department of behavioral health lps 5150 certification

County of Fresno

Department of Behavioral Health

2019-2020

Annual 5150 Re-Certification

Self-Study Training

LPS Re-Certification Process

This presentation is designed for self-study use for those individuals who have previously been certified by your agency one year earlier.

Renewal/Recertification can be accomplished either through this self-study presentation & completion of posttest or by attending a live training course &

completion of posttest.

In Fresno County, Initial LPS 5150 Certification with your agency must include completion of the FCMHP Post-test proctored by FCMHP Managed Care staff along with completion of a sample application, either at a live training with

FCMHP or by appointment at the Managed Care office.

For further information, please call the FCMHP Managed Care office at (559)600-4645.

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Outline & Goals

This training is for certain licensed/waivered professional staff at local hospitals, identified DBH-contracted mental health programs, and employees the Department of Behavioral Health that are determined to be eligible by the local Mental Health Director as approved by the Fresno County Board of Supervisors, to write “5150” applications.

The training will provide an introduction to mental health law and an overview of clinical and ethical issues as they relate to involuntary detention and confinement.

It is expected that all designated persons complete this course annually and pass an accompanying examination in order to be qualified to write 5150 applications.

Fresno County 5150 Certification Guidelines:

Who is eligible to be certified

Department in-house programs and select/DBH-approved designated sites (e.g. Exodus

Recovery CSU/PHF, Turning Point programs):

1) Licensed Mental Health Clinicians – includes LMFT, LCSW and licensed psychologists

2) Unlicensed Mental Health Clinicians – includes MFT Interns, ASWs, and waivered

psychologists (Does not include “trainees”/students in professional programs not yet

possessing masters/Ph.D. or registration with a CA professional licensing board)

3) Registered Nurses (RN) and Licensed Vocational Nurses (LVN)

4) Licensed Psychiatric Technicians (LPT)

5) Licensed Psychiatrists

Eligibility for 5150 designees in Fresno County is determined by job classification, not

individual educational degree. (e.g. Though an individual may have a masters-degree and is

registered with the BBS, if hired as a case manager, the individual is not eligible.)

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As a result of this training, participants

should be able to:

Complete an accurate 5150 application and oral advisement.

Understand the impact of the Lanterman-Petris-Short Act on the rights of the mentally ill.

Articulate who has the authority to initiate an involuntary detention form and understand the scope of that authority.

Understand the fundamental law and criteria involving involuntary detention for adults, minor children.

Lanterman-Petris-Short ActDevelopment and History

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Lanterman Petris Short Act

Signed into law in 1967 by Ronald Reagan, became effective on

Jan. 1, 1969.

Intent of the bill-To end inappropriate, indefinite and involuntary commitment of mentally disordered persons, developmentally disabled persons, persons impaired by chronic alcoholism.

To provide evaluation and treatment of persons with serious mental disorders or impaired by chronic alcoholism.

To guarantee and protect the public safety.

To safeguard individual rights through judicial review.

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Lanterman Petris Short Act

The purpose of the LPS Act

To provide individualized treatment, supervision and placement services by a Conservatorship program for gravely disabled persons.

To encourage the full use of all existing agencies, professional personnel and public funds to accomplish these objectives and to prevent duplication of services and unnecessary expenditures.

To protect mentally disordered persons and developmentally disabled persons from criminal acts.

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LPS HISTORY

This Act begins with Welfare & Institutions

code 5000 and covers a wide range of topics

including voluntary and involuntary

treatment, patient’s rights, confidentiality

and conservatorship.

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LPS HISTORY

The bill was amended nearly 300 times, and was as good as dead until the author Frank Lanterman refused to allow another bill out of a committee he chaired unless the commitment bill was amended into it.

The bill was amended into a popular bill by Senator Short, which called for an increase in then state financial participation in the Short-Doyle system.

As a result the new commitment scheme became known as the Lanterman-Petris-Short Act. The heart of the LPS Act are the rules that govern involuntary treatment.

This law does not define “mental disorder” or what constitutes a “danger”. Today, state hospitals are primarily forensic and house fewer than 4,000 mentally ill patients. Between 20,000 and 30,000 people with mental illness are in our jails and prisons. At least an equal number are homeless on the streets.

