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Crisis

Crisis and 5150 Process

If you or someone close to you is experiencing a crisis due to a mental health challenge and may be a danger to themselves or others, you should call 911. Crisis support services of Alameda County offers support to all ages and backgrounds during times of crisis or difficulty. The 24-hour Crisis line can be reached at 1-800-309-2131.

What You Need To Know During A Crisis

How do I know if I should call 911?

If your family member or loved one is threatening to harm themselves, you, or another person OR exhibiting violent behavior then you need to call 911. You can request that police send Crisis Intervention Trained (CIT) officers who have been through extra hours of additional training on how to handle psychiatric emergencies in the community. Not all law enforcement agencies can access CIT officers from their dispatch center, but it doesn’t hurt to ask*.

What do I do after 911 is called?

  1. Prepare your home before police arrival by removing any items that could be used or perceived as a weapon. Turn on all the lights in your home to improve visibility and turn off all the audio (televisions, stereos) to reduce distractions.
  2. Try to meet the police officers outside before they interact with your loved one. Brief them on what has been going on, the emotional state of your loved one, and share helpful suggestions on what may work best for your loved one.
  3. Be direct and open. Do not exaggerate the situation or leave out relevant information. Be prepared to give a brief history of your loved one’s behavior.
  4. Give police at the scene a brief information sheet (1-2 pages), that includes a photograph of your family member, medical and psychiatric history, treatment information, and family caregiver contact information. [Click here for more details (AB 1424 historical info form)].
  5. Ask the police officer or ambulance driver where your friend or relative is being taken. If the police believe that the person meets criteria (see below), they will be placed on a 5150 and transported (typically by ambulance) to a designated facility for psychiatric evaluation and treatment. The individual can be held at a designated facility for up to 72 hours.

What is a 5150 or 72-hour hold?

5150 is the number of the section of the Welfare and Institutions Code, which allows a person with a mental challenge to be involuntarily detained for a 72-hour psychiatric hospitalization. A person on a 5150 can be held in the psychiatric hospital against their will for up to 72 hours. This does not mean that they will necessarily be held the entire 72 hours; it means that psychiatric hospitals have the legal right to do so if determined to be necessary.

What makes someone eligible for a 5150?

A person can be held against their will in a psychiatric facility only if they meet at least one of the three basic criteria listed:

  1. The person is a danger to others. Historically, the courts have most often interpreted this in a very restrictive way. Before the passing of AB 1194, it must be generally shown that an imminent threat exists, and that someone will do so immediately. Now, danger to others may be interpreted as the person means to carry out the threat. The threat must also be substantially related to the mental health challenge.
  2. If the person is a danger to self. The courts generally interpret this as a life-threatening danger to self (i.e. suicide).
  3. If the person is gravely disabled. The law states that a person must be unable to provide for their own food, clothing or shelter as the result of a mental challenge to qualify as gravely disabled. Across California jurisdictions, "grave disability as the result of a mental illness" is interpreted differently. Courts generally rule a person is not gravely disabled (even if they are incapacitated) if they have friends or family who will provide food, clothing, or shelter for them. This is important, as 'having a place to go' and 'having someone to provide for them’ influences decisions as to whether to release a loved one. It is important to discuss as a family whether you are able to take a loved one home with you and safely provide care for them at this time.

What is a "5250"?

  • A 5250 is a 14-day extension of the involuntary hold. (As with the 5150, the hospital may or may not hold someone for the entire 14 days).
  • At the end of 72 hours, if someone has been on a 5150 hold and still meets one of the three  criteria (e.g. danger to self, others, or gravely disabled) then the attending psychiatrist can file a 5250, or "certification for up to fourteen days of intensive psychiatric treatment". By law the client must receive a copy of this certification.
  • The client is entitled to an automatic hearing called a certification review hearing, which is informal and a Patients’ Rights Advocate from the Patients’ Rights Advocacy office represents the consumer.
  • The client can also request a Writ of Habeus Corpus hearing at anytime to contest being held in front of a judge.

Confidentiality And Rights

When a family member or loved one is hospitalized, it is natural to be concerned and want the most up-to-date information possible. You may even have helpful information to share. It is important to note that for adults, age 18 and over who are hospitalized, confidentiality rights protect their rights to privacy. This means your relative, friend, or partner must first authorize the treatment facility to contact or disclose information to you before they are allowed to involve you in their care. Below are some of the important forms and laws that family members need to know about or fill out to have access to supporting their loved one.

How to Receive Information about your Loved One

Release of Confidential Information is a form that must be signed for each hospital admission, and each individual seeking to be involved in care. For you to hear any information about your loved one’s case you need your love one to sign a Release of Information (ROI). Ask your loved one if they will add you to their list of individuals authorized to speak to their providers. Staff at the nurses’ station have this form in your loved one’s files. Click here for an example of a Release of Information Form. The release form given here is a sample form that might be recognized by an institution, though most prefer their own form. Release forms can specify information and dates when it is enforced.

How to Share Information about your Loved One

AB 1424 is a California law that requires all individuals making decisions about involuntary treatment to consider historical information supplied by family members. Mental health staff will place this form in the consumer’s mental health chart, and under state and federal law, consumers have the right to view their chart. The Family member completing this form also has the right to withdraw consent to release information given by them and have the information regarded as confidential {Welfare & Institutions Code 5328(b)}.

Filling out the AB 1424 form is the best way to assure your personal understanding of your loved one’s situation can be considered to their treatment team. If possible, you should fill out this form in advance, keep the information current, and have extra copies at hand to give to police or other professionals who are called on a 5150. Click here for the AB1424 Form. This form was developed jointly by Alameda County Behavioral Health Care Services, Alameda County Family Coalition, family members, mental health consumers, mental health providers, patients’ rights advocates and the judicial system.

What are other important laws for family members to know about?

AB 1194

An important legislative change that impacts families is AB 1194. This law removes the word “imminent” from danger to self or others from 5150 eligibility criteria, which basically means families don’t have to wait until they are witnessing someone harming themselves or others to call for help. This law also requires the LPS 5150 application to record whether the historical course of person’s mental health challenge was considered in the determination of probable cause. 

SB 1152

SB 1152 requires hospitals to revise current discharge policies to assist homeless patients in preparing for their return to the community by helping them identify a post-discharge destination, with priority given to identifying a sheltered destination with supportive services. Prior to discharging a homeless patient, hospitals are required to document and perform a checklist of events, such as offering the homeless patient a meal, screening for infectious disease, weather-appropriate clothing and transportation to a certain destination within a 30-mile radius.  Hospitals must also have a written plan for coordinating services and referrals for homeless patients with the county behavioral health agency, health care and social services agencies in the region, health care providers and nonprofit social services providers. Each hospital will be required to maintain a log of the homeless patients discharged from their facilities and the post-discharge destinations.

What is a Patient Rights Advocate?

Patients’ Rights Advocates are a part of the Mental Health Association of Alameda County, our sister program. Patients’ Rights advocates are available to provide education and consultation on the laws governing mental health treatment including involuntary detention. You can reach Alameda County Patients’ Rights Advocates at 1-800-734-2504.

What is a Certification Review Hearing?

A Certification Review Hearing is also known as a Probable Cause Hearing. It is an informal hearing held at the hospital to determine if there is "good cause" to keep someone in the hospital. At the hearing, a hearing officer will determine whether or not the patient is still a danger to themselves, others, or gravely disabled as a result of a mental illness. If there is no good cause determined to keep the person in the hospital, the hearing officer can discharge the person from the hospital immediately. If there is good cause, the hearing officer will allow the psychiatrist to keep the patient in the hospital for up to fourteen more days.