1. Sierra Vista Hospital Department of Psychological Services Understanding 5150 Laws Presented by Scott Christian Selinsky MA Sierra Vista Hospital Court Liaison

2. Learning Objectives  Participants will understand the 5150 Process.  Participants will become familiar with legal language used in involuntary detentions.  Participants will understand how to interact effectively with the involuntary detention process to achieve more favorable outcomes for themselves and family.

3. Overview of Topics  Important Terms  Lanterman, Petris, Short Act  Criteria for an Involuntary Hold  Voluntary vs. Involuntary  What Happens After a 5150 Expires  Patients’ Rights  Due Process Right  The Parent’s Role When the Detainee is a Minor  Glossary  Where to Find More Information

4. Important Terms  Involuntary  Voluntary  LPS  Criteria  Probable Cause

5. WHY? Lanterman-Petris-Short Act of 1968  Rising public awareness and concern for abuses related to involuntary commitment, as well as to threats to the welfare of the community prompted legislatures to frame legal codes that attempt to balance the needs of individuals for freedom with their need for treatment.

6. WHY? LPS Legislative Intent  To end the inappropriate, indefinite, and involuntary commitment of mentally disordered and developmentally disabled persons, and those impaired with chronic alcoholism. least restrictive alternative  To require treatment and rehabilitation be the least restrictive alternative to a total curtailment of freedom and the personal liberty of the individual.  To provide prompt evaluation and treatment for these persons.  To guarantee and protect the public interest.  To safeguard individual rights through judicial review.

7. WHY? Who Can Write Holds? Mental Health Director Certified 5150 Designees Authorized staff at a designated 5150 psychiatric facility Law Enforcement-Peace Officers

8. WHO? Criteria for an Involuntary Hold WHO? Criteria for an Involuntary Hold Danger to Self and/or Danger to Others and/or Gravely Disabled Adult/Minor

9. WHO? Danger to Self Deliberate plan to inflict serious and severe harm to the self, possibly life-threatening, with the means and intention to use the means other life-threatening behaviors where impending severe injury or death is imminent. Some Factors Being Considered May Be:  Words or actions showing intent to commit suicide or serious bodily harm  Words or actions indicating gross disregard for personal safety  Words or actions indicating a specific plan for suicide  Means available to carry out suicide plan

10. WHO? Danger to Others Danger to Others is based on criteria including behaviors and verbalizations indicating the person in question either intends to cause severe harm to a particular individual, or intends to engage in acts potentially life-threatening against others, or intends to engage in acts with gross disregard for the health and safety of others. Some Factors Being Considered May Be:  Nature of the threats against society, others in general, or a particular individual(s)  Current and prior threats or attempts to harm others or a particular individual(s)  Means available to carry out threats (i.e., firearms, weapons, poisons);  Expressed intention or attempts to engage in life threatening activities.

11. WHO? Gravely Disabled Minor "Gravely disabled minor" means a minor who, as a result of a mental disorder, is unable to use the elements of life which are essential to health, safety, and development, including food, clothing, and shelter, even though provided to the minor by others. (W & I Code 5585.25)

12. Involuntary Hospitalization The LPS Act permits involuntary hospitalization only of those mentally disabled persons for whom such confinement, with its accompanying severe deprivation of liberty, is necessary and appropriate. The LPS Act authorized involuntary evaluation and treatment only for individuals who are dangerous to themselves and others, and/or gravely disabled. Involuntary hospitalization is a temporary suspension of an individuals rights and freedoms.

13. Voluntary Hospitalization 5150 application NOT always required When, as a result of a mental disorder, someone is a danger to self, danger to others and/or gravely disabled and they are willing and capable of voluntarily self- admitting into a 5150 psychiatric facility then the criteria for admission can be voluntary. It is important to have safeguards and supports in place whether voluntary or involuntary.

14. Legal Status Can Change A patient who is admitted to the an inpatient psychiatric facility on a voluntary basis but later becomes unwilling or unable to accept voluntary treatment, and is deemed to be a danger to self, others, or gravely disabled due to a mental disorder, can be placed on an involuntary hold. On the other hand, a patient admitted involuntarily to an inpatient psychiatric facility may be signed in voluntarily for additional inpatient treatment by themselves (adults only), or by a parent/legal guardian (minors).