LPS Recent Changes –Revisions Effective January 1, 2014

Senate Bill 364, effective January 1, 2014, amended the Lanterman-

Petris-Short (LPS) Act.

Recognition of cultural and linguistic diversity and needs of

California

Recognition of need for clarifying language within WIC 5000 (i.e.

mental disorder now identified as mental health disorder)

Advisement processes most affected, as needed clear statements

of patient’s rights and personal needs

LPS Recent Changes –

Revisions Effective January 1, 2016LPS

History –Revisions effective January 1, 2016Changes to the concept of “imminent danger” and “Historical Course” Of a Mental Health Condition

Statutory mandate requires, when determining if a person is a danger to him- or herself or to others, as a result of a mental health disorder, the writer making the determination shall consider any available relevant information about the historical course of the person's mental health disorder. The writer should use that information if it has a reasonable

bearing on the determination of the 5150 hold.

The historical course considered in the determination of probable cause must be documented on the 5150 application.

LPS Recent Changes –

5150 Application Revisions Effective June 1, 2018

Application

effective June 2018The historical course considered in the determination of

probable cause must be documented on the 5150 application.

On the 5150 application, the writer must indicate:

“I have considered the historical course of the person’s mental

disorder”;

“No reasonable bearing in determination”; or

“No information available because…”

NEW DHCS 1801 (a.ka. 5150 application) is

now 2 pages plus 2 pages of references

NEW DHCS 1801 (a.ka. 5150 application)

is now 2 pages plus 2 pages of references (continued)

LPS 5150 “Hold”

It is important to remember that the initial involuntary hold is

Part of the California Welfare & Institution Code, not a Penal Code, and therefore is will never appear on an individual’s “criminal record” as a misdemeanor or felony charge

An Application for Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment. This application refers the individual for further assessment, but the person himself/herself is not “a 5150.”

AB 2099, effective September 5, 2018: Copy of

application same as the original for transfer or

placement

This bill requires a copy of an application for 72-hour psychiatric detention to be

treated as the original. This bill resolves a technical issue that has been an

unnecessary barrier to admission for many individuals we serve, as prior to AB

2099 only the original 5150 application was recognized and accepted for transfer

when an individual was referred for involuntary detention for evaluation and

treatment.

Effective immediately, this single revision to the WIC 5150 reads:

5150 (e) If, in the judgment of the professional person in charge of the facility

designated by the county for evaluation and treatment, member of the attending staff,

or the professional person designated by the county, the person cannot be properly

served without being detained, the admitting facility shall require an application in

writing ... A copy of the application shall be treated as the original.

Initiating an Involuntary Psychiatric

Hold

Beginning the Process

What is a 5150 Hold?

Beginning the process - Commonly known as a “5150 Hold”:

The initial process of detaining a person involuntary (without his/her consent) due to a psychiatric crisis

An Application for 72 Hour Detention for Evaluation and Treatment

Part of the Welfare & Institution Code, not the California Penal Code, and therefore neither a misdemeanor or felony.

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When can a 5150 be initiated?

A peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the

county, designated members of a mobile crisis team provided by Section 5651.7, or other professional person

designated by the county may, upon probable cause, take or cause to be taken, the person into custody and place

him or her in a facility designated by the county and approved by the State Department of Mental Health as a

facility for 72 hour treatment and evaluation.

Requirements for Initiating

an Involuntary Psychiatric Hold

In order to place a person on an involuntary psychiatric hold, designated personnel must believe

that there is probable cause that the individual meets 1 of 3 criteria, including:

Danger to Self

Danger to Others

Gravely Disabled

Additionally…

Behaviors must be directly attributed to mental illness

Individual refuses to seek voluntary treatment or it is believed unlikely that consumer will seek treatment

Historical course of the mental health condition, when available, must be considered

NOTE: Code 5150.05 allows for taking into consideration opinions and statements made by family members

and/or treating professionals. (i.e. if a person is currently denying suicidal thoughts, he/she may still be

placed on a hold if family members report that the person made threats to self-harm.)

Involuntary Treatment process:

Levels of Involuntary Psychiatric Holds

NOTES:

Any of these levels of involuntary hold may be disrupted (lifted) prior to the expiration.

