Understanding Involuntary Holds

In my experience working as a mental health worker, the reality of the floor is physical. But the structure of the floor is legal. 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 outsiders ask is not about therapy or medication. It is about custody. How and why can someone be held in a facility against their will?

In California, the code that governs this is the Lanterman-Petris-Short (LPS) Act. It is not a criminal process. It is a civil one, designed for crisis intervention. The workflow most often begins with an emergency 72-hour hold. For adults, this is the WIC 5150. It allows for assessment and evaluation if a person meets one of three strict criteria: they are a danger to themselves, a danger to others, or gravely disabled.

That last term is the most complex variable. Gravely disabled means someone cannot provide for their own basic needs like food, clothing, or shelter due to a mental health condition. A recent update, Senate Bill 43, expanded this definition to potentially include severe substance use disorders. (A similar hold, the WIC 5585, applies to children).

The system has built-in logic gates. 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, the system activates legal protections. 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 against the hospital. If a person remains an explicit suicide risk after this period, their treatment can be extended for another 14 days under a WIC 5260.

For situations requiring longer care, the legal frameworks become more complex. A person with a developmental disability who is dangerous can be placed in a facility by a regional center under a WIC 6500, which requires court review. In other cases, a school district may determine that a hospital's youth wing is the only safe placement for a child.

The most restrictive measure is an LPS Conservatorship. This is where the court appoints a guardian to make major life decisions for a person, stripping them of significant civil liberties.

Of course, a person can always admit themselves voluntarily. But on the floor, that line often 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, yet they remain because there are no safe places for them to go in the community. They are voluntary by default, not by choice.

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