How and When to write a 5150 Hold

Kathryn Parlet LPCC LMFT CIT Certified Coordinator

Crafting the ArtHow and When to write 5150 holds

• Learn when to write them

• Learn how to paint the picture

• Fill out the form properly

5150 Hold (Your Canvas)

An Application for Involuntary Admission

http://www.dhcs.ca.gov/formsandpubs/forms/Pages/Men

tal_Health-Forms.aspx

Who are we holding?

• Brothers, sisters, children mothers, employees, & fathers

• Patients, Clients, Consumers or Subjects

What 5150 means

• A forced evaluation (missing work, children, pets, etc..)

• Having a mental illness (Mental illness = mental health symptoms)

Legal Hold = Legal Process

5150 to EPS to Inpatient unit

The inpatient unit does 5250

5250 in hospital hearing

Conservatorship

Send to an IMD

Stabilization and release to the community

Who reads this?

Who are we not Holding?

• Does not apply to Intellectual Disabilities or Dementia (WIC 5585.25)

• Does not apply to medical non-compliance

What 5150 does not mean• Held 72 hours

• Released after 72 hours

• It is a an involuntary detention,

not an arrest

5151 is Assessment5152 is the below advisement:

State of California - Health and Human Services Agency Department of Mental Health

INVOLUNTARY PATIENT ADVISEMENT (TO BE READ AND GIVEN TO THE PATIENT AT TIME OF ADMISSION) MH 303 E/S (Rev. 08/04)

Confidential Patient Information See W&I Code Section 5328 and

HIPAA Privacy Rule 45 C.F.R. Section 164.508

Name of Facility

Patient’s Name

Admission Date

Section 5157 (c) and (d) of the Welfare and Institutions Code requires that each person admitted for 72-hour evaluation be given specific information orally and in writing, and a record of the advisement be kept in the patient’s medical record.

My name is _______________________________ My position here is ________________________

You are being placed in this psychiatric facility because it is the opinion of the professional staff, that as a result of a mental disorder, you are: (check applicable)

Dangerous to yourself

Dangerous to others

Gravely Disabled (unable to provide for your own food clothing or shelter)

(Document specific evidence which substantiates reason for hold):

We feel this is true because ___________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

You will be held for a period of up to 72 hours. This (does not) (does) include weekends or holidays.

Your 72-hour period will begin: ____________________________________________________________ (Time and Date)

Your 72-hour evaluation and treatment period will end at: _______________________________________ (Time and Date)

During these 72 hours you will be evaluated by the hospital staff, and the treatment you receive may include medications. IT is possible for you to be released before the end of the 72 hours, but if the professional staff decide that you need continued treatment, you can be held for a longer period of time. If you are held longer than 72 hours, you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided free.

State law presumes you to be competent regardless of whether you have been evaluated or treated for mental disorder as a voluntary or involuntary patient.

Good cause for Incomplete Advisement

Date

Advisement Completed by

Position

Date

CC: Original to the Patient Carbon to the Patient’s Record

Who can write 5150s?

Law Enforcement

• Law Enforcement officers Under California law: Peace Officers, including Sheriffs, State Park Rangers, State University Peace Officers. (There holds are valid in any county)

The Great Hold

• Work Place Safety Training

• Would you want to write the best hold?

Therapist

• Mental health professionals approved by the county after completing training and passing a test, while working in their capacity

• Data base

Selected members

• Selected members of attending staff at evaluation facilities/hospitals that are designated for involuntary detainment by the county

• ER MD starts the hold when the patient is medically stable waiting for transport

Who can contribute inspiration to your 5150?

5150.05: Any reliable 3rd party since 2001

What would your mother say?

Three Criteria for a 5150• Danger to others

• Danger to self

• Grave Disability

Danger to others

Satin vs. Satan

Danger to Others• “I’m going to kill you.”

• “I’m going to kill the Aliens. They are after me.”

• “I hear voices telling me to kill people.”

• “My wife has an implant that is spying on me.”

• Duty to protect

• Follow the Policy where you work

• The first time have someone assist you or follow the policy and procedure exactly.

Perseus killing

Medusa

Danger to Self

• “They are after me, so I am going to end it before they can.”

• Patient took 60 Tylenol Tablets because he wanted to end his life.

• “Shoot me.”

You can save a life

What city in our county has the most suicides?

Kevin Hines example, just one person

Each Mind Matters PBS

Danger To Self

• “I’m going to cut off my ear.”