An individual currently identified as a Fresno County LPS conservatee does not need to beplaced on a 5150 hold (but it may still be helpful to ensure timely transportation).

W & I 5300 = 180 day hold for treatment (DTO only)

W & I 5352 = Temporary conservatorship (GD only)

W & I 5358 = One year conservatorship (GD only)

W & I 5150 = up to 72 hour hold for the

purpose of evaluation and treatment

W & I 5250 = up to additional 14 day hold

for treatment (DTS/DTO/GD)

W & I 5260 = Second 14 day hold for

treatment (DTS only)

W & I 5270 = 30 day certification (GD

only)

Note for Understanding:

Emergency Rooms & 1799

Health and Safety Code 1799.111

Is an emergency psychiatric hold ordered by licensed professional staff (physicians) who provide emergency medical services in a licensed general acute care hospital (once an individual is otherwise medically cleared)

This Health & Safety Code allows detention for psychiatric evaluation within the emergency room when, in the opinion of the treating physician, the person, as a result of a mental disorder, is a danger to self, others, or gravely disabled

Allows detention for up to 24 hours

Provides time for medical social worker/licensed mental health clinician to assess

Note for Understanding:

Emergency Rooms & 1799

Health & Safety Code 1799.111

A person detained under this section shall be credited for

the time detained, up to 24 hours, in the event he or she is

placed on a subsequent 72-hour hold pursuant to Section 5150

of the Welfare and Institutions Code.

Who can write (initiate) 5150’s in Fresno County?

The Fresno County’s local Mental Health Director, as approved by the County Board of Supervisors, designates individuals or job classifications

1. All law enforcement peace officers (city; county; CHP)

2. Within the Department of Behavioral Health itself, both licensed and unlicensed/waivered medical and mental health professionals working in direct client care.

3. Contracted Providers that are also certified agencies by the County and designated by the Mental Health Director: Both licensed and waivered medical/mental health professionals as identified by program or agency. (Does not include all contracted providers.)

Completion of the 5150 Involuntary Detention Training is mandatory for any authorized person at least once a year.

Once you receive 5150 certification from Fresno County, it is not transferrable to any agency you work, as 5150 certification is

specific to your program.

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Fresno County

5150 Certification Requirements

The Fresno County certification process requires staff to complete initial and annual 5150 training, score 85% or higher on the post-test and possess a current 5150 identification card issued by the local Mental Health Director.

This certification authorizes the professional to complete 5150 applications in Fresno County only.

5150 certification in Fresno County is program-specific and does not transfer with the writer to a new/different employer.

Authorization to write 5150 applications outside of Fresno County must be obtained from the appropriate County agency.

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5150 Site Coordinators

at Local Hospitals, Agencies, Programs

The County first identifies 5150 Designated Program

Sites with a 5150 Site Coordinator at each local

hospital, agency or program for communication and

monitoring of designated 5150 staff.

The Site Coordinator works closely with the County to

ensure that staff have completed the required 5150

certification process and implements the process

appropriately, and is responsible for submitting

completed 5150 applications to the County on a

monthly basis.

Where can 5150 applications be written?

For those individuals designated/trained in Fresno County - only within the County of Fresno

At your agency/facility only, or within the course of your practice as a community-based mental health professional, unless part of mobile crisis psychiatric response team or peace officer

(Not at home! Per LPS, you may not initiate a hold on a family member or persons you have had a past personal relationship)

LPS Involuntary Detention - Forms

1801: Application for 72 Hour Detention for Evaluation and Treatment

1802: Involuntary Patient Advisement

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DHCS 1801: Application for 72 Hour Detention…

Detainment Advisement

Found at the top of the 5150 application, the Detainment

Advisement

Must be read to an individual at the time he or she is first

taken into custody under provisions of WIC 5150, and shall

be provided by the person who takes such the individual

into custody in a modality and language that the person

served understands.

It is necessary to read/provide this legal advisement every

time the person is placed on a 5150 hold.

