, at the end of a 14-day certification period, there is sufficient reason to believe that someone poses a danger to others due to a mental disorder, the individual in charge of the facility may petition the court to require the patient to remain at the facility for further treatment. This treatment is not to exceed 180 days. The individual has the right to be represented by an attorney and to a jury trial. "5300 et.al." comes from Welfare and Institutions Code Section 5300 et. al.
Temporary Conservatorship or "5352.1"
If someone in charge of the facility where a person is staying believes that an individual may benefit from the services of a conservator because they remain gravely disabled, they may be placed on temporary conservatorship (T-con) for up to 30 days. At the end of 30 days, a hearing will be held to determine whether the individual remains gravely disabled and whether a one-year conservatorship will be necessary. An advocate or attorney can assist with the conservatorship hearing process. The name "5352.1" comes from Welfare and Institutions Code Section 5352.1
Navigating an Involuntary Hold: Guidance for Patients + Family Members
?? Looking for help navigating a mental health crisis? We recently discussed how to navigate a mental health emergency & what to expect. You can read the article here.
Navigating an involuntary hold can be an emotional and confusing process for the hospitalized individual and their loved ones. It's important that patients and their families understand Patients' rights and have a clear line of sight on how the process works, what laws and regulations are in place, and what to do when a crisis situation occurs.
We've included a detailed list of Patients' Rights in the section below. This is a helpful point of reference to keep for the future. Please note that the State of California may change these rights at any time.
You can download Orange County Health Care Agency's guide here. This is a guide for family members and loved ones. NAMI also has a helpful FAQ and quick guide that offers a different perspective and can provide additional insight.
The Family Education & Resource Center also has a helpful 5150 Family Tips Brochure that provides helpful insight for families navigating an involuntary hold.
Confidentiality + Privacy
When a loved one is hospitalized, it's normal to feel worried and want the latest updates or to provide helpful information to the medical staff. However, it's important to understand that adults (18+) have confidentiality rights that protect their privacy. This means the hospital needs your loved one's permission to contact you or share information about their condition. They must authorize the facility to involve you in their care before any information can be disclosed.
To receive information about your loved one's medical case, they need to sign a Release of Information (ROI) form. This form must be filled out for each hospital admission. The hospital will have an ROI form available and will add the completed forms to your loved one's file.
?? Click here for a sample ROI form from FERC. Note that this form might differ from the one used by the hospital where your loved one is admitted.
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AB 1424 Form for Families
AB 1424 is a California law that requires decision-makers involved in involuntary treatment to consider historical information provided by family members. This information is recorded on a form, which is then included in the patient's mental health record. According to state and federal law, patients have the right to access their records. Family members who provide this information can also withdraw their consent to ensure the confidentiality of the information, as stated in Welfare & Institutions Code 5328(b).
Filling out the AB 1424 Historical Information Form is the most effective way to ensure that your insights about your loved one's condition are taken into consideration by their treatment team. It is recommended to complete this form in advance, keep it updated, and have additional copies available for sharing with law enforcement or other professionals in response to a 5150 situation. The form was developed through collaboration among Alameda County Behavioral Health Care Services, the Alameda County Family Coalition, family members, mental health consumers, providers, patients' rights advocates, and the judicial system. There is also a shorter Family Input Form available.
What is law AB 1194?
There's an important legal update for families to be aware of, known as AB 1194. This new legislation removes the necessity for "imminent" danger to oneself or others as a requirement for 5150 eligibility. This change means that families no longer have to wait until they witness someone harming themselves or others before seeking help. Furthermore, the updated law requires the LPS 5150 application to note whether the individual's mental health history was considered when establishing probable cause.
What is law AB 1152?
SB 1152 requires hospitals to update their discharge policies to better support homeless patients as they transition back into the community. This includes helping them find a place to go after leaving the hospital and prioritizing sheltered locations with supportive services. Before discharging a homeless patient, hospitals must complete and document a checklist of actions, such as offering a meal, screening for infectious diseases, providing weather-appropriate clothing, and arranging transportation within a 30-mile radius. In addition, hospitals must have a written plan for coordinating services and referrals with the county behavioral health agency, regional health care and social services agencies, health care providers, and nonprofit organizations. Hospitals are also required to keep a record of discharged homeless patients and where they go after being discharged.
What is a Certification Review Hearing
A Certification Review Hearing is commonly referred to as a Probable Cause Hearing. It is an informal evaluation conducted at the hospital to assess whether legitimate reasons exist to keep an individual in the hospital. During this hearing, a designated officer reviews the individual's status to determine if they still pose a risk to themselves or others or are severely impaired due to a mental illness. If it is found that there are no valid reasons to keep the person in the hospital, the officer has the authority to release them immediately. However, if there are legitimate reasons, the officer can extend the individual's stay in the hospital by up to fourteen days based on the psychiatrist's recommendation.
