Occasionally, I’ll get the call where a family member asks if there is a process to forcibly send a person into treatment. Generally speaking, the answer is no. There are certain exceptions, for instance, minors, and leverage can certainly be used if there are some legal issues (criminal or civil) hanging over the addicts head. But absent some very specific and limited exceptions, you can’t just force a person into treatment.

In California, however, you can attempt to get an involuntary psychiatric evaluation, commonly referred to as a 5150, with an eye toward obtaining some level of short term medical treatment during the mandatory hold. The 5150 process does have specific criteria and is not an easy undertaking, especially if you are dealing with a reluctant participant to the treatment process.

The California Welfare and Institutions Code (WIC) 5150 is an application for involuntary admission for up to 72 hours from the time the declaration is written. WIC 5150 is not itself a direct admission form and does not of itself authorize the involuntary admission; it merely gets the individual to the door. Then, as described in WIC 5151: Prior to admitting a person to the facility, the professional person in charge of the facility or his or her designee shall assess the individual in person to determine the appropriateness of the involuntary detention. During the period of confinement, a confined individual is evaluated by a mental health professional to determine if a psychiatric admission is warranted. Confinement and evaluation usually occurs in a county mental health hospital or in a designated emergency room facility. If the individual is then admitted to a psychiatric unit, only a psychiatrist may rescind the 5150 and allow the person to either remain voluntarily or be discharged.

On or previous to the expiration of the 72 hours, the psychiatrist must assess the person to see if they still meet criteria for hospitalization. If so, the person may be offered a voluntary admission. If it is refused, then another hold for up to 14 days may be applied for.

The criteria for a 5150 hold requires probable cause. This includes danger to self, danger to others together with some indication, prior to the administering of the hold, of symptoms of a mental disorder, and/or grave disability. The conditions must exist under the context of a mental illness and the person must be refusing psychiatric treatment.

I can report from experience that a 5150 hold is not an easy process and one that local authorities take very seriously. A family called me and shared their experience with the process. Their loved one, a 50ish year old female alcoholic, was resistant to treatment. She lived alone in a large house and was a recluse. It was clear that her alcoholism was progressing to the point where her family feared that she would soon die from the disease. They called the local authorities (911) and attempted to get an involuntary hold. Police and the fire department arrived and preformed a brief assessment using the above-referenced criteria. After asking her a series of questions to determine mental state (name, where do you live, what day is it, etc.) and questioning her further regarding suicidality and homicidality, they determined that she did not meet the criteria for a 5150 hold. Although she arguably was gravely disabled (she was drunk at the time, empty bottles all over the floor, empty food containers strewn about), her condition was nevertheless insufficient to satisfy the “gravely disabled” provision of the code and the authorities had no alternative but to leave the house.

While a 5150 hold is available where appropriate, it is not a guarantee. Specific statutory criteria must be met. In cases where a 5150 is requested resulting from addiction, there still remains the very serious question of drug/alcohol treatment. At best, the family hopes for three days (and perhaps an additional 14 if granted) to plant the seed of treatment to address the addiction issues.

For information on interventions visit Steven Lodge Interventions or call 866 534 4443.