Lanterman–Petris–Short Act


The Lanterman–Petris–Short Act regulates involuntary civil commitment to a mental health institution in the state of California. The act set the precedent for modern mental health commitment procedures in the United States. The bipartisan bill was co-authored by California State Assemblyman Frank D. Lanterman and California State Senators Nicholas C. Petris and Alan Short, and signed into law in 1967 by Governor Ronald Reagan. The Act went into full effect on July 1, 1972. It cited seven articles of intent:
The Act in effect ended all hospital commitments by the judiciary system, except in the case of criminal sentencing, e.g., convicted sexual offenders, and those who were "gravely disabled", defined as unable to obtain food, clothing, or housing. It did not, however, impede the right of voluntary commitments. It expanded the evaluative power of psychiatrists and created provisions and criteria for holds.
Prior to 1987 it was assumed that the Act allowed involuntary treatment for those who were detained under an initial three-day hold and a subsequent fourteen-day hospitalization. However, in the 1987 case of Riese v. St. Mary’s Hospital and Medical Center, the California Court of Appeal declared that these patients had the right to exercise informed consent regarding the use of antipsychotic drugs, except in an emergency, and if they rejected medication "a judicial determination of their incapacity to make treatment decisions" was required before they could be involuntarily treated. This case was a class action suit brought in the name of patient Eleanor Riese by the California ACLU. Eleanor Riese's story is depicted in the movie 55 Steps.

LPS evaluation, detention and Conservatorship process

Under the LPS Act, individuals can be detained into a locked psychiatric facility in the following process.

5150 Hold

Under California Welfare and Institutions Code 5150, an individual can be placed to a locked psychiatric facility, for an evaluation for up to 72 hours. Any peace officer or specific individuals authorized by a county government may place the hold. Three criteria apply – the individual is assessed to be: a danger to themselves, a danger to others, or "gravely disabled". Per WIC 5008, grave disability is defined as an individual's lack of ability, due to their mental illness, to provide for their food, clothing, or shelter. In the case of children, it is the inability to use food, clothing, or shelter even if it is supplied.
As the individual in question is likely in a state of distress, and likely also causing a disturbance in the community, it is not uncommon for police to be the party who places them on the 5150 hold and then takes the individual to the hospital for further assessment. Over the next 72 hours, the hospital / psychiatrist must determine the individuals need for further locked psychiatric detainment. If the individual's condition clears up and they are no longer a danger to others or themselves or gravely disabled, they are released from the hospital. If, however, they remain a danger to others or themselves or continue to be gravely disabled, the hospital/psychiatrist may then request a 5250 hold to thereby keep the individual in the hospital beyond the 72-hour limit of the 5150 hold.

In popular culture

Largely because the production of many American movies and television programs are based in California, usage of the term "5150" has spread beyond its original location and user population. An album of the same name by the California hard rock band Van Halen was named directly for the code section, and several derivative uses followed.

5250 Hold

If, after a 72-hour hold, an individual is deemed to still be a danger to others or themselves, or is gravely disabled, WIC 5250 permits for an individual to be involuntarily held for another 14 days.
Unlike a 5150 hold a 5250 hold requires that the individual served receive a court hearing within 4 days of being served to ascertain the validity of the hold. Court hearings are often held in hospital. Individuals are provided an attorney and a county court officer reviews the evidence for the hold presented by the hospital, hears the argument of the client and their attorney, and decides whether or not to uphold the 5250.
Just as with the 5150 hold, during the 5250 hold, the individual is continually being assessed by psychiatric staff. Again, if the individual is deemed to be no longer a danger or gravely disabled, they are then released from the hospital.
According to section 5257 of the act, the individual must be released after 14 days, unless, they agree to further treatment on a voluntary basis; they are certified for an additional 14 days of intensive treatment; they are certified for an additional 30 days of intensive treatment; they are the subject of a conservatorship petition or they are the subject of a petition for post-certification treatment of a dangerous person.

