When a loved one is severely depressed, psychotic, manic, suicidal, threatening others, or unable to care for themselves, families often face the same frightening question:
“How do I get them help if they refuse?”
In California, the answer may involve the Lanterman-Petris-Short (LPS) Act, the legal framework governing involuntary psychiatric evaluation and treatment.
Terms such as 5150, 5250, Riese hearing, and writ hearing are often used quickly in hospitals, but families may have little idea what they actually mean.
Understanding the process can make an overwhelming situation easier to navigate.
The Three Main Reasons Someone Can Be Held
A person may be detained involuntarily when, because of a mental health disorder or other qualifying condition, they meet one or more legal criteria.
The three terms families hear most often are:
DTS — Danger to Self
This can include suicidal behavior, serious suicidal intent, or circumstances showing a substantial risk of self-harm.
DTO — Danger to Others
This refers to circumstances in which a person poses a significant danger to another person because of their psychiatric condition.
GD — Gravely Disabled
This term is often misunderstood. Under current California law, grave disability can include being unable, because of a mental health disorder, severe substance use disorder, or both, to provide for basic personal needs such as food, clothing, shelter, personal safety, or necessary medical care.
A psychiatric diagnosis by itself is not enough. The issue is whether the person’s condition is creating the level of danger or disability required by law.
5150: The Initial 72-Hour Hold
A 5150 allows certain authorized professionals to take a person into custody for psychiatric assessment, evaluation, and crisis intervention for up to 72 hours when the legal criteria are met.
The phrase “72-hour hold” can be misleading.
A 5150 does not automatically mean the patient will remain hospitalized for three full days. If the treating team determines that the person no longer meets involuntary-hold criteria, the person may be released earlier or may agree to continue treatment voluntarily.
During this period, the treatment team evaluates questions such as:
- Is there a psychiatric or substance-related condition?
- Does the person remain dangerous to themselves or others?
- Are they gravely disabled?
- Can they safely be treated outside the hospital?
- Would they accept treatment voluntarily?
If the person continues to meet legal criteria when additional treatment is needed, the next stage may be a 5250.
5250: Up to 14 Additional Days
A 5250 is a certification for up to 14 days of intensive psychiatric treatment.
It is not simply an automatic extension of a 5150.
The facility must certify that the person continues to meet qualifying criteria and cannot appropriately be treated voluntarily.
Once a person is placed on a 5250, they are entitled to legal review of the detention.
The Certification Review Hearing
A certification review hearing, often called a probable-cause hearing, is generally held within four days after certification unless the patient requests judicial review instead or a permitted postponement occurs.
At this hearing, the hospital must present evidence supporting continued involuntary detention.
The patient may be assisted by a patients’ rights advocate or attorney and may present their own evidence.
The hearing officer decides whether probable cause exists to continue the hold.
If probable cause is not established, the patient must be released from involuntary detention, although they may choose to remain voluntarily.
If the hold is upheld, the patient may continue to be treated under the certification.
The Writ Hearing: Asking a Judge to Review the Hold
A person detained under the LPS Act also has the right to seek judicial review through a writ of habeas corpus.
In practical terms, the patient is asking:
“Does the hospital still have sufficient legal grounds to keep me here?”
California law provides that a detained person, or someone acting on their behalf, may request release and judicial review. The court must either release the person or arrange an evidentiary hearing within the statutory timeframe; under WIC §5275, that hearing is generally to occur within two judicial days after the petition is filed.
A writ hearing differs from the hospital-based certification hearing because it places the question of continued detention before the court.
These hearings are an important safeguard: involuntary treatment is a significant restriction of liberty, and the hospital must continue to justify why detention remains legally necessary.
What Happens After the 5250?
Most patients do not progress through every stage of California’s involuntary-treatment system.
Some improve and are discharged.
Some transition to voluntary treatment.
Some continue to meet criteria for further detention.
For a person who remains gravely disabled after the 14-day period, California law allows additional intensive treatment under WIC §5270.15, often informally referred to as a “5270.”
This permits up to 30 additional days when the person remains gravely disabled and remains unwilling or unable to accept treatment voluntarily. Another certification review process applies.
5270.70: Another Possible 30 Days
California law now also permits, in qualifying cases, an additional period of up to 30 more days under WIC §5270.70.
This is different from simply extending the hold administratively.
During the initial 30-day period, if the patient remains gravely disabled and continues to be unable or unwilling to accept voluntary treatment, the treating facility may petition the Superior Court.