Detainment Advisement on 5150 Application

Must indicate

modality

DHCS 1801: Application for Assessment,

Evaluation, and Crisis … Detainment Advisement

WIC 5150(f) and (g) – Detainment Advisement statement is located at the top right corner of the 5150 Application. First section is communicated to ensure all persons being detained and

transported for a mental health evaluation understand he/she is not under arrest

Second section is communicated only when involuntary hold is initiated at the person’s residence.

Involuntary Patient Advisement Form (DHCS 1802) – to be discussed later –may NOT substitute for Detainment Advisement

DHCS 1801: Application for Assessment, Evaluation,

and Crisis Intervention or Placement for Evaluation

and Treatment

The 5150 Application

This is a legal document required to begin the process

Must contain:

Identifying information of the person being detained

How the person’s condition was called to the writer’s attention

Writer’s probable cause to believe the person meets criteria for detention (Writer’s first hand statements, observations) to justify DTS, DTO, and/or GD (When determining criteria, one, two, or three criteria may be marked as appropriate)

Historical course of the individual’s mental disorder information

Writer’s original signature

Date and time the 72-hour detention began

DHCS 1801 is utilized for both initiating a WIC 5150 hold for adults, and a WIC 5585 hold for minors.

The newly revised 2 page DHCS 1801/5150 application must be used by Fresno County Designated 5150 Program Sites.

LPS Involuntary Detention - Forms

DHCS 1801: Application for Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment Commonly known as the 5150 Hold Application

Required legal document when initiating the involuntary hold process

Used by staff within Fresno County DBH, designated LPS facilities, local ED’s, law enforcement, and other certified contracted providers/programs

Multiple components

Detainment Advisement (previously known as the “Oral Advisement”)

Application narrative section

NEW! Historical Course of Mental Disorder section

Notifications to Be Provided to Law Enforcement section

Application Instructions (References and Definitions on back)

DHCS 1802: Involuntary Patient Advisement Written notice to be read and given to a person at the time of admission to a designated LPS

facility

2014 Revisions – Involuntary Patient Advisement

Revisions consistent with those of the 5150 Hold Application:

Statutory authority for Involuntary Patient Advisement moved

Clarification in wording – “mental health disorder” to LPS Act, reflected in revisions on 5150 Application

Language or Modality used to convey Involuntary Patient Advisement now required.

Advisement must be given in a language OR format accessible to the individual.

Advisement must also be given in English and in the person’s primary language.

Accommodations for other disabilities that may affect communication shall also be provided.

New Elements of the 5150 Application:

Notation of “legally

responsible party”In addition to identifying

the individual and his/her

address of residence here…

For minors and conservatees

the “legally responsible

party” must be checked and

their names, addresses and

telephone numbers must be

included.

New Elements of the 5150 Application:

Historical course of the

person’s mental disorder

Found at the top of page 2,

The writer must include known

information regarding the

historical course of the person’s

mental disorder, what the

information is, whether it has a

reasonable bearing on your

determination, and who

provided the history.

DHCS 1802: Involuntary Patient Advisement

(for use at Psychiatric Inpatient Facilities)

Involuntary Patient Advisement W&I 5150 (h) and (i) Advisement given by the designated facility staff to the

consumer/patient.

B) Each person admitted to a designated facility [not simply taken to a local emergency room] for 72-hour evaluation and treatment shall be given the following information by admission staff at the evaluation unit. The information shall be given orally and in writing and in a language or modality accessible to the person. The written information shall be available in the person’s native language or the language which is the person’s principal means of communication.

2014 Revisions – Involuntary Patient Advisement

(continued)

Choice of facility or provider Language has been added to inform individuals of his/her right to be treated at a facility of his/her choice

and/or provider of choice if available

Patients’ Rights Advocate Contact Information Space has been provided on form, with the statement, “If you have questions about your legal rights, you

may contact the county Patients’ Rights Advocate at ___________.”

Language within the Involuntary Patient Advisement Form has also been adjusted to reflect changes in the statute for clarification, both

for the person receiving the advisement, and mental health professionals providing care.

Criteria for Initiating the 72 Hour

Detention for Evaluation and

Treatment

DTS, DTO, and GD

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Involuntary Psychiatric Hold Criteria: Danger to

Self & Danger to Others

The LPS law does not define “danger” and there has been some misinformation and misinterpretation of the term and its use by 5150 writers.

