What is a 5150 hold?

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Many people may have heard the term “5150” in the news related to the Britney Spears conservatorship case when she was placed on a 5150 in 2008, the beginning of her battle to free herself from her family. These emergency psychiatric holds are not just for celebrities and happen daily for the general population who are mentally distressed. A “5150” pertains to the involuntary hold of “mentally disordered” people and allows certain professionals to initiate a 72-hour mandatory observation period for mentally distressed individuals in approved mental health facilities such as hospitals to undergo a thorough psychiatric evaluation.

The “5150” name is California-specific, but most U.S. states have laws that pertain to mandatory emergency psychiatric holds. For example, a mandatory psychiatric hold is known as a “section 12” in Massachusetts. In Colorado, it is known as an “M1 hold,” but they both pertain to an emergency hold for a certain period for people imposing a danger to themselves or others. Every state sets guidelines on the duration of emergency holds, who can initiate an emergency hold, and the patient’s rights during the hold. Despite these state-by-state differences, there are still plenty of overarching similarities regarding these holds.

A 5150 is not an arrest, nor is it a form of punishment, but rather, it is a potential life-saving avenue for people who are having a mental health crisis and are deemed the following:

A danger to themselves

A danger to others

Who are severely mentally disabled (the person is unable to provide for their basic necessities such as food, clothing, or shelter).

Behaviors that may warrant a 5150 may include the following:

Showing aggressive, erratic, or dangerous behaviors.

Expressing suicidal thoughts or behaviors.

Showing signs of severe psychosis (delusions, hallucinations, disorganized thinking or speech).

Communicating a specific plan to harm oneself or others.

Experiencing severe depressive or manic episodes that interfere with the ability to function.

Mental health workers, including psychiatrists and psychologists, and law enforcement officers are the only people allowed to formally initiate a 5150. However, friends, family, physicians, and the general public can recognize that someone is in dire need of help and call the police or a mental health professional for an evaluation.

What happens if my loved one is experiencing a mental health crisis?

If your loved one is experiencing a mental health crisis and is exhibiting any of the above signs or symptoms, there are a few things you can do to protect your loved one and yourself.

Have the phone numbers for psychiatric emergency care and mental health crisis hotlines readily available. If you cannot reach these numbers in time, 911 also works.

If your loved one’s mental health crisis puts you or anyone else (including your loved one) in an immediate unsafe position, call 911 immediately.

If your loved one has a history of a mental health disorder, have a written history or their history and medications. If this is their first mental health crisis, be prepared to provide specific information about what occurred to the first responders.

Remove any items that can be used as a weapon, if possible.

Go into a locked room or a safe place if you are in danger until first responders arrive.

Be prepared for your loved one to be restrained and taken away by law enforcement.

Law enforcement may place your loved one under a 5150 hold when they arrive, or they may wait for mental health professionals to evaluate your loved one in the emergency room.

Consider contacting an attorney with experience in 5150 holds for guidance and as a potential legal representative for your loved one, as this can be a long journey.

The goal is to place the person in a safe environment and evaluate them for 72 hours. If the mental health professional who evaluates them determines that the person is no longer a danger to themselves or others and is able to care for their basic needs, the person is released at the end of the 72-hour hold.

What rights do you have during a 5150 hold?

As a patient, you have the legal right:

To have an attorney to help advocate for your rights and guide you through the legal process (especially if a conservatorship is potentially on the table)

To a court hearing in front of a judge to deem whether involuntary confinement is necessary

To refuse medical treatment (except in situations where immediate medical intervention is necessary to prevent harm to oneself or others)

To informed consent

To review the treatment plan with all providers

It is possible to be released before the 72 hours is up; this happens if the person no longer meets the legal criteria to be held and if the person has presented their case in front of a judge, and it is ruled that this hold is unnecessary.

What happens after a 5150 hold?

Generally, the person is held and evaluated for 72 hours, and they are either released or:

Conservatorship: If over age 18, the person may be referred for a conservatorship. Under a conservatorship, the “conservator,” or the adult legally in charge, can make certain medical and financial decisions for the person under their care. A court of law determines a conservatorship. It may be wise for the individual under a conservatorship to have legal representation. These decisions may not align with the person’s beliefs or desires, which is why a conservatorship can be tricky.

5250: The mental health facility may seek an additional 14-day involuntary hold called a “5250” if the person is still deemed to be in a mental health crisis. When mental health professionals believe that the person under a 5150 hold is still a danger to themselves or others or suffers from a grave disability, they can seek a 5250 hold. The person stays in a psychiatric facility for an additional 14 days, where they receive intensive mental health treatment.

Ongoing voluntary treatment: While a 5150 hold provides immediate intervention, its effectiveness largely depends on what happens next and how the person continues to care for their mental health. The person needs to seek long-term mental health treatment, whether that is an inpatient or outpatient program at a credible mental health treatment facility. An inpatient mental treatment program at AKUA Mind and Body can provide a structured and supportive treatment environment where the person engages closely with their therapist, treatment team, and other clients in group therapy settings. A mental health treatment professional can make a thorough assessment to determine the length and type of care needed and devise a treatment plan that works to uncover and address underlying triggers associated with the person’s current mental state and behavioral patterns. Prescription medications and support groups also play a pivotal role in the treatment journey. Hopefully, the person will be able to manage their symptoms with healthy coping mechanisms and live a fulfilling life.