Involuntary Evaluation and Treatment for Psychiatric Problems in California: Status and Recent Case Interpretations
California, like many other states, has established laws and regulations to protect individuals who may be suffering from severe mental health issues but are unable or unwilling to seek help voluntarily. Below we have set forth the various ways in which an individual in California can be involuntarily evaluated and treated for psychiatric problems, as well as significant case law since 2010 that has shaped these statutes.
1. Involuntary Detention and Evaluation
a. 5150 Hold (Welfare and Institutions Code Section 5150): Under this statute, a person who presents a danger to themselves or others, or is gravely disabled due to a mental disorder, may be involuntarily detained and evaluated in a designated psychiatric facility for up to 72 hours. This provision is commonly referred to as a “5150 hold.”
b. 5250 Hold (Welfare and Institutions Code Section 5250): If, after a 72-hour evaluation, it is determined that the individual continues to meet the criteria for involuntary detention and requires further treatment, a 5250 hold may be initiated. This hold allows for an additional 14 days of intensive treatment in a psychiatric facility.
What to Expect at a 5250 Hearing in California
A 5250 hearing in California refers to a legal proceeding that occurs when a person is involuntarily detained for a psychiatric hospitalization under Welfare and Institutions Code, Section 5250. This law allows for an additional 14-day involuntary hold if a person is deemed to be a danger to themselves or others due to a mental disorder or chronic alcoholism. Here’s a general overview of what a patient can expect during a 5250 hearing:
- Legal Representation: The patient has a right to be represented by a legal advocate at the hearing, often a patients’ rights advocate or an attorney. This person can help explain the process, the patient’s rights, and how to challenge the hold.
- Presentation of Evidence: The facility will present evidence justifying the 5250 hold. This typically involves testimony from the psychiatrist or other mental health professionals who have assessed the patient. They may present information about the patient’s mental status, behavior, and why they believe the patient is a danger to themselves or others.
- Patient’s Testimony: The patient also has the right to present evidence and testimony. They can speak on their own behalf, present their own witnesses, and rebut the facility’s evidence. They can explain their side of the story and why they believe they should not be held further.
- Decision by the Hearing Officer: The hearing officer, often a county-appointed official not affiliated with the hospital, will review the evidence and make a decision. If the hearing officer determines that there is probable cause to believe that the patient is a danger to themselves or others, the hold can be continued for up to 14 more days.
- Possible Outcomes: If the hold is upheld, the patient will continue to receive treatment in the hospital. If the hold is not upheld, the patient will be discharged unless the hospital takes further steps to continue the involuntary detention, such as filing for conservatorship.
- Right to Appeal: If the hearing decision is not favorable, the patient can seek a writ of habeas corpus in the Superior Court. This is a legal action where an individual can report an unlawful detention or imprisonment.
Please note that the above process can be affected by a variety of factors, including the specific circumstances of the patient’s situation, the hospital’s policies, and local laws and regulations.
c. Conservatorship (Lanterman-Petris-Short Act – LPS): In certain cases, when individuals with chronic mental health conditions are unable to care for themselves or are at risk of harm, a conservatorship may be established. A conservator, typically a family member or a designated individual, is appointed by the court to make treatment decisions on behalf of the individual.
2. Criteria and Legal Process
a. Danger to Self or Others: In order to initiate an involuntary hold, there must be a demonstrated risk that the individual poses a danger to themselves or others due to a mental disorder. This criterion is often evaluated by mental health professionals and law enforcement officers.
b. Grave Disability: An individual may also be involuntarily detained if they are found to be gravely disabled, meaning they are unable to provide for their basic needs such as food, shelter, or medical care due to a mental disorder.
c. Legal Process: In each case, a legal process is followed to ensure the rights of the individual are protected. This includes providing them with an opportunity to contest the hold, representation by an attorney, and periodic reviews of their status by a judge.
3. Relevant Case Law Since 2010
a. Lanterman-Petris-Short Act (LPS) Reform:
- Riese v. St. Mary’s Hospital (2010): This case clarified the criteria for involuntary treatment under LPS and emphasized the need for a judicial determination of an individual’s capacity to make informed treatment decisions.
- B.G. v. County of Los Angeles (2019): The court held that the “grave disability” standard could not be expanded to include individuals who were capable of surviving with the assistance of third-party support services.
b. Use of Force and Restraints:
- Pickens v. County of San Diego (2015): The court held that the use of handcuffs and restraints during an involuntary mental health detention must be based on an individualized determination of necessity rather than a blanket policy.
- Duran v. City of Douglas (2018): The court ruled that excessive use of force against an individual with mental illness during an involuntary detention violated their constitutional rights.
c. Access to Medication:
- Mays v. County of San Diego (2015): The court emphasized that individuals under involuntary detention.