• “I have a chip implanted in my head that I am going to remove, by cutting it out.”

• “I’m going to kill myself.”

• Patient was found hanging from a noose

Grave Disability

“I have not eaten

because they are

poisoning my food.”

Grave Disability• Signs of malnourishment or dehydration.

• Destruction or giving away of clothing to the point where the person cannot cloth themselves.

• Inability to formulate a reasonable plan to obtain shelter.

• Unkempt

Not a Reason for Grave Disability• Ten Years of Homelessness

• Walking around naked

• Refuses to spend money on housing or food, but eats anyway

• Politically motivated hunger strike

• Talking to yourself

Examples of Grave Disability• “They are out to get me so I have to

hide here….I cannot leave to eat or they will jump me.”

• Patient did not move or speak for 30 minutes except for moving his hands from his sides into the air above his head every few minutes.

No. 5, 1948 Jackson Polk Sold 250 Million in 2006

Who can alter your 5150?

Very small, but important section

If a minor, to the best of my knowledge, the legally responsible party appears to be / is: (Circle one) Parent; Legal Guardian; Juvenile Court as a WIC 300; Juvenile Court as a WIC 601/602; Conservator. If known, provide names, address and telephone number:

• Emancipated Minor: Marriage, Army, or Court

• Provide information about residency

• Provide friend, family, or neighbor information.

• Provide Address and Date of Birth and Complete name

• Circle the “Section 5150” (adult) or “Section 5585”(minor) to indicate which type of hold you are writing on the line below.

The above person’s condition was called to my attention under the following circumstances:

Patient called and said she would cut her wrists

Patient posted on Facebook that he was going to jump in front of a train on the way home from school

Patient texted his girlfriend that he was planning to hang himself

Reason for the hold sectionWhat use is writing the following?

Patient is taking Zyprexa Patient is diagnosed with Bi-Polar Disorder Patient is a paranoid schizophrenic who is

threatening people in the street Patient is Gravely Disabled Patient is Psychotic or Hallucinating Patient is suicidal

Satin Versus SatanPatient anxious & agitated

Patient was walking from one end of the room to the other while speaking loudly and rapidly

Patient having auditory hallucinations

Patient says, “I am hearing the voice of a little girl.”

Patient experiencing thought insertion

Patient says, “I think the TV is sending me messages.”

Patient is paranoid. Patient says, “They are after me…they are trying to kill me.”

Questions to ask• Does the TV ever send you messages?

• Is anyone out to get you?

• Do you ever think people are following you?

• When was the last time you ate?

• What are going to do after you are done taking to me?

• What are you doing tomorrow?

Should you write it?• Patient appears to respond to internal stimuli

• Patient says, “I am going to kill them if they don’t stop putting thoughts in my head.”

• Patient psychotic.

• Patient has fixed delusions

• Patient is diagnosed with Bipolar disorder and is on Lithium

• Patient said, “The voices are telling me to hang myself”

• Patient’s mother says he has not eaten in three days.

Reporting Responsibilities

Getting the patient to the evaluation

If the patient is being sent from the street with a wheelchair or bicycle, it is the your responsibility to take it to the

facility, or find a safe place to store it.

When writing a hold at a home You may bring a few

personal items with you, which I will have to approve. Please inform me if you need assistance turning off any appliance or water. You may make a phone call and leave a note to tell your friends or family where you have been taken.

• The evaluator must ensure that the resident area is secured;

windows and doors should be locked.

You are responsible to help with pets. Either help them make arrangements for care, or make

arrangements for the pet’s care.• San Jose Animal Shelter (408)794-7297San Jose Cupertino Los Gatos Saratoga

• Silicon Valley Animal Shelter (408) 764-0344

Mountain View, Campbell, Monte Sereno , Santa Clara

• Santa Clara County Animal Shelter

(408) 201-0660

Culturally Informed Interventions

Culturally Informed Interventions

• Different cultures have words we do not as well as lack the words to describe symptoms.

• Always ask questions. Some things to consider:

– What country has the most suicides?

– Okay Japan Money, France zero, Brazil/Germany Obscene

– Words to describe snow (12)

– Describing depression

– Exorcism

What Questions Do You Have???

After you finish the test

Please turn in the following:

1) Test booklet

2) Test answer key

3) Evaluation form

• Pick up a participation certificate

• Sign out where you signed in

Please clean up after yourself