A Simple Guide to Psychiatric Holds

In my experience working as a mental health worker, I have been exposed daily to the complex reality of mental health care. Stepping into a locked psychiatric facility grounds you in a profound reality: you are standing where human struggle meets strict, life-altering legal decisions.

The most common question people have is how and why someone can be held in a facility against their will. In California, the law that governs this is the Lanterman-Petris-Short (LPS) Act. It’s not a criminal process, but a civil one, designed for crisis intervention. The process most often begins with an emergency 72-hour hold. For adults, this is known as a WIC 5150, and it allows for assessment and evaluation if a person is considered a danger to themselves, a danger to others, or is “gravely disabled.” That last term is critical; it means someone cannot provide for their own basic needs like food, clothing, or shelter due to a mental health condition. A recent law, Senate Bill 43, expanded this to include severe substance use disorders. A similar hold, the WIC 5585, applies to children.

If, after 72 hours, a person is still unwell, their hold can be extended for up to 14 days of intensive treatment under a WIC 5250. At this stage, legal protections are activated, and patients have the right to a legal hearing to determine if there is probable cause to keep them. They are assigned a Patients’ Rights Advocate, whose only job is to represent their interests. If a person remains a suicide risk after this period, their treatment can be extended for another 14 days under a WIC 5260.

For situations requiring even longer care, the legal frameworks become more complex. A person with a developmental disability who is a danger to themselves or others can be placed in a facility by a regional center under a WIC 6500, which is reviewed by the court. In other cases, a child’s school district may determine that the best place for them is a hospital's youth wing. The most restrictive measure is an LPS Conservatorship, where a court appoints a guardian to make major life decisions for a person. Of course, a person can always admit themselves voluntarily, but sometimes that line blurs. I have seen patients in our DDMI (Developmental Disabilities and Mental Illness) unit who are technically "voluntary" only because their previous involuntary hold expired and there were no other safe places for them to go in the community.

Navigating this system is difficult, but understanding the legal framework is the first step toward ensuring that the rights and dignity of every individual are upheld.