When someone is experiencing a severe mental health crisis in California, there’s a legal process designed to protect both the individual and the community. This process is known as a “5150 hold,” and understanding what it means can help families navigate one of the most challenging situations in mental health care.
Understanding the 5150 Hold: The Basics
A 5150 hold is an involuntary psychiatric hold that allows designated professionals to detain someone experiencing a mental health crisis for up to 72 hours for evaluation and treatment. Named after Section 5150 of the California Welfare and Institutions Code, this law is part of the Lanterman-Petris-Short (LPS) Act, which has governed involuntary mental health treatment in California since 1967.
The 5150 hold is not a criminal arrest. Rather, it’s a civil mental health intervention designed to provide immediate evaluation and stabilization when someone is unable to recognize their need for care during a crisis.
Who Can Initiate a 5150 Hold?
Not just anyone can place someone on a 5150 hold. According to California law, only specific authorized professionals can initiate this process:
- Peace officers (police)
- Licensed members of a mobile crisis team
- Mental health professionals designated by the county
- Professional persons in charge of facilities designated for evaluation and treatment
- Members of the attending staff at designated facilities
These professionals must have probable cause to believe the person meets the criteria for a hold based on their direct observations or credible reports from others.
The Three Criteria for a 5150 Hold
For someone to be placed on a 5150 hold, they must meet at least one of three specific criteria as a result of a mental health disorder:
Danger to Self
This includes individuals who have made suicide attempts, expressed serious suicidal ideation with a plan, or engaged in self-harming behaviors that could result in serious injury or death. The assessment considers both current actions and the imminent risk of harm.
Danger to Others
This criterion applies when someone has made credible threats to harm others or has attempted to cause harm. The focus is on actual threats or behaviors that indicate a person poses a genuine risk to someone else’s safety.
Gravely Disabled
Being “gravely disabled” means a person can no longer provide for their own basic needs—food, clothing, or shelter—because of a mental health disorder. This doesn’t apply to someone who simply has an unconventional lifestyle. Instead, it refers to individuals who are genuinely unable to care for themselves due to their mental health condition. A person who can survive safely with help from a willing friend or family member would typically not be considered gravely disabled.
It’s important to note that a 5150 hold cannot be based solely on someone’s mental health history. The criteria must be met in the present moment.
Recent Changes to California’s 5150 Law
California has recently expanded the definition of “grave disability” under Senate Bill 43, signed by Governor Gavin Newsom in October 2023 and implemented in January 2025 in most counties. The new law now includes individuals who cannot keep themselves safe or secure necessary medical care, and it applies to those experiencing either mental illness or substance use disorder as a standalone condition.
This represents a significant shift in California’s approach to involuntary mental health treatment, with the goal of connecting more people experiencing severe mental health crises to the care they need.
What Happens During a 5150 Hold?
When someone is placed on a 5150 hold, they are transported to a psychiatric hospital or county-designated mental health facility certified to provide emergency psychiatric evaluation and treatment. They cannot simply be taken to a regular emergency room unless that facility has the proper psychiatric certification.
During the 72-hour period, mental health professionals conduct comprehensive evaluations to determine:
- The person’s current mental state and level of risk
- Whether they can be safely released
- If voluntary mental health services would be appropriate
- Whether additional involuntary treatment is necessary
The facility must inform the individual of their legal rights, including the right to contact a Patient’s Rights Advocate. Importantly, the hospital does not need to hold someone for the full 72 hours—if staff determine the person is stabilized and no longer meets the criteria, they should be released sooner.
The 72-hour timeframe does not include weekends or holidays, meaning the actual duration may extend beyond three calendar days.
Patient Rights During a 5150 Hold
Despite being detained involuntarily, individuals on a 5150 hold retain almost all their civil rights under the Lanterman-Petris-Short Act. These rights include:
- Keeping and using personal possessions, including clothing and toiletries
- Keeping and spending a reasonable amount of money
- Having access to storage space for personal belongings
- Making phone calls and receiving visitors (with some facility-specific restrictions)
- Receiving mail and sending sealed mail
- Refusing convulsive treatment (electroconvulsive therapy)
- Refusing psychosurgery
- Access to legal representation and a patients’ rights advocate
The only significant right that is limited is the ability to leave the facility during the hold period.
