By Susan Finley, Ed.D., NCC
There are many misconceptions regarding the detention of mentally disordered persons for evaluation and treatment. This article will help to explain the ins and outs of a 5150 Article 1 psychiatric hold under the state of California. Differing facilities and health insurance policies may have differing procedures. Getting help for yourself or another person for serious mental health concerns is of utmost importance.
5150 ARTICLE 1. Detention of Mentally Disordered Persons for Evaluation and Treatment
When a person, as a result of a mental health disorder, is (a) in danger to others, (b) himself or herself, or (c) gravely disabled, a professional person designated by the county may upon probable cause, take the person into custody for 72 hours. This is commonly referred to as “5150,” or Detention of Mentally Disordered Persons for Evaluation and Treatment.
Going to the Facility
The person may request to be evaluated or treated at a facility and by a mental health professional of their choice. However, the county cannot guarantee the facility or mental health professional chosen will be available, but they will honor the person’s choice if able. For involuntary admission, the person may or may not be restrained in transit to the facility. Transportation to the facility may be via ambulance for the person’s safety. If there are no beds available at the psychiatric facility, the person may be taken to a local ER where they will be closely monitored until there is an opening at the facility.
Arrival to the Facility
The person will be held for a period of up to 72 hours for assessment, evaluation, and crisis intervention. A staff member, if deemed appropriate, will be assigned to monitor the person the first 12 hours in solitary confinement in the event they attempt to harm themselves or others. This means no doors on bathroom, shower, etc. The first-night lights may be kept on and a staff member assigned to be in the room while the person sleeps.
Upon admission, drawstrings, shoelaces, wire bras, and anything else that may be used for self-harm must be removed from the person’s clothing. A counselor of the same gender will search the person to ensure that they do not have anything hidden underneath their clothing. They will also check for any marks or bruises on the person’s body. If taken into custody at his or her own residence, the person shall also be provided the following information:
“You may bring a few personal items with you, which I will have to approve. Please inform me if you need assistance turning off any appliance or water. You may make a phone call and leave a note to tell your friends or family where you have been taken.”
The person may ask the facility prior to admittance what is allowed and what will be confiscated during their stay. If the person is involuntarily committed and has no packed clothing, additional garments (robe, socks, underwear) will be provided.
A thorough mental health evaluation will be taken upon arrival, as well as prior to discharge. This involves an extensive profile of the person’s prior psychological history.
Vitals and Medication
Vitals are taken upon admission and checked regularly (every hour) the first 12 hours, and the person’s physical and mental health is closely monitored throughout the 72 hour period. During these 72 hours, the person will be evaluated by the facility staff and may be given treatment, including medications.
Purses, bags, wallets, or anything else that is in the person’s possession will be checked upon admission and held in the nurse’s station for safekeeping and returned upon discharge. An inventory of all personal belongings (anything the person came in with) will be recorded so that the person can review that everything is safely returned to them.
Basic amenities will be provided to the person. These include food (regular meals), bedding, towels, soap, toothbrush, toothpaste, shampoo, comb, pads or tampons. No razors for shaving or any sharp objects permitted.
Outside Communication and use of Electronics
Cell phone or computer usage is prohibited. However, the person is given access to a payphone within the facility. Prior to confiscation of personal belongings, persons are able to get a list of numbers off their cellphone for use during their stay.
Group and individual therapy throughout the person’s stay is common. Activities to calm and promote interaction with other persons include classes such as coping skills, self-care, craft making, snack breaks, smoke breaks, and TV usage. Activities are not mandatory but highly encouraged to promote maintaining connection with others and deter isolation. Many persons find that speaking with one another is a healing act in itself. It is not uncommon that persons help one another with getting well by establishing a rapport and understanding.
Common Area/Sleeping Arrangement
Most facilities have common areas where there are books/magazines/board games and cards available for persons to use. A person may be kept separate or share a room with up to 6 other persons, depending on their condition. Men and women may or may not be housed on the same floor. However, sleeping area and bathroom are segregated by gender.
After 72 hours the person is ready for discharge. It is possible for the person to be released before the end of the 72 hours. But if the staff decides that they need continued treatment the person can be held for a longer period of time. If the person is held longer than 72 hours, they have the right to a lawyer and a qualified interpreter and a hearing before a judge. If they are unable to pay for the lawyer, then one will be provided to them free of charge. After the medical team of professionals deem the person safe for discharge, a treatment plan will be introduced and regular follow up with the person is common.
California Legislative Information. ARTICLE 1. Detention of Mentally Disordered Persons for Evaluation and Treatment [5150 – 5155]
Susan Finley, Ed.D., NCC is an educator, published researcher, and social media consultant for therapists. She is a National Certified Counselor (NCC), Board Certified-TeleMental Health Provider (BC-TMH), and Suicide Prevention Instructor (QPR) under the National Board for Certified Counselors.
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