5150 is the number in the Welfare and Institutions Code that allows an adult in a mental health crisis to be involuntarily detained for up to 72 hours.
In the state of California, a 5150 hold refers to an involuntary mental health hold. These holds are for individuals who are actively suicidal, homicidal, or gravely disabled.
What Is a 5150 Hold In California?
A 5150 hold refers to a brief period of acute stabilization. When someone is held involuntarily, it is because they are perceived to be a danger to themselves or others. The intent is to keep them safe and monitored until the most severe symptoms pass.
A person meets the criteria for an involuntary hold if they meet one of the following conditions:
Danger to Self
There are significant differences between passive suicidal ideation and active suicidal ideation. Passive ideation is common and can sound like, I hope I don't wake up tomorrow. I'd be better off dead. Active ideation entails actual plans to engage in suicide. If someone has the intent, plan, and means to harm themselves, they meet the criteria for a 5150 hold.
Danger to Others
Danger to others means there is reasonable cause that a person will significantly harm someone else. The threat must be imminent and intentional. Someone who is a danger to others usually meets the criteria for a specific mental illness, such as bipolar disorder, schizophrenia, or an acute substance use disorder.
Grave Disability
Grave disability refers to the inability to care for one's physical or mental health. If someone is gravely disabled, they cannot eat, wash themselves, or function appropriately without basic assistance. Grave disability can be a symptom of severe mental illness. To meet the criteria for a 5150 hold, the grave disability impairs nearly all areas of daily living.
Who Can Initiate a 5150 Hold?
It's important to understand how the prospects of an involuntary psychiatric hold can impact confidentiality. Many patients, for instance, worry about their therapists breaching their trust.
Every mental health professional in California is considered a mandated reporter. That means they legally must breach confidentiality if they have probable cause that someone is at risk of taking their own life (or taking someone else's).
According to California law, both mental health professionals and police officers can initiate a 5150 hold. These laws are not meant to harm or discourage people from telling the truth. Instead, the system of involuntary hospitalization is designed to ensure people get the crisis intervention and mental health treatment needed to be safe.
History of Involuntary Holds
Treating mental illness isn't easy, and our society hasn't always considered a patient's rights or dignity when providing psychiatric care. Unfortunately, even mental health professionals argue about the best approaches for psychiatric emergencies.
Psychiatric hospitals date back to the mid-1800s. The government wanted to provide safe housing and food for those in acute distress. Their efforts were the first movement toward the inpatient care model.
Unfortunately, the average mental health facility was not up to standard. Most facilities were significantly underfunded and understaffed. By current standards, they were downright inhumane (and are now often known as asylums).
By the 1950s, there were greater efforts to treat mental illness humanely. We made significant breakthroughs with psychiatric medication. This new medical care provided symptom relief while also encouraging emotional well-being. As health care services continued advancing, there became more of a shift away from long-term, inpatient setting care and more community-based living.
Involuntary Treatment Vs. Voluntary Treatment
Many people think about involuntary detention when they hear about a 5150. But you have the right to voluntarily admit yourself into a hospital setting if you feel concerned about your emotional state or recognize you're in an acute mental health crisis. Every state department has different laws regarding voluntary patient admission and status.
What Kind of Mental Health Treatment Will You Receive?
The first stage of a 5150 hold is a thorough psychiatric evaluation. A qualified mental health staff will complete an assessment overviewing one's medical and psychiatric history. These assessments are not always straightforward, particularly if the patient is under the influence or in an active state of psychosis.
The designated facility will provide food, clothing, and other essentials. Patients are not permitted to bring in outside belongings. They also do not generally have access to speak to family members (except for specific exceptions) during this time.
During their hospital admission, patients meet with various mental health professionals, including psychiatrists, therapists, doctors, and registered nurses.
How Long Is a 5150 Hold?