What Happens After the 72-Hour Hold?
At the end of a 5150 hold, one of several outcomes will occur:
Release
If mental health professionals determine the person no longer meets the criteria for involuntary detention and can be safely released, they will be discharged. This is the most common outcome.
Voluntary Treatment
The person may agree to continue receiving mental health treatment voluntarily, either as an inpatient or through outpatient services. For individuals experiencing depression, anxiety, or post-traumatic stress disorder, transitioning to ongoing care is essential for long-term stability.
5250 Hold (14-Day Certification)
If the person continues to meet the danger-to-self, danger-to-others, or gravely-disabled criteria and is unwilling or unable to accept voluntary treatment, the facility may file for a 5250 hold. This extends involuntary detention for up to 14 additional days of intensive treatment.
Unlike a 5150, a 5250 requires a certification review hearing where the person has the right to legal representation and can present evidence contesting the hold. The hearing typically occurs at the hospital within four days of the 5250 being filed.
Extended Holds Beyond 5250
In cases where someone remains gravely disabled after the 14-day hold, additional extensions may be pursued:
- 5270 Hold: An additional 30 days of treatment for individuals who remain gravely disabled and are unwilling or unable to accept voluntary treatment
- 5300 Hold: Up to 180 days of treatment for individuals who continue to pose a danger to others due to their mental health condition
Conservatorship
For individuals with ongoing, severe impairments who cannot care for themselves, the county may initiate conservatorship proceedings. This is a court process where a third party is appointed to make decisions about treatment and placement.
Understanding the Purpose: Crisis Intervention, Not Punishment
It’s crucial to understand that a 5150 hold is designed as a mental health intervention during acute crisis situations, not as a form of punishment. The primary goals are to:
- Ensure the immediate safety of the individual and the community
- Provide professional psychiatric evaluation during a crisis
- Connect individuals to appropriate mental health treatment
- Stabilize the person’s condition so they can transition to ongoing care
Many people experiencing mental health challenges during a crisis are unable to recognize their need for treatment. The 5150 process provides a critical window to assess the situation, provide stabilization, and ideally transition individuals to voluntary treatment.
After a 5150: The Importance of Ongoing Care
One of the most critical aspects of recovery after a mental health crisis is ensuring continuity of care. A 5150 hold addresses the immediate emergency, but lasting wellness requires ongoing support and treatment.
For many individuals, virtual mental health treatment offers an accessible and effective path forward. Virtual intensive outpatient programs provide structured therapeutic support while allowing people to maintain their daily routines and responsibilities. These programs typically include:
- Individual therapy sessions with licensed clinicians
- Group therapy focusing on skill development and peer support
- Evidence-based treatment modalities like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT)
- Psychiatric medication management when appropriate
- Crisis planning and relapse prevention strategies
Virtual treatment is particularly valuable for individuals who may have experienced trauma or those in need of trauma-informed care. Many people find that receiving care from the comfort and safety of their own home reduces barriers to engagement and supports more consistent participation in treatment.
Specialized Support for Unique Needs
Mental health recovery is not one-size-fits-all. Different individuals require different approaches to healing, particularly those from marginalized communities who may have faced discrimination or lack of understanding in traditional treatment settings.
For LGBTQIA+ individuals who have experienced unique stressors related to identity, family rejection, or minority stress, affirming and supportive mental health care can make all the difference in recovery outcomes. Similarly, individuals managing borderline personality disorder or bipolar disorder often benefit from specialized treatment approaches that address their specific symptom patterns.
Recognizing When Someone Needs Help
Understanding the signs that someone may need mental health support can help families intervene before a crisis reaches the point of requiring a 5150 hold. Some signs that someone may need virtual outpatient care include:
- Significant changes in mood, behavior, or personality
- Withdrawal from relationships and activities they once enjoyed
- Expressing feelings of hopelessness or worthlessness
- Difficulty managing daily responsibilities
- Increased substance use as a coping mechanism
- Declining self-care and personal hygiene
Early intervention through voluntary treatment is always preferable to waiting for a crisis that may require involuntary intervention.
Support for Families: The Role of AB 1424
California recognizes that families play a crucial role in their loved one’s mental health journey. Assembly Bill 1424 modified the LPS Act to allow family members to provide input about their loved one’s mental health history during involuntary treatment and conservatorship decisions.
