5150 (Involuntary Psychiatric Hold) - The Process

The Process

The 5150 hold may be written out on Form MH 302, Application for 72 Hour Detention for Evaluation and Treatment.

The Los Angeles County Department of Mental Health (LACDMH) has provided manuals that cover process and procedure for the implementation of WIC 5150-5157. In a recent version of the LACDMH LPS Training Manual, it is stated that: A 5150, or 72-hour hold, is a means by which someone who is in serious need of mental health treatment can be transported to a designated psychiatric inpatient facility for evaluation and treatment for up to 72-hours against their will. (page 5) While this is one protocol enabled by WIC 5150-5157, it is certainly not the only scenario in which an individual may be detained. Persons can and have been subject to a 72-hour hold who have not been transported in custody to a designated facility. Further, Welfare and Institutions Code (WIC) 5150 is interpreted by the LACDMH LPS Designation Handbook (page 5), as ... an application for involuntary admission. According to this interpretation, WIC 5150 is not ... a direct admission form and does not of itself authorize the involuntary admission; it merely gets the individual to the door. Then, as described in WIC 5151: Prior to admitting a person to the facility, the professional person in charge of the facility or his or her designee shall assess the individual in person to determine the appropriateness of the involuntary detention (face to face assessment). (page 5) This could be interpreted as specifying a required time line consisting of the WIC 5150 application first followed by WIC 5151. This would seem to be consistent with paragraph #2 of WIC 5151, which states that: Prior to admitting a person to the facility for 72-hour treatment and evaluation pursuant to Section 5150, the professional person in charge of the facility or his or her designee shall assess the individual in person to determine the appropriateness of the involuntary detention. This time line is not, however, always practiced by the staff of designated LACDMH facilities. If the individual is physically present at the facility, but is not in legal custody, in the sense that no WIC 5150 legal status exists, this individual is nonetheless considered to be at ...the door.... Both the interview to determine probable cause for the purposes of the application in writing, and also the assessment required by WIC 5151, can then be executed simultaneously and documented on the same form, namely MH 302. This practice then creates two classes of individuals, one class for which the assessment required by WIC 5151 is executed whilst a legal state of involuntary detention already exists, and a second class for which this assessment is done while the individual, not yet in legal custody, still retains liberty. The legality of performing the face to face assessment required by WIC 5151 on individuals for whom ...the involuntary detention ... does not exist, remains to be tested. Note that Form MH 302 contains no specific language pertaining to documentation of WIC 5151.

The LPS Handbook fails to mention that Section 5150 is not intended to be used to hold a person reported to the police by a non-professional. But it does enable a police officer to detain a subject when the officer has observed the qualifying symptoms in the routine process of a response. This is commonly used to allow the officer to process a subject into the psychiatric facility without requiring criminal processing.

It can be used to hold an inebriated person in the drunk tank to be released upon sobriety with a citation issued. If there are exigent circumstances that preclude a WIC 5200 process, an officer may respond to the call, but, whenever possible, is to respond in an unmarked car in plain clothes (WIC 5153). The unmarked car and plain clothes recommendation is routinely ignored by police agencies.

If there are no exigent circumstances, such as an immediate risk to life, then Section 5200, a judicial hold, is the proper section to follow to hold a person suspected by citizens/family of needing assessment. A pre-assessment is done by qualified mental health personnel to establish probable cause for a judge's order of 72 hour hold.

During the period of confinement, a confined individual is evaluated by a mental health professional to determine if a psychiatric admission is warranted. Confinement and evaluation usually occurs in a county mental health hospital or in a designated Emergency Department. If the individual is then admitted to a psychiatric unit, only a psychiatrist may rescind the 5150 and allow the person to either remain voluntarily or be discharged.

On or previous to the expiration of the 72 hours, the psychiatrist must assess the person to see if they still meet criteria for hospitalization. If so, the person may be offered a voluntary admission. If it is refused, then another hold for up to 14 days, the 5250 (WIC-5250), must be written to continue the involuntary confinement of the person. A Certification Review Hearing (W&I 5256) must occur within four days before a judge or hearing officer to determine whether probable cause exists to support the 5250. Alternatively, the person can demand a writ of habeas corpus to be filed for their release after they are certified for a 5250, and once filed, by law, the person must appear in front of a judge in two (2) days, which is two days sooner than the Certification Review Hearing. If the person demands to file a writ of habeas corpus right at the time of being given notice of certification, the Certification Review Hearing will not take place. Many patients wait to see how things go at the Certification Review Hearing first, because if the person loses at the Certification Review Hearing, he/she can then take advantage of the right to file writ of habeas corpus and end up having two hearings, instead of just one. If the 72-hour timeframe has elapsed before the person is offered a voluntary admission or placed on the 5250 hold, the person must be immediately released.

A 5150 hold written by a peace officer is valid in any county in California; therefore, a person could theoretically be moved from one county to another according to available resources. When the 5150 hold is written by a designated clinician, the hold is only valid in that county. The designated clinician is only able to write a 5150 hold while present at the facility where they work, unless they work as part of a Psychiatric mobile response team.