15. What Happens After the 72 Hours?  5250 14-Day Certification  Certification Review Hearing for contesting a 5250 Hold  Writ of Habeas Corpus by Judicial Review  5260 Re-Certification as Suicidal 14 more Days  Certification Review Hearing for contesting a 5260 Hold  Writ of Habeas Corpus by Judicial Review  5270 Additional 30 Days Intensive Treatment (GD Only)  Certification Review Hearing for contesting a 5270 Hold  Writ of Habeas Corpus by Judicial Review Other Matters:  5300 Post-Certification (Dangerous Persons) 180 Days  5352 Temporary Conservatorship (Gravely Disabled)  5350 Conservatorship for Grave Disability

16. Patients Rights While Detained  Rights that can be denied with good cause. – Clothing – Money – Visitors – Storage Space – Personal Possessions – Telephone – Mail – Writing Materials  Rights that CANNOT be denied. – Humane Care – Social Activities and Recreation – Education – Religious Freedom and Practice – Freedom from Discrimination

17. Due Process Rights  Any person placed on an involuntary hold is entitled to due process. This means that within four days of the hold being written, he they are guaranteed an opportunity to speak to a Superior Court Judge or Hearing Officer about their hold status, within 4 days of the hold being written.  Certification Review Hearings  Writ of Habeas Corpus Hearings

18. The Parent’s Role  As best you can, understand what the LPS law says before you child is ever placed on a hold.  Your child can be placed on an involuntary hold without you present, so be as readily available to offer information to the person evaluating your child for 5150 criteria.  Know that the designee writing the hold can detain your child for assessment— without your consent. LPS law gives them this authority.  If your child is hospitalized, immediately after admit, request to speak to the treating physician. If not available, ask when you can call back. Do not hesitate to ask the hospital’s administration to assist you in securing contact with the doctor.  If you disagree with the detainment, inform the doctor and let the doctor know why.  Be emotionally prepared for the doctor to detain your child for the duration of the 5150 anyway. Most doctors treat children with great caution.  Be ready to discuss medications, and be sure to ask lots of questions, so as to make an informed decision. Try to be flexible. Conflict is typically counterproductive to your child’s hospital experience.  Even if you and the doctor do not reach consensus, recognize that in the vast majority of cases, the doctor is trying to help, using the tools they have been extensively trained to apply to these types of circumstances.  INCLUDE YOUR CHILD IN THIS DIALOGUE.

19. Brief Glossary 5250—14 day hold for DTS and/or DTO and/or GD 5260—14 day hold that can be written after a 5250 expires; it is for DTS only 5270—30 day hold that can be written after a 5250 expires; it is for GS only 5300—180 day hold that can be written after a 5250 or 5270; it is for DTO only Cert Hearing—shorthand for Certification Review Hearing, granted to any patient placed on 5250 or 5270. These matters are presided over by a Hearing Officer, and the patient receives the assistance of a Patients’ Rights Advocate to present their case at the hearing. Confidential—the obligation during the course of a professional relationship, not to disclose information about a patient or client without the explicit permission of the individual DTO—shorthand for Danger To Others DTS—shorthand for Danger To Self GD—shorthand for Grave Disability Good Cause—refers to the criteria for denying a specific patients right; good cause exists only when allowing the right would cause injury to that person or others, serious infringement on the rights of others, or serious damage to the facility ICR—shorthand for Independent Clinical Review. It is the right of all minor patients to seek to get out of the hospital after their parent or legal guardian has signed them in voluntarily for more inpatient treatment. The minor can ask the hospital to arrange for a such a review of their case, and if the reviewer agrees with the minor, the minor must be discharged, even if it against the wishes of the parent/guardian and/or the treating physician. Involuntary—the circumstance where an individual is placed on a legal hold and detained against their will (or perhaps against the will of their parent/guardian) for the purpose of evaluation and treatment LPS—shorthand for the Lanterman, Petris, Short Act Privacy—refers to the basic constitutional right of all citizens of the United States to decide how much personal information can be shared with others

20. Brief Glossary cont’d Probable Cause—the standard of evidence applied to Certification Review Hearings. Specifically it is commonly understood to mean a reasonable amount of suspicion, supported by circumstances sufficiently strong to justify a prudent and cautious person’s belief that certain facts are probably true Risk Assessment—this is commonly the most significant aspect of assessing whether or not an individual meets criteria to be placed on an involuntary legal hold. Most professionals that write legal holds utilize the standard of “reasonable and cautious” in assessing risk. Voluntary—the circumstance where an individual makes an informed decision to accept treatment in an inpatient setting. The individual is being detained, for treatment, and significant freedoms are curtailed, but this is NOT being done against their will. Writ Hearing—If an individual does not prevail at their Cert hearing, they are allowed one opportunity to have their matter heard before the court. The individual is represented by an attorney (typically a Public Defender) at these hearings, and the matter is presided over by a judge from the Superior Court.

21. Where To Find More Information Disability Rights California: Primary Source for MH Advocacy in CA http://www.disabilityrightsca.org/ CA State Codes for Mental Health: Full Text of the LPS Act http://leginfo.legislature.ca.gov/faces/codesTOCSelected.xhtml http://leginfo.legislature.ca.gov/faces/codesTOCSelected.xhtml Kathi’s Mental Health Review: Site with great information on advocacy http://www.toddlertime.com/advocacy/5150/rights/ http://www.toddlertime.com/advocacy/5150/rights/ NAMI: National Alliance on Mental Illness: Education and support for individuals and families effected by mental illness http://www.namicalifornia.org/ Your Presenter: Scott “Christian” Selinsky (916)288-0321 my office christian.selinsky@uhsinc.comchristian.selinsky@uhsinc.com my email