The danger to self or others does not have to be an “active” danger, the person doesn’t need to be actively suicidal or making threats, threatening or actually physically injuring another party.

Danger can come in many forms, including “passive” danger such as endangering one’s child or own health and safety through behaviors caused by untreated symptoms of mental illness. Such “passive” danger could include, not taking needed medication for a serious medical condition or exposing oneself to violent elements on the streets.

The governing rule becomes whether or not this “passive” danger is the result of a mental disorder.

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5150 Detention Screening:

Danger to Self

Danger to Self: This criterion may be satisfied by either a deliberate intention to injure oneself (e.g., overdose) or a disregard of personal safety to the point where injury is imminent (e.g., wandering

around in heavy traffic.) due to severely impaired insight and judgment.

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Danger to Self (Continued)

Things to look for:

Words or actions showing intent to commit suicide or bodily harm

Words or actions indicating gross disregard for personal safety

Words or actions indicating a specific plan for suicide

Means available to carry out suicide plan (e.g., pills, firearms present or

available)

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Danger to Others

Danger to others may be inferred from

words or actions that indicate the

person in question either intends to

cause harm to a particular individual or

intends to engage in dangerous acts

with gross disregard for the safety of

others.

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Danger to Others

Things to look for:

Threats against particular individuals

Attempts to harm certain individuals

Are the means available to carry out threats or repeat attempts? (e.g., firearms, other weapons)

Expressed intention or attempts to drive a car while exhibiting behavior which, under the circumstances, reasonably suggests a mental disorder to the point where the person’s driving would endanger other motorists or passengers (especially minors in the person’s care)

Gravely Disabled: (W&I 5150) (W&I

5008h1A & h2) A condition in which a person, presently, as a result of a mental

disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter, to the extent that failure to do so results in danger or harm to the person.

The person is unwilling and/or unable to accept voluntary treatment

If a family member or other person is providing these basic needs, the consumer may not be gravely disabled unless; they can’t make use of the resources due to their mental disorder. (Unable to safely survive in the care of others.)

All of the above = criteria for GD

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5008h1A & h2)

Doe v. Gallinot,

Court case which explores the definition of grave disability. “…standards for commitment are constitutional only if they require a finding of dangerousness to others or self,” “The threat of harm to oneself may be through neglect or inability to care for oneself.”

The court determined that California’s standard of “grave disability” meets the constitutional test, in that, “it implicitly requires a finding of harm to self: an inability to provide for one’s basic personal needs.”

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5008h1A & h2)

NOTE: Though the criteria for placing a minor on an involuntary detention for evaluation and treatment are the same for

danger to self and danger to others as with an adult, there are different standards for gravely disabled; however, the same 5150 application can be used for both minors and

adults in Fresno County.

A minor is considered gravely disabled if he or she is presently unable as a result of a mental disorder, to use the elements of life which are essential to health, safety and development, including food, clothing and shelter, even though provided to the minor by others.

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Grave Disability

The accompanying mental disorder must be present or reasonably be

suspected.

Poverty is neither a crime nor a justification for 5150 detention.

Also a vagabond lifestyle, deliberately chosen, does not qualify a person for

5150 detention.

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Grave Disability

Things to look for: Signs of malnourishment or dehydration

No foods available in the house or at hand if not in a house

Irrational beliefs about food that is available (e.g., it’s poisoned, inedible, etc.)

Destruction or giving away of clothing to the point where the person cannot clothe himself/herself

Eviction from housing for behavioral problems

What if you perform a crisis assessment

and do not place a hold?

Important Note!

When a person is being assessed for a 72-hour hold, and it is decided to not

involuntarily detain the individual, then alternative voluntary services shall be offered

per WIC 5150.3:

“Whenever any person presented for evaluation at a facility designated under section

5150 is found to be in need of mental health services, but is not admitted to the facility,

all available alternative services provided for pursuant to Section 5151 shall be offered

as determined by the county mental health director.”

After the Psychiatric Hold

is InitiatedLPS Process Continued

County EMS Transfer Protocols

The Fresno County Department of Community Health sets forth the “Patient Destination” policy regarding the appropriate EMS transport of patients on a 5150 hold (Policy No. 547).