The AB 1424 form allows families to document important information about their loved one’s condition, treatment history, and what has or hasn’t worked in the past. While submitting this form doesn’t guarantee specific requests will be followed, it ensures that those making treatment decisions have access to valuable context that only family members can provide.
The Importance of Prevention and Early Intervention
While the 5150 system exists to protect individuals during acute crises, the most effective approach to mental health is preventing crises before they occur. This includes:
- Seeking treatment early when symptoms first emerge
- Maintaining consistent engagement with mental health care
- Building a strong support system of family, friends, and professionals
- Developing coping skills and crisis management strategies
- Understanding your own mental health patterns and early warning signs
Resources like mental health awareness education can help individuals and families understand the importance of proactive mental health care.
Addressing Common Questions About 5150 Holds
Is a 5150 Hold a Criminal Record?
No. A 5150 hold is a civil mental health process, not a criminal arrest. It does not result in a criminal record. However, under certain circumstances, a 5150 hold can affect firearm ownership rights, particularly if the person is officially admitted to a designated inpatient facility for being a danger to themselves or others.
Can Someone Be Released Before 72 Hours?
Yes. If mental health professionals determine at any point during the hold that the person no longer meets the criteria, they must be released. The 72-hour period is a maximum, not a requirement.
What If Someone Disagrees with the 5150?
Individuals have the right to contest the hold and can work with a patients’ rights advocate or attorney to challenge it. If the hold is extended to a 5250, they have the right to a certification review hearing where they can present evidence.
Will Insurance Cover Treatment During and After a 5150?
Most health insurance plans cover emergency psychiatric care, including 5150 holds and subsequent treatment. Understanding insurance and coverage for virtual outpatient care can help families navigate the financial aspects of mental health treatment.
Moving Forward: From Crisis to Recovery
A 5150 hold represents one of the most challenging moments in a person’s mental health journey—and often in their family’s experience as well. While the involuntary nature of the process can feel frightening and disempowering, it exists to provide critical protection and connection to care during life-threatening crises.
The path forward from a mental health crisis involves commitment to ongoing treatment, development of coping skills, and building a sustainable support system. Whether through traditional in-person services or virtual therapy options, the key is finding treatment that fits your life and addresses your unique needs.
Recovery is possible, and with the right support, individuals who have experienced mental health crises can build fulfilling lives characterized by stability, connection, and hope.
Getting Help: Resources and Next Steps
If you or someone you love is experiencing a mental health crisis:
- Immediate Crisis: Call 911 or go to the nearest emergency room
- 988 Suicide and Crisis Lifeline: Call or text 988 for immediate support
- SAMHSA National Helpline: 1-800-662-HELP (4357) for treatment referrals and information
For ongoing mental health treatment and support, consider reaching out to a virtual intensive outpatient program that can provide comprehensive care while you maintain your daily life. Programs offering flexible evening sessions can work around your schedule, making it easier to prioritize your mental health without disrupting work or family commitments.
Mental health challenges don’t define you, and seeking help is a sign of strength, not weakness. Whether you’re navigating the aftermath of a crisis or looking to prevent one, professional support can make all the difference in your journey toward lasting wellness.
If you’re looking for compassionate, evidence-based mental health care, Higher Purpose Recovery offers virtual outpatient programs designed to support your recovery journey. Contact us today at wren@hproutpatient.com to learn more about how we can help.
References
- California Department of Health Care Services. (n.d.). Handbook: Rights for Individuals in Mental Health Facilities. Retrieved from https://www.dhcs.ca.gov/services/Documents/DHCS_Handbook_English.pdf
- California Welfare and Institutions Code Section 5150. Retrieved from https://law.justia.com/codes/california/code-wic/division-5/part-1/chapter-2/article-1/section-5150/
- Disability Rights California. (n.d.). Understanding the Lanterman-Petris-Short (LPS) Act. Retrieved from https://www.disabilityrightsca.org/publications/understanding-the-lanterman-petris-short-lps-act
- National Alliance on Mental Illness (NAMI). Involuntary Hospitalization (5150). Retrieved from https://namisonomacounty.org/hospitalization/
- Substance Abuse and Mental Health Services Administration (SAMHSA). 988 Suicide & Crisis Lifeline. Retrieved from https://988lifeline.org
