California Involuntary Commitment: SB 43 Criteria, Holds, and Rights

In California, involuntary commitment is the process under the Lanterman-Petris-Short (LPS) Act that allows a person with a mental health disorder to be held for psychiatric evaluation and treatment against their will if they are a danger to themselves, a danger to others, or gravely disabled.¹ It begins with a 72-hour emergency hold and can escalate through a 14-day certification, a 30-day or 180-day extension, and, in long-term cases, a one-year conservatorship. A 2024 law, SB 43, broadened who qualifies, bringing severe substance use disorders into the framework for the first time.

Who Can Be Held and Why

A person can be detained only if a mental health disorder causes them to meet at least one of three standards.²

Danger to self: the person has threatened, attempted, or taken actions showing a serious intent to harm or kill themselves.
Danger to others: the person has made credible threats of violence or has actually tried to physically hurt someone.
Gravely disabled: a mental health disorder leaves the person unable to meet their own basic needs.

The gravely disabled standard generates the most confusion because it does not require any threat of violence. Someone disorganized and living on the street, refusing food and unable to care for themselves because of psychosis, can meet this standard even though they pose no physical danger to anyone.

What SB 43 Changed in 2024

Before 2024, “gravely disabled” was limited to the inability to provide food, clothing, or shelter. SB 43 added two new categories to that list: personal safety and necessary medical care. A person who cannot keep themselves physically safe in the community, or who is refusing critical medical treatment that a doctor says is needed to prevent serious bodily injury, now qualifies.³

The law also extended the gravely disabled standard beyond mental health disorders. A person with a severe substance use disorder, or a co-occurring mental health and substance use disorder, can now be involuntarily held if that condition prevents them from meeting their basic needs. “Severe substance use disorder” means the person meets the highest severity level under the current Diagnostic and Statistical Manual of Mental Disorders.³ This was the most significant change to California’s commitment framework in decades.

The 72-Hour Emergency Hold

The entry point is the 5150 hold, named after the Welfare and Institutions Code section that authorizes it. It allows a person to be taken into custody for up to 72 hours for assessment, evaluation, and crisis intervention. The clock starts the moment the person is first detained, not when they arrive at the hospital.⁴

Not just anyone can place a 5150 hold. The law limits that authority to peace officers, the clinician in charge of a county-designated evaluation and treatment facility, attending staff at such a facility, designated members of a mobile crisis team, and mental health professionals designated by the county.⁴ A family member, employer, or friend cannot place one directly. They can call 911 or a county crisis team, but someone with statutory authority has to make the final probable-cause determination based on their own observations.

A 5150 hold is not a criminal arrest, and the person is not charged with a crime. Once initiated, the person must be taken to a county-designated facility approved for psychiatric evaluation. The treating psychiatrist must release the person as soon as they believe evaluation or treatment is no longer needed, which often happens well before 72 hours expire.⁵

The 14-Day Certification

If the treatment team determines the person still meets one of the three criteria as the 72-hour hold nears its end, the facility can certify the person for up to 14 additional days of intensive treatment. This is commonly called a 5250 hold. The facility must document specifically why the person continues to be dangerous or gravely disabled.⁶

The person gets an important procedural protection: a certification review hearing must take place within four days of the certification, unless the person or their attorney requests a postponement.⁶ The hearing is administrative rather than a full courtroom trial, but the facility must present evidence justifying continued detention.

Longer Extensions: 30 Days and 180 Days

When 14 days are not enough, the law provides two further tracks depending on the reason for the hold.

For someone who remains gravely disabled, the facility can seek a 30-day additional intensive treatment period under WIC 5270.15. Combined with the initial 72-hour hold and the 14-day certification, the maximum total detention through this track is 77 days.⁷ If longer oversight is likely to be needed, the facility must make a conservatorship referral early enough for the investigation to happen before the hold runs out.

A separate and more restrictive path applies to people who pose an imminent danger to others. If a person has threatened or actually inflicted serious physical harm on another during the hold period, the district attorney can file a petition for a 180-day postcertification hold under WIC 5300. This requires a formal court proceeding, and the person has the right to a jury trial within 10 days of the petition being filed. The 180-day hold is renewable, meaning the state can seek additional 180-day periods if the criteria continue to be met.

LPS Conservatorship for Long-Term Cases

When someone is chronically gravely disabled and short-term holds are not resolving the situation, the LPS Act provides for an LPS conservatorship. This is fundamentally different from the holds above. It is a formal court proceeding that gives a conservator authority to make decisions about the individual’s treatment, housing, and in some cases finances.

The process typically starts when a treating physician or care provider refers the case to the county Public Guardian. An investigator evaluates whether conservatorship is truly necessary, including whether any alternative exists. The law requires that conservatorship be a last resort.⁸ If the investigator recommends moving forward, the Public Guardian files a petition with the court.

The court must find that the person is gravely disabled due to a mental health disorder (or, after SB 43, a severe substance use disorder or co-occurring condition) and is unable or unwilling to accept voluntary treatment. An LPS conservatorship lasts a maximum of one year. At the end of that year, the county must either drop it or ask the court to renew; if it seeks renewal, the conservatee can challenge it and request a trial before a judge or jury.⁸ The conservator’s powers often include authorization to place the person in a locked treatment facility and to consent to psychotropic medication on the person’s behalf.