If the individual has a life- threatening situation, he/she will be transported to the closest emergency department “equipped, staffed, and prepared to administer care appropriate to the needs of the patient.” Individuals under EMS transport may elect their destination facility.

REMEMBER – A COPY OF THE 5150 ADVISEMENT/APPLICATION MUST STAY OR GO ALONG WITH THE PERSON IF TRANSFERRED TO ANOTHER FACILITY!!!

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County EMS Transfer

Protocols (Continued)

In the event the destination facility stated on the 5150 Application does not state the name of the correct receiving facility, a note

should be made in the individual’s chart to this effect.

The County does not require that the writer of the original 5150 application correct the application form for this reason.

Per the LPS Act, the person placed on a 5150 hold has the right to be treated at a facility of his/her choice and/or provider of choice if available

Who can release a person from 5150? (aka “discontinue” “lift” or “disrupt” a hold)

Emergency Room Setting: Any licensed or waivered mental health professional (e.g., physicians, psychiatrists, registered and licensed vocational nurses, MFT and LCSW including registered interns, psych technicians)

Inpatient Acute Psychiatric Facility (e.g., CBHC or PHF, etc):Psychiatrist or psychologist working directly with the client

Important Note: A 5150 hold may be lifted before the entire 72 hours have expired, as long as the individual no longer meets criteria for the involuntary psychiatric detention.

W&I 5325.2 “The Right to Refuse Treatment…”

Right to Refuse Treatment

Any person who is subject to detention pursuant to Section 5150, 5250, 5260, or 5270.15 shall have the right to refuse treatment with antipsychotic medication subject to provisions

The Riese or Capacity hearing provides that the patient who is to be involuntarily medicated must be proven to lack capacity by "clear and convincing evidence". California case law describes this standard as "so clear as to leave no substantial doubt; sufficiently strong to command the unhesitating assent of every reasonable mind.“

In order to meet this standard, the physician needs to present a compelling case establishing the existence of a mental disorder, a lack of capacity to reason about medications and a link between these two elements.

Treatment Environment

Least Restrictive Environment:

(W&I 5325.1) (a) Persons with mental illness have a “right to treatment services which promote the potential of the person to function independently. Treatment should be provided in ways that are least restrictive of the personal liberty of the individual.” In your professional opinion you decide that there is no less restrictive environment or action that can respond adequately or in a timely enough manner to the risk presented by the person.

Least restrictive environment also refers to a course of action that is designed to preserve the person’s dignity and autonomy as much as possible and maximize the opportunities for recovery.

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State Mental Health Firearms

Prohibition Database

An individual who is placed on a 72-hour hold (also known as a "5150"[1]) as a danger to self or others and admitted to a facility for treatment, he/she is prohibited from purchasing or possessing firearms for five years from the date of admission to the facility. The facility is required to notify the state Department of Justice. The DOJ then adds the individual’s name to the state mental health firearms prohibition database.

http://caag.state.ca.us/firearms/forms/pdf/pfecapp.pdf

http://caag.state.ca.us/firearms/forms/pdf/pfecapp.pdf

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Other Important Definitions

Probable Cause:

(W&I 5150.05) when determining if probable cause exists to place someone on a 5150, the designated person shall consider available reasonable and relevant information about the historical course of the person’s mental disorder. This information can include evidence presented by members of the family, treating personnel or persons designated by the person who is subject to the 5150.

(W&I 4900 h) The individual making the probable cause determination may base the decision on reasonable inferences drawn from his or her experiences or training regarding similar incidents, conditions, or problems.

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Historical Course of the Mental Health Disorder:

(W&I 5008.2) historical course shall include, but is not limited to, evidence presented by persons who have provided or are providing mental health or related support services to the patient, the patient’s medical records as presented to the court, including psychiatric records or evidence voluntarily presented by family members, the patient or any other person designated by the patient.


Informed Consent:

When a person accepts or agrees to something that somebody else proposes. When a person knowingly and intelligently, without duress or coercion, clearly and explicitly manifests (gives) consent to the proposed therapy to the treating person. Can be done verbally but for these purposes it is required to do it in writing and on a standard consent form

(W&I 5326(a)

Clear and Convincing Evidence Standard:

Evidence that leads the writer toward a conclusion that is more than just a preponderance of evidence but less than beyond a reasonable doubt. The direct observation by a trained mental health provider should be included in the statement.

