Civil commitment in California is the legal process for detaining a person for psychiatric treatment against their will, governed primarily by the Lanterman-Petris-Short (LPS) Act. It moves in stages: a 72-hour emergency hold, a 14-day certification, and, when someone needs long-term care, a conservatorship that can last a year at a time. Each step tightens the procedural protections and raises the burden on the state, and each carries consequences that outlast the hospital stay.
The 72-Hour Hold Under 5150
The entry point is the “5150 hold,” named for Welfare and Institutions Code 5150. A person can be taken into custody when there is probable cause to believe that a mental health disorder makes them dangerous to themselves, dangerous to others, or gravely disabled.1California Legislative Information. California Welfare and Institutions Code 5150 The 72-hour clock starts at the moment of detention, not on arrival at a facility.
Not everyone can place a hold. The authority is limited to peace officers, the professional person in charge of a county-designated evaluation facility, attending staff at that facility, designated mobile crisis team members, and other professionals specifically designated by the county.1California Legislative Information. California Welfare and Institutions Code 5150 A family member, neighbor, or employer cannot initiate a 5150. They can call law enforcement or a mobile crisis team, but the decision to detain rests with authorized personnel.
“Gravely disabled” has a statutory meaning: a person who, because of a mental health disorder, a severe substance use disorder, or both, cannot provide for their own basic needs for food, clothing, shelter, personal safety, or necessary medical care. A substance use disorder alone, without resulting grave disability or dangerousness, does not qualify.
The standard requires observable evidence of immediate risk. A person expressing suicidal intent with a specific plan, or engaging in violent behavior toward others, would typically meet it. General distress, unusual behavior, or a diagnosis on its own would not. The Ninth Circuit’s decision in Doe v. Gallinot (1981) reinforced that due process requires a probable cause hearing following emergency detention, and that vague or speculative concerns cannot justify taking away someone’s liberty.
What Happens During the 72 Hours
Once detained, the person is transported to a county-designated psychiatric facility for assessment and crisis intervention. Clinical staff evaluate psychiatric history, current symptoms, and immediate risk. The person must receive written notice explaining why they are being held, including which of the three criteria the facility believes they meet.1California Legislative Information. California Welfare and Institutions Code 5150
The 72 hours are a maximum, not a fixed sentence. If the treating clinician determines at any point that the person no longer meets the criteria, they must be released. When the clock runs out, three things can happen: release, agreement to stay voluntarily, or the facility initiates a 14-day certification.
The 14-Day Certification Hold
If someone continues to meet the criteria at the end of the evaluation, the facility can certify them for up to 14 additional days of intensive treatment under Welfare and Institutions Code 5250.2California Legislative Information. California Welfare and Institutions Code 5250 This requires a written certification from professional staff explaining why continued detention is necessary.
Protections increase at this stage. The patient must receive written notice, has the right to request a writ of habeas corpus to challenge the detention in court, and must have their designated advocate or legal representative notified. A certification review hearing must take place within four days of the hold being filed, unless the patient or their attorney requests a postponement.3California Legislative Information. California Welfare and Institutions Code 5256 Missing that deadline without a requested postponement is a due process violation.
The hearing itself is administrative, not a full trial. A neutral hearing officer, typically an attorney or administrative law judge, decides whether the facility has shown enough evidence to justify continued detention. The patient can attend, be represented, present evidence, and cross-examine witnesses. If the criteria are not met, the patient must be released immediately. A diagnosis alone is never sufficient; there must be concrete evidence that the person’s condition actively prevents them from caring for themselves or creates real danger.
Longer Holds and LPS Conservatorship
California law provides several paths for extending involuntary treatment beyond 14 days, each with escalating safeguards.
The 30-Day Intensive Treatment Hold
Under Welfare and Institutions Code 5270.15, a person who remains gravely disabled at the end of the 14-day hold can be certified for up to 30 additional days. The facility must provide a certification review hearing, clinical staff must reassess the person at least every 10 days, and the facility must make reasonable attempts to notify family members at least 36 hours before the hearing.
The 180-Day Post-Certification Hold
For individuals who pose a continuing danger to others because of a mental disorder and have recently committed violent acts, a 180-day post-certification commitment is available under Welfare and Institutions Code 5300. It requires a court petition, and the patient has the right to a jury trial if they request one. Outpatient treatment may be ordered as an alternative to full hospitalization.
LPS Conservatorship
For long-term involuntary care, the county can petition for an LPS conservatorship under Welfare and Institutions Code 5350. A temporary conservatorship can be established for up to 30 days while the full petition is prepared.4California Legislative Information. California Welfare and Institutions Code 5352.1 If a full conservatorship is granted, a court-appointed conservator gains authority over treatment decisions and living arrangements for up to one year. The conservatorship can be renewed annually, and there is no cap on renewals. The burden of proof for a full LPS conservatorship is beyond a reasonable doubt, and the person has the right to a jury trial.
This is where the system reaches furthest. An LPS conservator can decide where someone lives, whether they take psychiatric medication, and whether they accept other medical treatment. The person under conservatorship retains the right to challenge it through a writ of habeas corpus at any time.
Rights During Detention
Involuntary detention does not strip someone of all their rights. Under Welfare and Institutions Code 5325, detained individuals retain the right to receive visitors daily, make and receive confidential phone calls, access letter-writing materials and stamps, and send and receive unopened mail. Patients also have an absolute right to refuse psychosurgery and convulsive treatments such as electroconvulsive therapy.5California Legislative Information. California Welfare and Institutions Code 5325
Legal representation is available at every stage. Anyone facing civil commitment has the right to an attorney, and if they cannot afford one, counsel must be appointed. California also mandates patients’ rights advocates in mental health facilities. These advocates investigate complaints about denial of rights or abuse, monitor compliance, and serve as a resource for anyone who believes their rights have been violated.
