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.
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.