Legal and Ethical Issues Related Involuntary Psychiatric Holds in California

Involuntary Psychiatric Holds in California

Today, the Lanterman-Petris-Short (LPS) Act of 1967 plays a central role in regulating involuntary psychiatric holds within the state of California. The successive ratification of this statute marked the end of inappropriate involuntary commitment of psychiatric patients, widespread in California at the time, with the aim of safeguarding the Constitutional rights of psychiatric patients while also promoting public safety. Furthermore, the new legislation also supported individualized psychiatric care as a reliable measure in inhibiting criminal tendencies among psychiatric patients as a consequence of their mental state (California Department of Corrections and Rehabilitation, 2020). Within California, involuntary psychiatric holds for children and adult emergencies are enforced under the “5150 Hold” code of the California Welfare Institution (WIC). The 5150 WIC Hold code categorizes situations warranting involuntary psychiatric holds for children and adults, in addition to specific considerations informing the same decisions. The enforcement of involuntary psychiatric holds in California aims to deliver relevant mental health services to at-risk populations and persons posing a safety risk to themselves and society.

Read also Involuntary Psychiatric Holds in the State of California

 Involuntary Psychiatric Holds for Child and Adult Psychiatric Emergencies in California      

The LPS Act of 1967 is, arguably, one of the most significant mental health statutes assented in the state of California. The 5150 WIC Hold code is one of its main components; addressing involuntary psychiatric holds in the state of California for children and adults during psychiatric emergencies.  Furthermore it also specifies circumstances that meet the basic requirements of a psychiatric emergency and clinical staff responsible for enforcing psychiatric holds within the state.  The 5150 code demands that involuntary psychiatric holds be applied for a 72-hours period and enforced by qualified personnel sanctioned by a given county government. According to Freeman, (2019), standards necessitating involuntary psychiatric holds for children and adults in California span cases of involving individuals long-established to be a danger to themselves (DTS), posing a danger to others (DTO), and persons classified as “gravely disabled” due to developmental disabilities. 

Psychiatric emergencies involving children, adults, or persons with developmental disabilities are generally characterized by patient’s inability to cater for their food and clothing needs, or a stable housing arrangement due to problems originating from a mental health disorders.  Additionally, they may exhibit psychosis, anxiety, unexplained agitation, and psychosis; signs commonly associated with symptomatic stages of serious psychiatric disorders. Beyond the 72-hour hold period, a peace officer is expected to consult with the resident psychiatrist in charge of particular psychiatric emergency.  The ensuing discussions are important in determining whether it will be appropriate to surrender the patient to the custody of a responsible guardian or further commitment in mental health facility. However, a 5250 hold may be recommended if the psychiatrist determines that the patient is either a DTS, DTO, or incapable of managing on their own after their hospital release due to developmental disabilities. A court hearing is then scheduled and held in the hospital within a 4-day period to determine the legitimacy of the proposed extended hold. The hearing will also identify a suitable release date for the patient or the need for conservatorship.

Emergency Hospitalization for Psychiatric Hold, Inpatient Commitment and  Outpatient Commitment in California        


The review of psychiatric emergencies, inpatient, and outpatient commitment in the state of California is distinguishable by several key distinctive characteristics. For instance, involuntary psychiatric holds for juveniles and adults are only deemed necessary when patients display symptoms commonly associated with severe psychiatric episodes. Hospitalization is particularly recommended for individuals exhibiting self-harm, suicidal ideations, and a degree of intent to harm others. A 5150 WIC Hold, therefore, ensures individuals experiencing a psychiatric emergency are hospitalized, evaluated by accredited mental health experts, and subjected to suitable interventions .A comprehensive report of the patient’s present condition is also developed by authorized personnel and presented to attending staff.

In California, inpatient commitment provides a unique opportunity for psychiatrists to conduct further review of persons placed under involuntary commitment in California. The 72-hour period designated under the 5150 WIC Hold code allows mental health experts to determine whether patients suffer from a known psychiatric condition (Morris, 2021). Furthermore, individuals placed under an involuntary psychiatric hold should satisfy diagnostic criteria in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for suspected mental health disorders. Mental health experts can also propose possible interventions and recommendations on whether a 5250 WIC Hold should be enforced.

Moreover, outpatient commitment is influenced by a peace officer’s initial report, recommendations by a mental health expert, and attending staff. This decision is fundamental to the well-being of individuals determined to be a danger to themselves (DTS), a direct danger to others (DTO), and persons with developmental disabilities.  Outpatient commitment is typically recommended for patients who successfully complete the mandatory 72-hour hold but still requiring psychiatric help. However, it is noteworthy to acknowledge that the success of outpatient commitment is solely dependent upon patient’s compliance to interventions and involvement of a responsible guardian.

Capacity and Competence & Legal and Ethical Issues

Capacity and competence are frequently applied in a mental health context and with far-reaching implications for legal and ethical issues. Today, clinical healthcare professionals required to adopt patient education as a routine practice when attending to patients placed under involuntary psychiatric holds. According to Fogel (2017), capacity refers to a practical review of patients’ ability to make informed mental health decisions within the intervention framework of a psychiatric emergency. Mental health experts typically conduct a broad review of clients to gauge their capacity to participate in proposed interventions and make rational decisions. Failure to take these factors into account may be detrimental to patient’s recovery in scenarios where interventions are introduced without their knowledge or consent. This may also expose mental health experts to the risk of possible future lawsuits linked to prior medical decisions. Competency refers to health care professionals’ ability to assess clients accurately for a psychiatric illness (Duncan, 2019). Today, competent healthcare professionals are those who meet minimum requirements required to review patients for mental health illnesses within a clinical environment. Furthermore, competency also covers the ability of healthcare professionals to meet specific work-related demands and scenarios involving psychiatric patients.

HIPPA Privacy Rules in Psychiatric Emergencies

            HIPPA privacy rules play an important role in the ethical management of psychiatric emergencies. In particular, the privacy and confidentiality of patients takes precedence during involuntary psychiatric holds for children and adults in the state of California. Healthcare professionals enforcing a mandatory 72-hour hold are still expected to remain in contact with patients’ guardians (Sisti, 2017).They are particularly expected to share relay information on the progress made by individual patients to their healthcare provider and immediate family members. Furthermore, healthcare experts are also expected to protect patient’s health care data by limiting access to authorized healthcare personnel.

Suicide Risk Assessment Tool

            In recent years, the Patient Health Questionnaire (PHQ-9) has become one of the most preferred suicide risk assessment tools in mental health facilities within California. It is common among state and local community mental health facilities due to its overall efficiency as a reliable evidence-based suicide risk assessment tool. Furthermore, the Patient Health Questionnaire (PHQ-9) is preferred over other suicide risk assessment tools since it self-administered and with a higher accuracy rate in identifying psychiatric disorders (Dadfar et al., 2021). Additionally, PHQ-9 is systematic in the classification of mental health diagnoses and in proposing the most appropriate interventions for psychiatric patients.

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