Your Rights While Held

Being involuntarily detained does not strip someone of their legal rights. California law guarantees a specific set of protections that must be posted in the facility in languages patients can read. These include the right to wear your own clothing, keep personal possessions, see visitors each day, make and receive confidential phone calls, and send and receive unopened mail.⁹ Every person on a hold also has the right to be represented by a patients’ rights advocate or public defender, particularly at the certification review hearing.

Refusing Medication

A person on an involuntary hold generally has the right to refuse psychotropic medications. The facility can override that refusal in only two situations. The first is a genuine emergency where the person’s behavior presents an immediate threat to safety. The second requires a court hearing known as a Riese hearing. At a Riese hearing, a judge must determine by clear and convincing evidence that the patient lacks the capacity to make an informed decision about their own treatment, looking at whether the person can understand the information given and act on it in a knowing and intelligent way. If the judge finds incapacity, the facility can administer medication over the patient’s objection for the duration authorized by the order.⁹

The right to refuse electroconvulsive therapy and other convulsive treatments is absolute. Those treatments cannot be administered without the patient’s informed written consent, and that right cannot be overridden even by court order.

Challenging the Detention

At any point during a hold, the person can file a petition for a writ of habeas corpus with the Superior Court. The petition asks a judge to review whether the detention is legally justified. If the court finds that the person does not meet the commitment criteria, it must order their release. The California Courts provide a specific form (HC-003) for this purpose, and the facility must assist patients who want to file one.¹⁰

Discharge and What Follows

When the treating psychiatrist determines the person no longer meets the commitment criteria, the facility must release them. Facilities cannot keep someone just because the hold has not yet expired if the clinical justification has disappeared.⁵

Before releasing someone referred for voluntary follow-up care, the facility must develop a care coordination plan with input from the person being discharged, the county behavioral health department, and the person’s health insurer. The plan must include a first follow-up appointment with a behavioral health professional, and the appointment details must be provided to the person before they leave.⁵ All treatment after discharge is voluntary unless a new hold or conservatorship is initiated.

Firearm Restrictions After a Hold

A 5150 hold carries consequences that outlast the detention. Under California law, any person detained on a 5150 hold is prohibited from owning, possessing, purchasing, or receiving a firearm for five years from the date of admission. The facility must notify the person of this ban before or at the time of discharge.¹¹ A person subject to the five-year restriction can petition for a hearing to have it lifted, but carries the burden of showing they can safely possess firearms.

A more severe restriction applies to anyone a court has formally adjudicated as a danger to others because of a mental disorder. That adjudication results in a lifetime firearm ban that can only be lifted by a court certificate stating the person no longer poses a danger.¹¹ Separately, federal law prohibits anyone “committed to a mental institution” from possessing firearms or ammunition.¹² Whether a California 5150 hold alone qualifies as a federal “commitment” is a legal question courts have not uniformly resolved. A formal LPS conservatorship or a court-ordered commitment almost certainly triggers the federal prohibition.

Effect on Social Security and VA Benefits

A 5150 hold by itself does not involve a court finding of incompetence and generally does not affect benefit payments. The risk arises when the process escalates. The Social Security Administration presumes that any adult a state court has found legally incompetent needs a representative payee to manage their benefits, and an LPS conservatorship can trigger that requirement. Once a representative payee is appointed, the beneficiary no longer receives checks directly; the payee manages the funds on their behalf.¹³

What Family Members Can Learn

Family members are often the ones who called for help and then find themselves shut out once the hold begins. Under HIPAA, a provider can disclose health information to family only if the patient agrees, or if the information is directly relevant to that family member’s involvement in the patient’s care. In practice, a hospital can confirm the patient’s location and general condition, but sharing treatment details without consent is restricted.¹⁴

If a court has appointed someone as a personal representative with authority to make healthcare decisions, that person generally has the same right to access medical information as the patient. A provider can still refuse to share even with a personal representative if they reasonably believe doing so would endanger the patient.¹⁵

1
Justia. California Code WIC Division 5 Part 1 – The Lanterman-Petris-Short Act
2
California Department of State Hospitals. Civil Commitments
3
California Department of Health Care Services. Senate Bill 43, Changes to Gravely Disabled Behavioral Health Criteria – FAQ
4
California Legislative Information. California Code WIC 5150 – Involuntary Psychiatric Hold
5
California Legislative Information. California Code WIC 5152 – Release Procedures
6
Justia. California Code WIC 5250-5259.3 – Certification for Intensive Treatment
7
California Legislative Information. California Code WIC 5270.55 – Maximum Detention Period for Gravely Disabled Persons
8
Los Angeles County Department of Mental Health. Frequently Asked Questions – LPS Conservatorships
9
California Legislative Information. California Code WIC 5325 – Rights of Persons Involuntarily Detained
10
California Courts. HC-003 Petition for Writ of Habeas Corpus – Mental Health
11
California Legislative Information. California Code WIC 8103 – Firearm Restrictions for Mental Health Detentions
12
Office of the Law Revision Counsel. 18 U.S. Code 922 – Unlawful Acts
13
Social Security Administration. Guide for Organizational Representative Payees
14
U.S. Department of Health & Human Services. Disclosures to Family and Friends
15
U.S. Department of Health & Human Services. Personal Representatives Under HIPAA