What You Need to Know During a Mental Health Crisis
Do I call 911 or the Crisis Team?
Call 911 if there is an immediate threat to life, such as violent behavior, presence of weapons, or a medical emergency (overdose, injury, etc.). You can request that police send Crisis Intervention Trained (CIT) officers, if available. These are officers who have been through specialized training on how to address mental health emergencies.
Call the Ventura County Crisis Team at 1-866-998-2243, if the individual is experiencing a mental health emergency and is otherwise physically and medically stable.
> See the 5150 Guide for Professionals
What do I do after 911 is called?
- Prepare your home before police arrive by removing any items that could be used or perceived as a weapon. Turn on all the lights in your home to improve visibility and turn off all the audio (televisions, stereos) to reduce distractions. Secure any pets that may appear to pose a threat or be an unwelcome distraction. Also, be prepared to tell police who else is in the home and/or make arrangements for those people to leave before the police arrive.
- Try to meet the police officers outside before they interact with the individual. Brief them on what is going on, the individual’s current emotional state, any medications/substances taken, and share helpful suggestions as to their strengths and what the person may find reassuring or calming.
- Also be prepared to give a brief history of the individual. Be honest, direct, and open. Do not exaggerate the situation or leave out relevant information.
- Relevant information may include demographic information (age, gender, etc.), medical and psychiatric history, past treatment information, and family caregiver contact information.
- Ask the police officer or ambulance driver where the individual is being taken. If the police believe that the person meets criteria (see below), they most likely will be placed on a 5150/5585 and transported (typically by ambulance) to the nearest emergency department for medical screening and/or to a designated facility (Crisis Stabilization Unit or psychiatric hospital) for psychiatric evaluation and treatment. The individual can be held at a designated facility for up to 72 hours on a 5150/5585.
What is Voluntary Psychiatric Hospitalization?
For adults, the individual must recognize the need for treatment, be willing to follow treatment recommendations and able to consent to treatment. For minors, the parent or legal guardian must be available to authorize voluntary treatment. Status of voluntary or involuntary is not necessarily an indicator of the severity of the condition or need for treatment.
Per Health & Safety Code 1317 (f), a general acute care hospital or acute psychiatric hospital shall not require a person who voluntarily seeks care to be in custody pursuant to section 5150 of the Welfare and Institutions Code as a condition of accepting. Requirement of an involuntary hold by the receiving hospitals creates an unnecessary barrier to care for patients and is a violation of the person’s civil liberties.
What is a 5150/5585?
For adults, Welfare & Institutions Code section 5150 (for minors, Welfare & Institutions Code section 5585) allows an authorized person to detain an individual who, as a result of a mental health disorder, may be a danger to self, others and/or gravely disabled.
- Danger to Self: There is probable cause to believe that, as a result of a mental health disorder, the individual presents as a danger to themselves. Factors considered may include; observable behavior, what the individual is saying/doing, relevant history, available collateral information, evidence of a deliberate attempt to hurt themselves, a disregard for personal safety, and/or prior suicide attempts.
- Danger to Others: There is probable cause to believe that, as a result of a mental health disorder, the individual presents as a danger to others. The factors considered include all of those listed above (in “1. Danger to Self”) plus additional factors such as access to weapons, any prior history of severe aggression or violence; and/or disregard for the safety of others.
- Grave Disability: An adult is gravely disabled when, as a result of a mental health disorder*, he/she is unable to provide for their own food, clothing or shelter or is currently unable to take advantage of food, clothing or shelter even though it may be provided to them by another person. A minor is gravely disabled when, as a result of a mental health disorder*, is unable to use the elements of life that are essential to health, safety, and development, including food, clothing, and shelter, even though provided to the minor by others.
*Intellectual disability, epilepsy, or other developmental disabilities, alcoholism, other drug abuse, or repeated antisocial behavior do not, by themselves, constitute a mental health disorder.
- The 5150/5585 is an application and does not guarantee the individual will be admitted to a psychiatric facility. The decision to admit, or not, will be made by a psychiatrist at the psychiatric hospital.
- The 5150/5585 application allows the individual to be detained and transported to a psychiatric facility for further assessment to determine the appropriateness of involuntary hospitalization. If admitted, an individual on a 5150/5585 may be held up to 72 hours for further observation and evaluation.