The standard length of a 5150 psychiatric hold is 72 hours. The law states that a person detained can be held involuntarily for up to 72 hours. That said, not all patients receive that long of an emergency hold.
If someone continues to meet the criteria for an involuntary hold, the attending psychiatrist will assess the need for a 5250. A 5250 has the same services as a 5150, but the intensive psychiatric treatment lasts for up to two weeks. 14 days is the maximum limit, and patients will continue to be closely monitored and assessed for safety during this time.
What Legal Rights Do You Have During a Psychiatric Hold?
All hospital patients receive an automatic hearing during their stay. This is also known as a certification review hearing, and it is a legal right for all patients. During this meeting, a patient's rights advocate can speak on the patient's behalf.
Although it's an informal hearing, they support determining whether it is necessary to keep someone hospitalized. The attending hearing officer ultimately makes the final decision. If the patient no longer meets the criteria for a 5150 hold, they will be released. If there are still concerns about suicide or imminent violent behavior, the hearing officer may request the attending psychiatrist to assign a 5250.
What Happens After You're Released?
A 5150 hold provides acute mental health services. Although patients receive evaluation and treatment, such acute crisis intervention is not a substitute for long-term psychiatric care. For this reason, post-discharge planning is an important part of any 5150 hold.
Many patients then transition into other long-term treatment settings like:
inpatient mental health care
partial hospitalization programs for mental illness
outpatient treatment
transitional mental health housing services
What Should Loved Ones Do During This Time?
Family members often feel frightened, anxious, or guilty when someone is hospitalized. They may blame themselves for not seeing the warning signs. They might be upset if this has happened in the past.
Remember that your loved one's mental health disorder isn't your fault. Empathic and trained mental health providers are there to help them feel better and reduce the likelihood of committing violent acts against themselves or others.
During this time, it may be beneficial to focus on direct action, which includes:
reviewing important boundaries you intend to set with your loved one
getting every family member on the same page
seeking support with your own mental health issues
practicing self-care
learning about your inpatient or outpatient treatment options
You may have rights to view various treatment records and receive progress updates. This all depends on how your loved one consents to share information with you.
Minors and Emergency Situations: What Parents Need to Know
If a minor person meets the criteria for a 5150 hold, they will be involuntarily held (often as a 5585 by California welfare). The time frame for this hold varies based on the child's presenting symptoms, their state of residence, and their compliance while in the hospital.
This, of course, can be terrifying for family members. But it's important to know that your child is safe and getting the support they need.
When your child leaves the hospital, it's important to review potential treatment options and ask for copies of psychiatric evaluation records. These records provide information about their diagnoses, medication, and behavior. The discharge summary will also offer helpful details regarding your child's needs.
Are 5150 Holds Actually Effective?
Psychiatric holds, by nature, are controversial. The first overarching issue is that some people report that they're intrusive and harsh.
Many patients report that they sometimes feel hesitant to be honest with healthcare providers because they worry about "getting punished." This, of course, makes sense, especially if they've had a long historical course with hospitalization.
Others feel that a psychiatric facility, by nature, is inhumane. It's hard to feel safe being vulnerable when held against one's will.
That said, no mental health treatment is perfect. These are the laws we currently coexist with, and it's important that individuals and their loved ones aim to do their best within these parameters.
How We Help Treat Mental Illness
The reality is that many patients leave the hospital without knowing where to turn. They may be medically stable, but they aren't able to adequately take care of themselves or manage the responsibilities of daily life.
This in-between time can be potentially dangerous. Family members may not be ready to take their loved one back in. At the same time, entering another inpatient or formal treatment facility might not be the best course of action- particularly if the individual is unmotivated or has important responsibilities.
At Resurface Group, we bridge the gap between an acute hospital setting and independent living. We recognize that there needs to be more treatment options focused on giving patients autonomy and agency. We also understand the need for appropriate and safe housing.
Our qualified staff provides the structured support your loved one needs after being in a psychiatric hospital. Contact us today to learn more.