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Due Process:

Based on the concept of “fundamental fairness”. The bare minimum is to be informed of any proceedings involving the person and the opportunity to be heard during these proceedings. Any action denying what is “due” would be unconstitutional. It requires that reasonable procedures are taken to protect the individual from undue deprivation. It comes down to a balance between the individual’s interests to be free and the state’s interest to promote the public health and safety of its citizens. At times it appears to give the overriding liberties to the illness itself rather than to the individual’s right and ability to enjoy that life and liberty. There is no substantial difference in the protection offered by the federal constitution or the state, although the state may extend even more protection to individual than federal law.

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Voluntary Status vs. Involuntary Status The 5150 is utilized for those consumers who clearly meet one of the three categories of Danger to Self, Danger

to Others, or Gravely Disabled, and who are either unwilling or unable to accept treatment voluntarily. It is important to keep in mind that a consumer may voluntarily seek mental health treatment, and if they indicate their agreement to do so and appear to have the capacity to do so, they should not be placed on a 5150 hold. This constitutes a “voluntary” status.

It is also important to take into account the consumer’s past history, present state of mind/ability to follow through with seeking and obtaining treatment, and likelihood in your clinical opinion that they can achieve this voluntarily. If there is doubt, or you suspect the consumer may change their mind and avoid seeking treatment on their way to the ED, you should put them on the 5150 hold. This is the only way to legally ensure they will be detained and evaluated.

Any 5150 hold on which police or other professionals have written “voluntary commitment” or similar language is still a 5150. There have been instances where agencies have written a hold despite a consumer’s statement of willingness to go to the hospital for treatment. The consumer is left with the impression that they are ‘voluntary’ and can change their minds about staying later on, but the reality is, once the hold has been written, it is in effect until a designated professional discontinues it. For legal purposes, if a person is to be a voluntary consumer, they should not be put on a hold. If they are to be involuntary, there must be a 5150 accompanying them to the facility.

Completion of

5150 Recertification Process2016 Posttest Submission

Initial 5150 Certification of Individuals

New to a Program but Previously Certified All requests for initial certification with Fresno County must be proctored (given by) by

FCMHP Managed Care staff at the DBH Managed Care Office and includes a posttest and completion of a sample application based on a given standardized scenario. Requests for initial certification testing may be sent to [email protected] .

Post-tests for re-certifications for your agency staff may be proctored by the program’s site coordinator. Re-certifications do not require completion of a sample application unless it is determined via the County’s Quality Assurance Review to be necessary.

5150 CERTIFICATIONS ARE PROGRAM-SPECIFIC AND ARE NONTRANSFERRABLE: If an individual has previously been previously certified with a Fresno County program to write 5150 holds, and is new to your current agency, this is considered an initial certification with your program and post-test must be proctored by FCMHP Managed Care staff.

If the individual has been through the County training as part of another agency, the program has the option of sending the new staff member to a live Initial 5150 Certification Training or the site coordinator may contact DBH Managed Care and request a testing appointment.

For initial certification post-tests or training requests, please contact Managed Care at (559)600-4645 or email requests to [email protected] .

mailto:[email protected]


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Completing the 5150 Training and

Identification Card Process

1. Please review all documents that accompany this presentation.

2. Complete the 2019 Posttest and sign. Submit the completed test to your program’s designated

5150 site coordinator.

3. Upon successfully passing the post test, you will receive a 5150 certification card (sent to your

program’s 5150 site coordinator) and will be valid for a period of one year from the date on

the post test.

4. The bearer of the card is authorized conduct crisis assessments and sign Applications for

Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment in

Fresno County only.

67

For more information or questions regarding

5150 Applications

For additional information regarding 5150 renewal or the recertification process,

please call the Department of Behavioral Health-at (559)600-4645 or email [email protected]

For questions regarding 5150 regulationsspecific to ethical, legal or clinical matters,please contact your immediate supervisor.


department of behavioral health lps 5150 certification

Documents