Table of Contents
Key Points
- California has several involuntary treatment laws to treat people struggling with mental health disorders.
- The California Welfare and Institutions Hold 5150 is the most common, which is a 72-hour hold for people who may be a risk to themselves or others.
- The California Welfare and Institutions Code 5250 can extend the 72-hour hold to 14 days if the person hasn’t become stabilized during their detention.
- The California Welfare and Institutions Code 5270.15 provides intensive treatment for people who haven’t been stabilized during their 14-day period.
- The CARE Court legislation offers resources for people struggling with serious mental illnesses at the request of family and other parties.
California has several laws regarding involuntary treatment detention for people struggling with mental health disorders. The 5150 hold is the best known, which allows a 72-hour hold for people who may be a risk to themselves or others because of a mental illness, but there are circumstances that may warrant longer periods of detention – up to 30 days.
Learn more about the involuntary treatment hold laws in California and the changes for mental health care under the governor’s CARE Court legislation.
Involuntary Treatment Laws in California: Welfare and Institutions Hold 5150 For Involuntary Treatment
The California Welfare and Institutions Code Section 5150, which is also known as a 5150 hold, allows for the involuntary detention of an adult experiencing a mental health crisis.[1] Under a 5150 hold, mental health professionals and law enforcement officers can admit a person if they are determined to be a danger to themselves or others or gravely disabled.
The 5150 hold can last up to 72 hours. During this hold, the person will be evaluated by facility staff and may receive mental health treatment. The person can be released prior to the 72 hours if the staff determines they are stabilized and no longer a risk. After this judgment has been made, the person can’t be forced to continue receiving treatment or medication. If the 72-hour hold expires, but the person is still deemed a danger to themselves or others, they can be held longer.
The 72-hour timeframe does not include weekends or holidays. The person can submit a request to be treated at a different facility or by a mental health professional of their choice, but the hospital doesn’t have to comply.
California Welfare and Institutions Code 5250: Extended Involuntary Treatment Hold
If the 72-hour hold has expired with a 5150 hold, and a person is still considered a danger to themselves or others, California Welfare and Institutions Code 5250 can be implemented to hold the person for another 14 days.[2]
Unlike the 5150 hold, a 5250 hold requires a court hearing, which typically takes place at the hospital. The person is provided legal counsel, and a court officer examines the evidence to make a judgment on their case. If they determine the person requires a 5250 hold, they can be detained in a hospital for a full 14 days and only released if they’re stabilized and no longer seen as a threat to themselves or others or if they agree to receive voluntary mental health treatment.
California Welfare and Institutions Code 5270.15: Intensive Involuntary Treatment Hold
After the 14-day period of intensive treatment with a 5250 hold, if the person is still seen as gravely disabled as the result of a mental disorder or impaired from “chronic alcoholism” (alcohol use disorder) and unwilling or unable to accept voluntary treatment, they may be certified for another period of intensive treatment of not more than 30 days under the California Welfare and Institutions Code 5270.15.[3]
Like a 5250 hold, the person will receive a certification review hearing to determine if they require an extended intensive hold. If they are determined to require a 5270.15 hold, they can be detained for no more than 30 days. They will be evaluated every 10 days by the court and treating staff to determine if they continue to meet the criteria for a temporary hold and monitor their progress. Once the 30 days is complete, they are free to leave.
California CARE Court
In September 2022, California Governor Gavin Newsom enacted the Community Assistance, Recovery, and Empowerment (CARE) Court. This is an attempt to compel people with untreated schizophrenia and other severe mental illnesses into housing and treatment.
Under the CARE Court framework, family, close friends, first responders, and behavioral health workers will be able to submit a petition to the court, signed under penalty of perjury, on behalf of a person with untreated schizophrenia spectrum or other psychotic disorders to indicate that they are a threat to themselves or others or may be unable to survive safely without support or supervision.[4] The petition must also have an affidavit from a licensed healthcare professional who examined them or proof that they were detained under intensive treatment.
The court will then order an evaluation of the person to see if they qualify for CARE Court. If they do, they will have an advocate, care plan with recommended treatment, medication, and housing, and legal counsel. Medication can be court-ordered, but they can refuse to take it. The person will need to attend court hearings over 12 months to ensure they’re adhering to the plan.
Once the treatment program is complete, they can elect to receive another year of treatment or graduate. If they fail to complete their treatment, they could be considered for conservatorship.
To be eligible for CARE Court, the person must:[5]
- Be 18 years or older,
- Have a diagnosis of schizophrenia spectrum or other psychotic disorder,
- Be currently experiencing a mental illness that is severe and affects their behavior enough to affect their activities of daily living and impacts their ability to function independently without treatment, support, and rehabilitation,
- Not currently clinically stabilized in a voluntary treatment program,
- Either unlikely to survive safely in the community without supervision with a deteriorating condition, or
- In need of services and support in order to prevent a relapse or deterioration that would result in disability or serious harm to themselves or others, as defined by Section 5150,
- CARE Court would be the least restrictive alternative to ensure the person’s recovery and stability,
- Likely to benefit from participation.
Certain conditions aren’t eligible, including:
- Serious mental illnesses outside of the psychotic disorder class, such as bipolar disorder, major depression, and post-traumatic stress disorder.
- Psychotic disorders due to medical conditions like autism, dementia, or traumatic brain injury.
- Substance use disorder that does not otherwise meet the definition of a psychotic disorder.
After much resistance, the pilot counties of San Francisco, San Diego, Orange, Riverside, Stanislaus, Tuolumne, and Glenn have to establish new courts by October 1, 2023. The remaining 51 counties have until December 2024.
What Are the Next Steps?
Though California has a few different laws to balance the need for treatment and the protection of individual rights, there are still opportunities for people to fall through the cracks. The landscape of mental health care is also changing in California under the CARE Court. It’s always better to seek voluntary treatment for mental health care instead of navigating the legal issues with an involuntary psychiatric hold. If you or a loved one is struggling with a mental health disorder, it’s crucial to take preventative steps to get the treatment you need and find a healthier path forward.
Frequently Asked Questions Involuntary Treatment Laws in California
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