“Psychiatric Hold”

Involuntary detention under the Lanterman Petris Short (LPS) Act:

• 72-hour hold (5150):
  • Only psychiatrists can place a 5150 hold in hospitalized patients in San Francisco.
  • Used when a person as a result of a mental health disorder or alcohol intoxication is:
    • A danger to self.
    • A danger to others.
    • Gravely disabled.
  • Does not confer permission for medical intervention in which case you must consult a surrogate decision maker or conservator. The exception is in cases of medical emergency.
• 14-day hold (e.g., in California 5250):
  • Extends a 72-hour hold if the patient still requires treatment for the above reasons (see 72-hour hold). Requires a judicial hearing and one of the same three criteria must be met.
• Temporary Conservatorship (T-Con):
  • A temporary 30-day psychiatric conservatorship for patients who remain gravely disabled and require additional treatment after the initiation of a 5150 and 5250.
  • Placed by Psychiatry.
  • Does not allow for the involuntary administration of psychotropic medications, except in urgent situations.
  • Riese hearings are the process by which a judge determines if the patient is able to provide informed consent to refuse psychiatric medications.
• LPS (Lanterman Petris Short) Conservatorship:
  • A conservator is appointed, via a court process, to make decisions in the best interest of a mentally ill adult, such as consent to mental health treatment, placement in a facility, and financial decisions (e.g. paying bills, collecting income).
  • The most common illnesses for which LPS conservatorship is pursued include schizophrenia, bipolar disorder, schizoaffective disorder, clinical depression, and obsessive-compulsive disorder.
  • LPS conservatorship does not apply to patients with organic brain disorders, brain trauma, addiction, developmental delay, or dementia unless there is also a concurrent DSM psychiatric disorder.

“Medical Hold”

Officially, this entity does not exist. If there is a medical emergency, a patient can be held involuntarily with appropriate documentation if they lack decision-making capacity. See The Hospitalist: Decision Making Capacity for details.

• For non-emergencies, seek out surrogate decision makers or medical probate conservatorship.
• When in doubt, consult with psychiatry, ethics committee, or risk management.

Holding Patients for Tuberculosis

• In California, health authorities can order directly observed therapy without seeking advance court approval.
• If a patient refuses TB treatment, they may be isolated or detained. The patient still has a right to due process.

Felker B, Yazel JJ, Short D: Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv 1996; 47:1356-1363

Tuberculosis Control Laws and Policies: A handbook for public health and legal practitioners. 2009. http://www.cdc.gov/tb/programs/TBLawPolicyHandbook.pdf

USCF Psychiatry Residents. Psychiatry Resident Handbook. 2010-2011 Version.

Welfare and Institutions Code – WIC. C. California Legislative Information. 2014. http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=5150