Refusing Antipsychotic Medication
The right to refuse antipsychotic medication is one of the most significant protections. Under Welfare and Institutions Code 5332, antipsychotic medication can only be given without consent after a court hearing determines that the patient lacks the capacity to make an informed decision about their treatment and that alternatives are unlikely to meet the patient’s needs.6California Legislative Information. California Welfare and Institutions Code 5332
This right was established by Riese v. St. Mary’s Hospital (1987), in which the California Court of Appeal held that involuntarily committed patients cannot be forced to take medications unless a judge determines they cannot make an informed decision about their own care, or unless there is an emergency.7Justia Law. Riese v. St. Marys Hospital and Medical Center The separate hearing that must precede forced medication is commonly called a “Riese hearing.” The one exception is emergencies: if a patient poses an immediate danger, medication can be administered without a prior hearing.
Confidentiality of Records
Mental health records receive strong confidentiality protections under both federal and state law. The HIPAA Privacy Rule restricts how providers can use and disclose protected health information, with heightened protections for psychotherapy notes.8Department of Health and Human Services. HIPAA Privacy Rule and Sharing Information Related to Mental Health California’s Confidentiality of Medical Information Act adds state-level restrictions.
There are exceptions. HIPAA permits disclosure to law enforcement, family members, or others when the provider believes the patient presents a serious and imminent threat, under 45 CFR 164.512(j).8Department of Health and Human Services. HIPAA Privacy Rule and Sharing Information Related to Mental Health Hospitals can also share limited identifying information with law enforcement to locate suspects, fugitives, or missing persons. When state law is stricter than HIPAA, the more protective rule controls.
Federal Firearm Restrictions
Many people don’t learn about this consequence until it’s too late. Under federal law, anyone who has been “committed to a mental institution” is prohibited from possessing firearms or ammunition.9Office of the Law Revision Counsel. 18 USC 922 – Unlawful Acts A 5150 hold alone does not typically trigger the prohibition, but a 14-day certification or longer commitment generally does, and the record is reported to the National Instant Criminal Background Check System.
The prohibition is not necessarily permanent. Federal law allows a person to seek relief through a “Relief from Disabilities” program administered by a qualifying federal or state authority, as required by the NICS Improvement Amendments Act of 2007.10Bureau of Alcohol, Tobacco, Firearms and Explosives. Federal Firearms Prohibition Under 18 USC 922(g)(4) The interaction between federal and California state law here is complex, and anyone who has been committed and wants to understand their firearm rights should consult an attorney.
Effects on Benefits and Housing
A lengthy commitment can disrupt federal benefits in ways that create serious problems at discharge.
Social Security Disability Insurance generally continues during involuntary hospitalization. Supplemental Security Income is different. Benefits may continue for up to three months if a physician certifies the stay will be short-term and the person maintains a home with ongoing living expenses like rent. After three months in an institution, SSI is typically reduced to a small personal needs allowance. After 12 months, SSI terminates entirely, and the person must file a new application upon release.
Housing is another casualty of extended commitment. Under federal Housing Choice Voucher (Section 8) rules, a family cannot be absent from their assisted unit for more than 180 consecutive days. If the commitment exceeds that period, housing assistance payments terminate and the lease ends. Psychiatric institutions themselves are not eligible for Section 8 assistance.11eCFR. 24 CFR Part 982 – Section 8 Tenant-Based Assistance Housing Choice Voucher Program The practical result is that a person committed for six months or more can emerge with no housing, no income, and a gap in benefits that takes months to restore.
The CARE Act as a Separate Track
California launched the Community Assistance, Recovery, and Empowerment (CARE) Act in October 2023 as an alternative pathway. As of December 2024, all 58 counties accept CARE Act petitions.12California Courts Newsroom. California Courts Implement CARE Act Statewide It is designed to reach people before they end up in psychiatric emergency holds or the criminal justice system.
A CARE petition can be filed by family members, first responders, healthcare providers, or the person themselves.13California Health and Human Services. CARE Act The process targets individuals with schizophrenia spectrum disorders or other psychotic disorders who meet specific criteria. In October 2025, eligible diagnoses were expanded to include bipolar I disorder with psychotic features.14California Department of Health Care Services. CARE Act
Unlike LPS, the CARE Act emphasizes voluntary engagement first. A CARE court can create a voluntary CARE agreement or, if the person does not engage, a court-ordered CARE plan that may include treatment, housing resources, and supportive services. The CARE Act does not replace LPS holds or conservatorships. It runs on a separate track, and someone who deteriorates under a CARE plan can still be subject to a 5150 hold if they meet the criteria.
Challenging an Unlawful Commitment
Facilities, providers, and law enforcement agencies that fail to follow commitment procedures face real consequences. Common violations include holding someone without proper authorization, denying access to counsel, failing to hold timely certification review hearings, and falsifying mental health evaluations.
A detained person or their representative can challenge unlawful confinement by filing a petition for a writ of habeas corpus. They can also bring a federal civil rights lawsuit under 42 U.S.C. 1983, which allows anyone deprived of constitutional rights under color of state law to sue for damages.15Office of the Law Revision Counsel. 42 USC 1983 – Civil Action for Deprivation of Rights In O’Connor v. Donaldson (1975), the U.S. Supreme Court held that a state cannot confine a nondangerous individual who is capable of surviving safely outside of an institution, either alone or with the help of willing family members or friends.16Cornell Law Institute. O’Connor v. Donaldson, 422 U.S. 563
The California Department of Health Care Services and other state agencies monitor facility compliance. Facilities in violation may face administrative penalties or loss of certification. Patients who can show their rights were knowingly or recklessly violated may recover monetary damages through civil litigation.