5350 hold / Temporary LPS Conservatorship

A 5350 hold, otherwise known as a Temporary LPS Conservatorship, is initiated at the end of 5250 / 14-day hold. Such is initiated by the individual's treating psychiatrist and co-signed by the medical director of the psychiatric facility to the Public Guardian Office in the individuals county of residence. The basis for the LPS Temporary Conservatorship is that the individual remains "gravely disabled."
There are 58 counties in California, each with its own independent Public Guardian Offices. Unlike other conservatorship processes in California - a LPS Conservatorship cannot be initiated by the public at large. Codified in the WIC - the individual must go through the 5150 - 5250 process and from there the county Public Guardian is the only authorized party to be able to request for a LPS Conservatorship. The legislative intent for such was that prior to the LPS act, it was felt individuals were often psychiatrically committed for subjective reasons. To combat such potential abuses, the county Public Guardian, seen as an impartial, third party was designated as sole party.
Once the individual is on a LPS Temporary Conservatorship, they are no longer legally on a "hold," but now, legal consent to treat and continue to detain the individual lies with the Public Guardian office.
A Temporary LPS Conservatorship can last a maximum of 180 days. As the county superior court has direct oversight of LPS Conservatorship matters, typically the conservatee is afforded court hearings every 30 days. Unlike other conservatorship hearing, LPS Conservatorship matters / records are NOT open to the public.
With 58 counties, the Public Guardian Office and Superior Courts may interpret and practice differing ways legal administration of LPS Conservatorship. In general, all conservatees are appointed legal counsel and during the course of their LPS Conservatorship they can ask for a series of writs and hearing or even a full jury trial to contest their detention and overall LPS Conservatorship. It is not uncommon for a psychiatrist to conversely declare the conservatee is no longer gravely disabled. During the course of the LPS Conservatorship if the conservatee stabilizes and can thereby be discharged to the community, a psychiatrist can request that the LPS Conservatorship be dismissed.
As of the Public Guardian office, during a Temporary LPS Conservatorship, it is their general duty to ensure the conservatee is properly cared for and that all reason efforts are ruled out, that the conservatee continues to require locked psychiatric care.
During the LPS Temporary Conservatorship, it is indeed the Public Guardian, not the conservatee, who consents to treatment and placement. A common way to understand such is parent to child - in that a minor child cannot consent to medical care. The same goes for the conservatee - in that the Public Guardian consents to their psychiatric treatment and placement.
If during the LPS Temporary Conservatorship, the Public Guardian feels the conservatee will need to remain in locked psychiatric care - they can then seek to have the LPS Conservatorship changed from Temporary to General. With the appointment of a Permanent LPS Conservatorship - the conservatee is now under the auspice / authority of the LPS Conservator for exactly 1 year. It is with a Permanent LPS Conservatorship that then the public can now become involved. If family / friends request and with court approval, they can be appointed as the General / Permanent LPS Conservator for the conservatee.
The 1-year duration for a General / Permanent LPS Conservatorship was again codified into the LPS act as to combat past abuses. This ensures that no individual is indefinitely detained in locked psychiatric care and that every year justification to continue the LPS Conservatorship is brought before the court. This too is another difference between LPS conservatorship and Probate or Limited Conservatorship - both which have no implicit expiration date. Indeed, if the LPS Conservator does not submit a request to renew the LPS Conservatorship, by default it expires. Renewal of the LPS Conservatorship requires that 2 MD / Psychiatrists / Psychologist formally declare that the LPS Conservatorship still remains appropriate.
During the course of a General / Permanent LPS Conservatorship, the conservatee is most likely held in long-term, locked psychiatric care. Although California State Hospital still exist and are in use, a most LPS Conservatees are placed at local locked psychiatric hospitals. Nothing though in the LPS act precludes a conservatee being under a LPS Conservatorship and living in the community. No time frame is quantified in the LPS act, but it is generally practiced that if a conservatee has been living in the community for an extended period of time – the legal justification to thereby continue the LPS equally diminishes and from there they are bound to dismiss the LPS Conservatorship. As such there is no common duration for a LPS Conservatorship. It can indeed vary from a conservatee being under a single LPS conservatorship continuously for 30 years to others undergoing multiple Temporary LPS Conservatorship over the course of a single year.
A common growing theme, especially among family of mentally ill individuals is the LPS act favors the individual's civil rights too much when weighed against their self-evident need for treatment. It can be very difficult for their family member to be placed on a 5150 hold or on a LPS Conservatorship. Again per the LPS act - "grave disability" is primarily codified with food, clothing, or shelter. Thus an individual may indeed be highly symptomatic - displaying paranoia, delusions, mania, etc. but if they can present a cogent plan to care for their food, clothing, or shelter - they may very well be released from psychiatric care. Many have argued that revisions should be made to thereby make it easier for individuals to be detained, lessening the restrictions made under the LPS act. In 2018 SB 1045 was signed into CA Law - establishing a pilot program in San Francisco, Los Angeles, and San Diego counties if the counties approve, creating a conservatorship for a person who is unable to care for their own health and well-being due to serious mental illness and substance use disorder. SB 1045 would provide the least restrictive and most clinically appropriate alternative needed for the protection of the person who is incapable of caring for the person's own health.