As challenges associated with mental and behavioral health illnesses increase, physicians should review available options when they suspect a patient may be a danger to themselves or to others so they can provide timely and appropriate care, not violate citizen/patient rights, and reduce professional and legal liability exposure for themselves.
All fifty states and the District of Columbia allow emergency holds to be placed on anyone who is a danger to themselves or others. While most laws specify that the danger must be due to mental illness, others do not. Generally, it must be shown that the threat is imminent and that the patient has the means and the plan to carry it out.1
In California, Welfare and Institutions Code 5150 establishes the conditions under which an adult who “as a result of a mental disorder is a danger to others or himself or herself, or gravely disabled,” may be detained for a 72-hour evaluation and treatment—involuntary detention or “5150 hold”.* 5150 falls under the broader California Lanterman-Petris Short Act2 which authorizes involuntary psychiatric treatment in very limited circumstances. Persons suffering from Alzheimer’s disease, brain injuries, or other organic brain disorders may be eligible for evaluation and treatment under 5150. A person may also be considered gravely disabled if they are debilitated by being under the influence of alcohol or controlled substances (as distinguished from a routine police arrest for intoxication) and may be detained for a period of 72 hours.3
Most physicians are not able or qualified to initiate and execute a 5150 involuntary hold on a person/patient. There are specific individuals, identified by statute, who can determine if a person/patient qualifies for 5150 detention. Detaining a patient under the 5150 statute when the healthcare provider is not designated or qualified to do so could lead to liability consequences for the healthcare provider, possibly resulting in allegations of false imprisonment.
Under 5150, only the following individuals or “professional persons” are qualified to execute a 5150 hold:
A peace officer
A professional person in charge of a county-designated evaluation and treatment facility (approved by the county Department Healthcare Services) or mobile crisis team
Other professional persons designated by the specific California county
There is a specific process which must be followed by professional persons processing a 5150 hold which includes: (1) assessing the patient to determine if they can receive voluntary treatment or must be detained as they are a danger to themselves, others, or are gravely disabled; (2) applying to the designated facility indicating the circumstances of the hold; (3) transporting the patient to the designated facility by ambulance or police car; (4) providing the person with pertinent information related to the 5150 hold; and (5) creating a medical record to document pertinent information, including the name of the professional person taking the patient into custody.4
While in an involuntary hold, the patient has the right to refuse medical treatment or treatment with medications, including antipsychotic medications, except in an emergency.
As a side note, persons who undergo a 5150 hold are prohibited from possessing or purchasing firearms for a five-year period. Persons who undergo two 5150 involuntary holds within a twelve-month period are prohibited, indefinitely, from access to firearms.
At the expiration of the 72-hour detention period, the patient may be:
Released or discharged if it is determined the patient is not a danger to self or others
Admitted to the facility as a voluntary patient
Certified by a qualified individual for additional 14 days of intensive treatment or “5250 hold” if certain criteria are met5
When faced with the prospect that a patient does not qualify for a 5150 hold, a provider may still be concerned about the welfare of a patient and the need for the patient to acknowledge they need professional help. The physician should encourage the patient to undergo mental and behavioral health treatment voluntarily. In this instance, it is important for the provider to be aware of mental and behavioral health resources in the county where they practice to make these resources available to patients while counseling and encouraging them to seek treatment. The provider may also enlist the aid of the patient’s support system to facilitate the patient’s engagement with appropriate mental, behavioral, and substance abuse resources and treatment options. A California county by county resource guide is included in the notes of this article.6
In summary:
Become familiar with provisions of 5150 involuntary holds and who is qualified to initiate and execute a 5150 hold
Stay within boundaries and do not exceed your scope of practice by attempting to execute an involuntary hold on a patient, as it could have serious implications for the patient and legal and liability consequences for you
Identify the facilities in your county that are officially designated as 5150 hold facilities
Identify and become familiar with mental, behavioral, and substance abuse resources in your county to assist patients with voluntary access to appropriate expertise, support, care, and treatment
Bradford Dunkin is Assistant Vice President, Risk Management and Patient Safety, CAP. Questions or comments related to this article should be directed to BDunkin@CAPphysicians.com.
* Section 5585 of the Welfare and Institutions Code under California State Law allows a minor (under 18) 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.
1What Is a 5150 Hold? 72-Hour Holds From a Nursing Perspective, Kirsten Slyter, 01/03/22
2Lanterman-Petris Short Act: https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80%93Short_Ac…, accessed 03/16/23
3, 4Mental Health: 51 Holds/72 Hour Detention, Document #3109, CMA Legal Counsel, California Medical Association, July 2022
5Rights for Individuals In Mental Health Facilities Admitted Under the Lanterman-Petris Short Act, Rights for Individuals In Mental Health Facilities.pdf, accessed 03/16/23
6California Mental Health Resources-Important Resources by County, Important Resources By County _ California Mental Health Resources.pdf, accessed 03/16/23
Arrested under a 5150 California Welfare & Institutions Code, Ivan Morse, former Oakland Police Officer, presently, Criminal Defense Attorney, Arrested under a 5150 California Welfare & Institutions Code - HG.org.pdf, accessed 03/16/23
Mental Health Holds, Mental Health Holds - BulletPoints Project.pdf, accessed 03/16/23