Education

Conditions and Treatments

The National Institute of Mental Health offers comprehensive expert-reviewed information on mental health disorders and a range of other topics.

For more information, please visit National Institute of Mental Health at https://www.nimh.nih.gov/health/topics/index.shtml

Information on Holds

Understanding Involuntary Holds

The evaluator placing the hold must deem that the behaviors resulting in the placement of the hold are due to a mental illness.

 Danger to Self (DTS)

 The patient has demonstrated threats or actions indicating the intent to commit suicide or inflict serious bodily harm on oneself.

 Danger to Others (DTO)

 The patient has made threats or demonstrated actions indicating a serious intent to cause bodily harm to another person.

 Grave Disability (GD)

 The person is unable to provide for his or her basic needs for food, clothing or shelter (WIC 5008), demonstrating an inability to care for himself or herself.

 If a person can avail themselves of food, clothing or shelter with the help of third parties, then he or she is not considered gravely disabled.

Duration of a Hold

The law requires that the evaluator breaks the hold when the patient no longer meets criteria for involuntary hospitalization. The treatment team assesses whether the patient meets hold criteria on a continual basis. This means that if a patient is on a 14 day hold or a 30 day hold, he or she will not necessarily be hospitalized for the complete duration of the hold.

5150 or 72 hour hold

5150 (and 5585) is the number of the section of the Welfare and Institutions Code, which allows for a person with a mental illness to be involuntarily detained in a psychiatric hospital for a 72 hour period. This 72 hour period is sometimes referred to as an “observation period”.

During this 72 hour period, the treatment team assesses whether the patient meets criteria for involuntary hospitalization. The law mandates that all patients must be treated in the least restrictive setting possible.

5250 or 14 day hold

If the patient continues to meet involuntary hold criteria, the psychiatrist or nurse practitioner will place the patient on a 5250, also known as a 14 day hold.

 At this point, the patient gains the right to a Probable Cause Hearing (PC Hearing). *see below for more information regarding what happens after a 5250 is written*

 Additional holds once the first 14 day hold expires if the patient continues to meet criteria for involuntary hospitalization, the treatment team may extend the hold.

•  For Danger to Self: Another 14 day hold may be placed at which time a new PC Hearing takes place.
•  For Grave Disability: A 30 day hold may be placed at which time a new PC hearing takes place.
•  For Danger to Others: A 180 day hold may be placed, and the District Attorney is contacted.

Probable Cause Hearings

If the patient continues to meet criteria for involuntary inpatient hospitalization, the psychiatrist will put the patient on a 14 day hold.

 1) The patient is assigned a patient’s rights representative who works for the county. The patient’s rights representative will meet with the patient to discuss the patient’s wishes.

•  The patient may wish to contest the hold, or
•  The patient may wish not to contest the hold.

 2) The patient and the patient’s rights officer will then attend a Probable Cause Hearing (PC Hearing). The hearing occurs in the hospital.

 The patient’s rights officer will ask the patient whether or not they wish to attend.

•  The patient may attend, or
•  The patient may choose not to attend, and instead to have the patient’s rights officer represent them at the hearing.

3) A hearing officer who works for the county will hear testimony from the hospital representative (the psychiatrist, the nurse practitioner or the social worker) and from the patient/patient’s rights representative.

 A patient’s family may be present if the patient allows. If the family is present, the hearing officer may ask the family to provide information as well.

 4) The hearing officer will determine whether the patient continues to meet LPS criteria for involuntary hold.

• If the hearing officer determines that the patient continues to meet hold criteria, the hearing officer will “uphold” the 5250. (See next cell for more information)
•  If the hearing officer determines that the patient does NOT meet hold criteria, the hearing officer will not uphold the 5250. At that point, the patient has the right to discharge from the hospital, though the treatment team may recommend to the patient to remain hospitalized on a voluntary basis.

5) If the hold is “upheld” the patient’s rights representative will explain to the patient that he or she has the right to file a writ of habeas corpus.

•  If the patient decides to “file a writ”, he or she will go to mental health court (downtown Los Angeles) and contest the 14 day hold in front of a judge, who will determine whether the patient continues to meet LPS criteria.
• The psychiatrist or nurse practitioner treating the patient in the hospital will attend the hearing and testify regarding reasons the patient continues to meet criteria for involuntary hold.
• The hospital will arrange transportation for the patient to and from the writ hearing.

6) If at the end of the 5250/14 day hold, the patient continues to meet criteria for involuntary hospitalization, the team may extend the hold.