WHat is a 5150 Hold?
Navigating the involuntary Hold Process
Important Resources
Crisis: 1-855-838-0404
Access: 1-800-555-5906
Warmline: 1-707-472-2311
Suicide Prevention: 1-855-587-6373 or 988
Trevor Project (LGBTQ+): 1-866-488-7386 or text START to 678678
Veterans Crisis Line: 1-800-273-8255
What is a 5150 hold?
“5150” refers to a California code for placing an individual on a 72 hour hold for assessment, evaluation, and psychiatric treatment if as a result of a mental health condition the individual is:
In danger of hurting themselves (suicidal)
In danger of hurting others (homicidal)
Gravely disabled due to a mental illness (unable to provide food, shelter or clothing for themselves)
Who can put someone on a 5150 hold?
In Mendocino County, the following individuals may place an individual on a 5150 hold:
A Law Enforcement officer
Mental Health Crisis Worker
What will happen?
A 5150 assessment can take place in a variety of settings including at home, in the community, at the local crisis center, or at the local hospital.
When a 5150 hold is placed by Law Enforcement, the individual is placed on the hold and then brought to the local crisis center or hospital. Once the individual arrives at the hospital, a Mental Health Crisis Worker is called to assess the individual.
When an individual comes to the hospital emergency room in a mental health crisis, a Mental Health Crisis Worker will be called to complete a crisis assessment.
If an individual is assessed by a Mental Health Crisis Worker in the community or the crisis center, once the individual has been placed on a 5150 hold, they will be brought to the local hospital emergency room for medical clearance.
In Mendocino County, the crisis worker will be an employee of RCS (Redwood Community Services) or Mendocino County Behavioral Health Department. During the assessment process, individuals should be prepared to answer a variety of questions and complete forms.
If you or your loved one is placed on a 5150 hold, the Mental Health Crisis Worker will start the process of locating a psychiatric facility. This process involves locating a facility that takes the individual’s health insurance and has an open bed. An individual will remain at the local hospital emergency room until an accepting facility is found or the individual no longer meets criteria for a hold.
During this time the hospital will conduct a medical clearance that includes lab tests and a toxicology screening. This is important because many physical conditions can exhibit as psychiatric distress. If physical problems are detected, the hospital will refer the individual for further medical care. A medical clearance is required for acceptance into a psychiatric facility.
Release of Information
During the crisis screening process, the individual will be asked if they are willing to sign a form to release information (ROI) to someone. This is very important for family members, because without an ROI they cannot get information about their loved one. Family members can always provide information to the doctor, hospital, crisis worker and staff, but the doctor, hospital, crisis worker, and staff will not be able to legally respond without a signed ROI.
Accompanying a Loved One During a Mental Health Crisis
If an individual is willing, family members are usually welcome to stay with their loved one in the emergency room. The family member is often in a better position to communicate with hospital staff and Mental Health Crisis Worker about the needs and condition of their loved one than the individual experiencing a psychiatric crisis. For example, they may be able to provide necessary information on the crisis form such as insurance information, any prescribed medications, and doctors caring for the patient, etc. Hospital staff will accommodate the needs of the patient by providing food and a bed. Often family members are welcome to spend the night in the same room. If the patient is agitated, the hospital security may stay nearby in case there is a need to restrain or de-escalate an individual.
Meeting Criteria
If an individual is deemed to be a danger to themselves or others or is gravely disabled, the crisis worker will start the process of locating a facility with an open bed. Once the crisis worker has been successful in obtaining a bed at a psychiatric facility, the patient will be taken by ambulance to that location. (All insurance companies will only pay for ambulance transport) Family members have the right to accompany their loved one in the ambulance, but they will not have return transportation. If you plan to accompany your loved one in the ambulance to the psychiatric facility, be sure that you have someone who can follow and provide a ride home. If you do not go with your family member to the psychiatric facility, a signed ROI by the individual will allow the crisis worker to inform you where your loved one is going.
Admission to a Psychiatric Facility
When an individual arrives at a psychiatric facility, they will again be reassessed for meeting 5150 hold criteria (72 hours). Generally, the individual still meets criteria and is admitted to the facility.
If in the rare circumstance that the individual is found to not still meet criteria for a 5150 hold, the facility will release the individual from the 5150 hold. If the facility is able to, due to confidentiality regulations, they will call Mendocino County Mental Health or its contracted provider to see about transporting the individual back to Mendocino County. If the individual does not want transportation from Mendocino County Mental Health, the facility will work with the individual on a transportation plan. This is another reason a ROI is helpful, as it would allow a call to a family member for transportation. Most psychiatric hospitals are several hours away from Mendocino County and having a family member stranded without knowing where they are can only contribute to further crisis.
Once admitted to a psychiatric facility, an individual may stay up to 72 hours (three days) on the current hold. If the individual requires more time at the facility to stabilize, the facility may place the individual on a 5250 (up to 14 days) hold or the individual may agree to stay voluntarily.
While at the psychiatric hospital, the patient will be seen by the hospital’s psychiatrist who will work with the individual on medication support needs; this may include prescribing different medications than the ones the patient was on before. The patient will have opportunities to participate in group therapy, and be overseen by hospital staff at all times. There will also be a social worker assigned to them to prepare for discharge and look after insurance matters.
Discharge Plan
If you or your loved one receive a 5150 assessment and are not hospitalized, the Mental Health Crisis Worker should discuss a discharge plan for follow up care, which will vary depending on your health insurance plan.
Insurance
Mental Health Services are provided and paid for by your insurance company. Mendocino County Mental Health is the Medi-Cal provider for Specialty Mental Health Services, Partnership is the Medi- Cal provider for Mental Health Services for individuals who do not need a high level of services. Mendocino County Mental Health or contracted providers will provide a mental health crisis assessment for anyone in Mendocino County regardless of their insurance company.
If an individual has Medicare or private insurance the insurance company will direct services following the crisis assessment. If an individual is hospitalized in a psychiatric facility, the insurance company (including Medi-Cal) will work with the facility on approved days and payment. An individuals insurance plan will determine what hospitals are available for acute psychiatric inpatient care.
It is important to have an ROI for family members, so that they can stay involved in the individuals care and know when the individual will be discharged. Mendocino County Mental Health and their contracted providers will not be provided information on clients that do not have Medi-Cal as their health insurance.
Additional Support
NAMI Mendocino County is a grassroots, family and peer self-help support, education and advocacy organization dedicated to improving the lives of people with mental illness and their families. NAMI Mendocino County is an affiliate of the National Alliance for Mental Illness (NAMI). NAMI Mendocino offers several support services that are run by volunteers.
Family-to-Family Support Group is a biweekly meeting for family members of individuals suffering from mental illness.
Family-to-Family Class is an eight-week education programfor family members of individuals suffering from mental illness. It is usually offered once a year in the fall in Ukiah,
Peer-to-Peer Class is an eight-week education program for peers who are suffering from mental illness. It is usually offered once a year.
For more information regarding NAMI and the support groups, please call:
NAMI Mendocino
Phone: 707-485-2008
Email: namimendocino@mcn.org
Web: www.namimendocino.org