LPS Designated Facilities
County-designated LPS facilities are mental health treatment facilities that are designated by the county for evaluation and treatment, approved by the State Department of Health Care Services, and licensed as a health facility as defined in subdivision (a) or (b) of Section 1250 or 1250.2 of the Health and Safety Code or is certified by the State Department of Health Care Services to provide mental health treatment. This is the County of Orange?HCA BHS LPS Designated & Non-Designated Facilities list.
For a broader list of LPS Designated facilities in California, these are helpful resources to reference:
When a specified professional plans to carry out a 72-hour evaluation, they complete an Application for Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment (5150/5585 Involuntary Hold).
Rights for Individuals in Mental Health Facilities
Understanding patient rights is an important aspect of mental health hospitalizations. The DHCS Handbook is a helpful resource for understanding the rights for individuals in mental health facilities. These apply to patients who are receiving voluntary or involuntary mental health services at — a state hospital, acute psychiatric hospital, psychiatric unit of a general acute care hospital, skilled nursing facility, special treatment program, licensed group home, adult residential facility, social rehabilitation facility, licensed family home, adult day care facility, psychiatric health facility, mental health rehabilitation center, community treatment facility, or 23-hour treatment facility.
Understanding patient rights is important for family members and loved ones involved in the hold or hospitalization process. By knowing these rights, family members can help ensure that their hospitalized loved one is treated fairly.
Tables reflect the rights & policies outlined in the DHS handbook:
County Patients’ Rights Advocate Contact Information — If you are unable to reach your patients’ rights advocate, contact:
Involuntary Detention Policies + Procedures
The Lanterman-Petris-Short (LPS) Act, enacted in 1967, reforms mental health care and protects individual rights. It aims to end unjust commitment, ensure prompt evaluation and treatment, uphold public safety while safeguarding individual liberties through judicial review, provide personalized treatment and supervision, utilize resources efficiently, protect against criminal acts, and establish consistent standards for services in the least restrictive setting. By prioritizing these objectives, the LPS Act establishes a comprehensive and rights-focused approach to mental health care, ensuring dignity, safety, and tailored support for individuals in need.
Are you ready to explore some of California's state policies to understand our state laws better? These documents were primarily created to provide guidance to healthcare professionals and law enforcement involved in involuntary detentions and mental health assessments. Reviewing these documents can offer clarity on the different aspects of these evaluations.
While these documents are the most current provided by OC Health Care Agency, it's important to note that laws change from time to time. Please always check for accuracy by referring to state & local government resources for the latest version of the documents. There are also a couple of resources for learning more about the history of the Act. You can learn more about the history and act by reading:
Understanding Conservatorship
Conservatorship is a significant legal arrangement that involves a court hearing with all relevant parties. When a conservatorship is established, the individual, known as the conservatee, loses many civil rights that most people take for granted. This can include the right to choose where to live, what medical treatments to accept or refuse, and how to manage their own finances and assets. The conservator, who takes over these responsibilities, is legally accountable to the court.
The public guardian oversees two main types of conservatorships: Lanterman-Petris-Short (LPS) Conservatorships and Probate Conservatorships.
LPS (Mental Health) Conservatorship
Legal Basis: Under the Welfare and Institutions Code, an LPS conservatorship can be appointed for someone who is gravely disabled, meaning they are unable to provide for their basic needs such as food, clothing, or shelter due to a mental disorder. This type of conservatorship can also apply to certain criminal defendants who are deemed incompetent to stand trial.
Purpose: The primary goals of an LPS conservatorship are to ensure that the conservatee receives personalized treatment, supervision, and appropriate placement, as well as to manage their financial resources effectively.
Who can be conserved?
Conservatorships are authorized by the court for adults who have been diagnosed with specific mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) and are deemed gravely disabled. Conservatorships are granted for people with:
Are there resources to help me understand LPS Conservatorship?
?? Our next newsletter will explore conservatorship and supported mental healthcare options. There's a lot to unpack about this topic!
Additional Sources:
Disclaimer: The information provided is for general informational purposes only and should not be construed as professional, medical, or legal advice. Readers should consult with appropriate professionals regarding their specific circumstances and needs. The author and any associated entities shall not be liable for any losses, injuries, or damages arising from the use of or reliance on the information provided in this article. By accessing and reading this article, you agree to release the author and any associated entities from any and all liability.