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

California involuntary commitment is governed by the Lanterman-Petris-Short Act, which allows a person to be held against their will only when a mental health disorder (or, since 2024, a severe substance use disorder) makes them dangerous or unable to meet their own basic needs.¹ The process begins with a 72-hour emergency hold and can extend, through defined steps, up to a one-year conservatorship. Each step carries its own criteria, timelines, and legal protections.

Who Qualifies for an Involuntary Hold

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

The first is danger to self: the person has threatened, attempted, or acted in a way showing a serious intent to harm or kill themselves. The second is danger to others, established by credible threats of violence or an actual attempt to physically hurt someone. The third is gravely disabled, which generates the most litigation because it requires no threat of violence. A disorganized person living on the street, refusing food, and unable to care for themselves because of psychosis can meet this standard even if they pose no physical danger.

How SB 43 Changed the Gravely Disabled Standard in 2024

Before 2024, “gravely disabled” was limited to the inability to provide food, clothing, or shelter. SB 43 widened it in two ways. First, personal safety and necessary medical care were added to the list of basic needs. A person who cannot keep themselves physically safe in the community, or who is refusing critical medical treatment a doctor says is needed to prevent serious bodily injury, can now qualify.³

Second, the standard reaches beyond mental health disorders alone. A person with a severe substance use disorder, or a co-occurring mental health and substance use disorder, can be involuntarily held if the condition prevents them from meeting their basic needs. “Severe substance use disorder” refers to the highest severity level under the current Diagnostic and Statistical Manual of Mental Disorders.³

The 72-Hour Hold (5150)

The starting point is the 5150 hold, named after the Welfare and Institutions Code section that authorizes it. It permits detention 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 initiate a 5150. 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 must decide, based on their own observations, that probable cause exists.

A 5150 is not a criminal arrest, and no charges are filed. The person must be taken to a county-designated psychiatric facility. Many people are released before the full 72 hours run. The treating psychiatrist has to let the person go as soon as they conclude further evaluation or treatment is no longer needed.⁵

The 14-Day Certification (5250)

If the treatment team decides the person still meets one of the criteria as the 72 hours end, the facility can certify them for up to 14 more days of intensive treatment. This is a 5250 hold, and the facility has to document specifically why the person remains dangerous or gravely disabled.⁶

An important protection kicks in here. A certification review hearing must occur within four days of the certification, unless the patient or their attorney asks to postpone it.⁶ The hearing is informal and administrative rather than a full trial, but the facility has to present evidence justifying continued detention. Under U.S. Supreme Court precedent, involuntary civil commitment requires proof by at least clear and convincing evidence.⁷

Longer Holds: 30 Days and 180 Days

Two additional tracks exist beyond 14 days, and they depend on which criterion the person meets.

For a person who remains gravely disabled, the facility can seek an additional 30-day intensive treatment period under WIC 5270.15. Combined with the 72-hour hold and the 14-day certification, the maximum involuntary detention through this track is 77 days.⁸ If long-term oversight looks likely, the facility must make a conservatorship referral early enough for the county to investigate before the hold expires.

A separate, more restrictive path applies to people who pose an imminent danger to others. If the person threatened or actually inflicted serious physical harm on someone during the hold, the district attorney can file a petition under WIC 5300 for a 180-day postcertification hold. That petition triggers a formal court proceeding, and the person has the right to a jury trial within 10 days of filing. Unlike the gravely disabled track, the 180-day hold is renewable, so the state can seek additional 180-day periods if the person continues to meet the criteria.

Your Rights During an Involuntary Hold

Being detained does not strip a person of their legal rights. California law guarantees a specific set of protections, which the facility must post in languages accessible to patients. They 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 representation 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 Riese hearing, named after the case that established the procedure. At a Riese hearing, a judge must find by clear and convincing evidence that the patient lacks the capacity to make an informed decision about their treatment. The judge looks at whether the person can understand the information given to them and whether they can 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 also covers electroconvulsive therapy and other convulsive treatments, which cannot be administered without informed written consent. That right is absolute and cannot be overridden by court order.

Challenging the Hold in Court

At any point during a hold, the person can file a petition for a writ of habeas corpus in the Superior Court. The petition asks a judge to review whether the detention is legally justified, and the court must order release if the person does not meet the criteria. California Courts publishes a specific form for this (HC-003), and the facility is required to help patients who want to file.¹⁰

LPS Conservatorship

When someone is chronically gravely disabled and short-term holds are not resolving the situation, the LPS Act allows for a more lasting arrangement: LPS conservatorship. This is a formal court proceeding that gives another person, the conservator, authority to make decisions about the individual’s treatment, housing, and in some cases finances.

The process typically begins when a treating physician or care provider refers the case to the county Public Guardian’s office. An investigator evaluates whether conservatorship is truly necessary, including examining alternatives. Conservatorship is meant to be a last resort, not a default.¹¹ If the investigator recommends moving forward, the Public Guardian files a petition with the court.

The court has to 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 renewal is sought, the conservatee can challenge it and request a trial before a judge or jury.¹¹ The conservator’s powers often include placing the person in a locked treatment facility and consenting to psychotropic medication on their behalf.

Firearm Restrictions After a Hold

A 5150 hold has consequences that outlast the detention itself. Anyone detained on a 5150 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.¹² A person subject to the five-year restriction can petition for a hearing to have it lifted, but they carry the burden of showing they can safely possess firearms.

A more severe restriction applies to anyone formally adjudicated by a court as a danger to others because of a mental disorder. That adjudication produces a lifetime firearm ban, liftable only by a court certificate stating the person no longer poses a danger.¹² Separately, federal law prohibits anyone who has been “committed to a mental institution” from possessing firearms or ammunition.¹³ Whether a California 5150 hold alone qualifies as a federal “commitment” is unsettled and courts have not uniformly resolved it. A formal LPS conservatorship or a court-ordered commitment almost certainly triggers the federal prohibition.

Discharge and Follow-Up Care

When the treating psychiatrist decides the person no longer meets the criteria, the facility must release them. Early release during a 72-hour hold can happen at any point. Facilities cannot keep someone simply because the hold has not yet expired if the clinical justification has disappeared.⁵

Before releasing someone who was referred for voluntary follow-up care, the facility has to 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 have to be given to the person before they leave.⁵ All treatment after discharge is voluntary unless a new hold or conservatorship is initiated.

What Family Members Can and Cannot Learn

Family members are often the ones calling for help, only to find themselves shut out of information 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 usually 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 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
Justia U.S. Supreme Court Center. Addington v. Texas, 441 U.S. 418 (1979)
8
California Legislative Information. California Code WIC 5270.55 – Maximum Detention Period for Gravely Disabled Persons
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
Los Angeles County Department of Mental Health. Frequently Asked Questions – LPS Conservatorships
12
California Legislative Information. California Code WIC 8103 – Firearm Restrictions for Mental Health Detentions
13
Office of the Law Revision Counsel. 18 U.S. Code 922 – Unlawful Acts
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