- In Ventura County, as well as throughout California and the country, the need for acute psychiatric treatment often exceeds available resources. Minors and adults may find themselves waiting in the local emergency department for a period of time while efforts are made to facilitate appropriate placement in a psychiatric facility. In the event that a 5150/5585 application expires while the person is waiting for placement, a subsequent application, or a “back-to-back” 5150/5585, will not be written in Ventura County. At that point, an individual may choose to pursue voluntary psychiatric hospitalization or will be further stabilized or discharged in accordance with the emergency department’s policy.
- Adults being considered for admission to the Ventura County Health Care Agency’s local psychiatric hospital, Hillmont Psychiatric Center (HPC), or Adult Crisis Stabilization Unit (CSU) must first be transported to the nearest emergency department for medical screening. The person then remains in the emergency department until a placement becomes available at Hillmont or another appropriate psychiatric facility.
- Under some circumstances, medically stable adults can be directly admitted to Ventura County’s local, private psychiatric hospital (Vista Del Mar).
- Medically stable minors ages 12-17 may also be admitted directly to Vista Del Mar. Minors ages 6 – 17 may also be admitted to the Children’s Crisis Stabilization Unit, operated by Seneca Family of Agencies.
- When local psychiatric facilities are full, individuals may be hospitalized out of the county. Admissions to all psychiatric facilities may be contingent upon any number of factors including (but not limited to): bed availability, type of insurance, and presenting symptoms.
- The emergency departments are required to provide ongoing assessment for individuals on 5150/5585s who are awaiting placement in a psychiatric facility. If the attending physician observes a change in behavior or symptoms leading her/him to believe the individual may no longer be a danger to self, danger to others, and/or gravely disabled, a reassessment process may be initiated to see if 5150/5585 criteria are still met. This process may vary across emergency departments and is based on their policies and practices. When the individual on a 5150/5585 no longer meets criteria for involuntary treatment, the application will be discontinued and alternatives for follow-up treatment and services will be offered.
What is a 5250?
- A 5250, Notice of Certification, is an extension which would allow the psychiatric hospital to keep the individual for up to an additional 14 days.
- At the end of 72 hours, if the individual still meets criteria for hospitalization and either is not willing to stay voluntarily or the treating psychiatrist does not feel they are appropriate for voluntary hospitalization, the psychiatrist files the Notice of Certification with the Superior Court. The individual has the right to a probable cause hearing within four days of the initiation of the Notice of Certification if they disagree with further hospitalization. The individual has the right to speak to a patients’ rights advocate at any time and they will also be appointed a public defender to represent them in the civil legal proceedings, if they choose to have a hearing.
- The treating psychiatrist will provide testimony and explain to the judge why they believe the individual will benefit from further hospitalization. The individual, with the assistance of the public defender, has the right to explain to the judge why they believe they should be released. Ultimately, the judge will make a determination whether or not probable cause exists that they continue to meet one or more of the criteria noted above (danger to self, danger to others, and/or gravely disabled).
- The individual can request a Writ of Habeus Corpus, requesting release, and this will be held as soon as possible.
Confidentiality and Receiving Information
During a mental health crisis, most limits to confidentiality and information sharing are suspended. A minimum necessary guideline would still apply, meaning that only information necessary for resolving the immediate crisis would be exchanged by providers.
When an individual you care about is hospitalized or admitted to a treatment setting, it is natural to be concerned and to want the most up-to-date information possible. The Health Insurance Portability and Accountability Act (HIPAA) and other regulations govern confidentiality. The individual must give consent to release information before anyone at the facility can share protected health information. Each facility will have its own ROI (Release of Information) form and process. Notably, if the individual changes their mind and withdraws their consent (which they can do at any time), the ability of the treatment providers to release information will cease. Family members or other individuals with pertinent information about the individual can provide the treatment providers with information; a release of information is not necessary for the staff treating the individual to receive information. The staff person can listen, but without consent they are unable to communicate details about the individual or even acknowledge the individual is in the facility.
What is a Patient Rights Advocate?
The Patients’ Rights Advocate (PRA) is a part of Ventura County Behavioral Health in Ventura County. The advocate is available to provide education on the laws governing mental health treatment. You can reach the Ventura County Patients’ Rights Advocate at (805) 477-5731.