The court may authorize another period of up to 30 days only after making the findings required by the statute, including that the person remains gravely disabled and is likely to benefit from continued treatment.
For families, the important point is that the progression is not:
5150 → automatic 5250 → automatic 5270 → automatic long-term hospitalization.
At each stage, there are additional clinical findings, legal requirements, and opportunities for review.
What Is a Riese Hearing?
A common misconception is that being placed on an involuntary psychiatric hold automatically means the hospital can force psychiatric medication.
That is generally not true.
California recognizes a patient’s right to refuse antipsychotic medication unless an exception applies.
If an involuntarily detained patient refuses prescribed antipsychotic medication, the treating team may request a capacity hearing, commonly called a Riese hearing, after the court decision Riese v. St. Mary’s Hospital. The question is not whether the patient agrees with the doctor. The issue is whether the patient has the legal capacity to give or withhold informed consent regarding the medication.
If the patient is found capable of making that decision, their refusal generally must be respected.
If they are found incapable, antipsychotic medication may be administered according to the legal authorization.
There is also an emergency exception: antipsychotic medication may be given over objection when required to treat an emergency, subject to the statutory requirements.
A Riese hearing concerns medication capacity.
A certification or writ hearing concerns whether the person may continue to be detained.
Those are separate legal questions.
What Can Families Do When a Loved One Refuses Help?
Families frequently feel powerless because they cannot simply “commit” an adult relative to a psychiatric hospital.
But families can play an extremely important role.
If there is an immediate threat of suicide, violence, severe psychosis, or inability to remain safe, call 911 or your local psychiatric crisis service and clearly describe the behavior that concerns you.
Do not rely only on diagnostic labels.
Saying:
“He has bipolar disorder and needs hospitalization”
is much less useful than explaining:
“He has not slept in five days, believes people are trying to kill him, walked into traffic twice today, and is refusing food because he believes it is poisoned.”
Describe specific, recent behaviors related to danger or grave disability.
Give the Treatment Team the History
Once someone is hospitalized, family members can provide valuable information even when the hospital is unable to disclose much in return because of confidentiality laws.
Tell the team about:
- suicide attempts or threats
- access to weapons
- violent behavior
- worsening psychosis or mania
- inability to obtain food or shelter
- refusal of essential medical care
- medication history
- previous hospitalizations
- substance use
- what the person is like when well
- what has helped previously
Write down dates and specific examples whenever possible.
A patient may appear calm during a brief hospital interview while the family has witnessed weeks of progressive deterioration. That history can matter.
Ask About the Legal Status
Families can respectfully ask:
“What type of hold is my loved one currently on?”
If permitted, also ask whether there is an upcoming:
- certification hearing
- writ hearing
- Riese hearing
- 5270 certification
- conservatorship evaluation
Under §5270.15, facilities must make reasonable attempts to notify family members or another person designated by the patient of a certification hearing unless the patient asks that notification not occur.
Confidentiality rules may restrict what staff can disclose, but they do not prevent families from providing information to the treatment team.
What if Your Loved One Does Not Meet 5150 Criteria?
This is one of the hardest situations for families.
A person can be severely mentally ill and still not meet the legal standard for involuntary detention at a particular moment.
In that situation, the goal becomes creating as many paths to voluntary care as possible.
That may include:
- psychiatric evaluation
- urgent outpatient appointments
- mobile crisis services
- substance-use treatment
- intensive outpatient or partial-hospital programs
- family support and education
- coordinated primary-care and psychiatric care
- county behavioral-health services
If the person’s condition worsens, document specific changes and seek reassessment.
The Goal Is Treatment, Not Detention
The purpose of California’s involuntary-treatment system is not punishment.
It attempts to balance two important principles:
protecting people during severe psychiatric crises while also protecting individual liberty and the right to make one’s own medical decisions.
That is why the system contains multiple stages of review.
A 5150 begins an evaluation.
A 5250 requires additional justification.
Certification hearings and writ hearings allow the detention to be challenged.
Riese hearings protect the patient’s right to make medication decisions unless incapacity is established.
And longer periods of involuntary treatment require progressively greater clinical and legal scrutiny.
For families watching someone they love deteriorate, that process can feel frustratingly complex.
Understanding it does not make the crisis easy.
But it can help families know what is happening, what questions to ask, what information to provide, and when to seek help.
If someone is in immediate danger, call 911 or your local emergency or behavioral-health crisis service.
This article provides general educational information about California’s involuntary psychiatric treatment process. It is not legal advice, and procedures may vary by county and facility.