For mental health clinicians and police officers, issuing a California Welfare and Institutions Code (WIC) 5150 hold is one of the most powerful and complex responsibilities. This 72-hour involuntary hold allows the temporary detention of an individual who presents a danger to self, danger to others, or is gravely disabled due to behavioral symptoms of a mental disorder or illness. While it is a critical tool to prevent immediate harm, it carries significant legal, ethical, and professional risks if not applied correctly. Specialty consultation provides an essential layer of protection and support, helping clinicians navigate this nuanced process and avoid legal pitfalls. In this post, we will explore the importance of ongoing specialty consultation, focusing on legal standards, the risks of disciplinary actions, potential civil liberties violations, and criminal liability for improperly issued 5150 holds.

Understanding the Legal Standard: Douglass vs. City of Los Angeles.

The United States District Court case, Douglas v. City of Los Angeles (C.D. Cal. Oct.3, 2023) highlights the need for probable cause when issuing a 5150 hold. The ruling clarified that a clinician or police officer must have "reasonable cause to believe" that the person poses a danger to themselves or others or is gravely disabled. Probable cause has been identified as the following…

“Probable cause under WIC 5150  exists when facts are known “that would lead a person of ordinary care and prudence to believe, or to entertain a strong suspicion, that the person detained is mentally disordered and is a danger to himself or herself. . .” People v. Triplett, 144 Cal.App.3 rd 283.288 (1983). The 5150 Application for Admission to and Inpatient Psychiatric Hospital “must be able to point to specific and articulable facts which, taken together with rational inferences from those facts, reasonably warrant his or her belief or suspicion.” 

Probable cause requires more than a hunch; it demands observable facts that point to a genuine mental health crisis necessitating involuntary detention. Failure to meet this standard can have severe legal consequences. If a 5150 hold is improperly issued, it could:

1. Violate the individual’s civil liberties, leading to claims of unlawful detention.
2. Expose to legal actions—including professional disciplinary proceedings, malpractice suits, and criminal liability for false imprisonment.
3. Compromise the quality of care, as premature or unnecessary holds can erode trust between the patient and the mental health system. Given these stakes, ongoing consultation with clinical specialists, supervisors, or legal experts is crucial to ensure that the probable cause threshold is met consistently.

A 2018 case involved a claim that the ED patient who initially was admitted to a hospital’s psychiatric unit voluntarily after making general statements regarding how her co- worker made her want to hit him in the head. “Her diagnosis was not homicidal, but, rather, was depression. The involuntary commitment issue arose after she wanted to leave the hospital, “ Langendorf stated. The psychiatric unit nurses testified that there was a policy preventing a voluntary patient from leaving until the on-call psychiatrist could be reached. The hospital denied there was such a policy. The on-call psychiatrist placed the patient on a 72-hour hold without a threat risk assessment.

The 72-hour-hold form was erroneously signed by the doctor who released the patient the following morning. The patient stated her doctor told her he didn’t know why she had been held. The on-call psychiatrist who was called had no memory of ordering the 72-hour hold. 1

Legal Ramifications of an Improper 5150 Hold Clinicians must recognize that an improperly issued WIC 5150 hold opens the door to multiple legal ramifications:

1. Professional Disciplinary Actions: The California Board of Behavioral Sciences (BBS) and the Medical Board of California have the authority to investigate clinicians who misuse 5150 holds. Sanctions may range from probation and fines to suspension or revocation of licensure. This can have career-damaging consequences, limiting the clinician’s ability to practice.
2. Civil Rights Violations: If a person is detained without sufficient probable cause, they may pursue a civil lawsuit against the clinician and their employer for unlawful detention. Violating a person’s right to liberty under the Fourth and Fourteenth Amendments can result in significant financial liability, including damages and attorney fees. Public agencies, such as hospitals or county behavioral health departments, may also face legal penalties.
3. Criminal Liability for False Imprisonment: Hospital sued for false imprisonment due to involuntary holds, Relias Media, Sept. 1, 2018. In extreme cases, a clinician could face criminal charges for issuing a hold without sufficient grounds. False imprisonment is a serious offense, and prosecutors may pursue charges if the detention is deemed egregious or malicious.

Given these potential consequences, every clinician must take appropriate precautions to ensure that their actions align with the standards of care and legal requirements.

Specialty Consultation as a Safeguard

While most clinicians receive general training on 5150 holds, continuing education and specialized consultation are critical to staying current on legal precedents and clinical best practices. Specialty consultation can provide key insights into: 

1. Legal Updates:

Case law, including Douglass v. City of Los Angeles, evolves over time. Specialty consultation offers access to the most recent regulatory updates, ensuring that clinicians remain compliant with the most recent interpretations of probable cause standards.

2. Complex Cases:

Some cases may present gray areas —for example, when the patient’s behavior fluctuates, or there are conflicting reports from family members. Consulting with colleagues or supervisors can help clarify whether the situation meets the threshold for a 5150 hold.

3. Ethical Considerations:

Specialty consultation provides a forum for clinicians to reflect on ethical dilemmas, such as balancing patient autonomy with the need for safety. This collaborative process helps reduce the emotional burden of these high-stakes decisions.

4. Documentation Standards:

A well-documented 5150 hold is essential to protect both the patient’s rights and the clinician from liability. Specialty consultation can provide guidance on proper documentation, including the need to clearly describe observed behaviors, evidence of mental health deterioration, and the rationale for detention.