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BEHAVIOR VARIABLES TO CONSIDER
The basis for holding a person in a Designated Psychiatric
Treatment Facility is not a medical model. It is a legal
model. The law and the Courts have consistently held that
personal freedom is the most important right we possess.
The Court is looking at behaviors that lead you to believe
that a person is a Danger to Self, Danger to Others, and/or
Gravely Disabled due to a mental disorder. Simply stating the
diagnosis without behaviors does not meet the criteria. Simply
believing the person is very sick and in need of psychiatric
treatment does not meet the criteria. The burden of proof is
on the Treatment Facility to show that the person meets the
legal criteria to be held involuntarily. The following
symptoms and behaviors should be assessed and the information
should be presented by the Treatment Facility representative
in all hearings.
Is the person telling you they are having auditory
hallucinations or does the person appear to be responding to
When asked if the person is having auditory hallucinations,
does the person answer?
If the person answers:
Are the auditory hallucinations sounds or words?
If they are words, is it someone they know?
Are the words saying good things or bad?
Are they commanding the person?
Are they telling the person to hurt self or others?
Are they telling the person to not eat or to not take
Has the person heard the voices in the past?
If so, did the person act on the voices or did the the voices
cause the person to do anything?
If they do not answer, describe any behaviors that seem
indicate that the person is responding to internal stimuli.
Do the auditory hallucinations help you establish that the
person meets the legal criteria of being a Danger To Self,
Danger To Others, and/or Gravely Disabled? If so, how?
What type of delusion is the person having?
How do you know that it is a delusion?
Is the delusion such that it would lead the person to cause
harm to self or others?
Has the person had the delusion in the past and has it caused
the person to do anything?
Does the delusion prevent the person from providing for food,
clothing and/or shelter? If so, how?
Seriousness Of Precipitating Events
Present all of the information specified on the 5150 (72
How serious were the circumstances that brought the person
into the hospital?
Who reported this information to you?
Was the situation serious and the person is dismissing it as
Did something happen physically or was it merely words?
Has the person done similar things in the past?
How does the precipitating event lead you to believe that the
person continues to be a Danger to Self, Danger to Others,
and/or Gravely Disabled at this time?
What is the nature and type of the thought disorder?
Have you considered cultural differences?
Is the thought disorder global, does it affect every part of
their thinking, or just a selected area?
If it is a selected area, how does it impact on Danger to
Self, Danger to Others, and/or Grave Disability?
Recent Discharge From Psychiatric Hospital
When was the person last in a psychiatric treatment
What were the circumstances of the release or discharge?
Was the release or discharge against medical advice?
Did the person elope or AWOL from the facility?
Does the person have a pattern of not complying with
outpatient treatment plans?
Support System In The Community
Is the person homeless?
If homeless, is the person able to maintain adequately on the
Does the person know how to get food and clothing?
Does the person know how to utilize homeless shelters?
What income does the person have? Specify the types of income
What other resources, if any, does the person have?
Is the person employed?
Does the person live independently?
Is the person current on rent or mortgage payments?
Is the person able to live safely at home currently?
Does the person live with family or others?
Are the family or others willing and able to assist the person
with food, clothing or shelter at the current time in the
personís current condition?
Is the person in long-term placement and can the person be
cared for at that level of placement in the personís current
Motivation To Take Medications
Does the person take their prescribed medications regularly
while in the facility?
Does the person have a pattern of repeated out-patient
medication noncompliance and repeated hospitalizations
resulting from this noncompliance?
Does the person drink alcohol or take illegal drugs?
Is the personís living situation such that the person can take
medications properly and have the prescriptions refilled?
Does the person have a problem with side effects from
Does the person need any special ongoing test to be on the
Is the person taking more or less than the prescribed amount
Are there any physical reasons that interfere with the person
taking psychiatric medications?
Does the person understand the reasons for taking the
If the person recently stopped taking the medications, why?
Did someone take the personís medications away or tell the
person not to take them?
Does the person feel medications have helped in the past?
Does the person see any reason for taking the medications?
Who Is At Risk - Patient's Proximity To, And Contact
With This Person
Has the hospital done a Tarosoff?
Is there a restraining order?
Is it an identified person?
Is it any person who fits a certain description?
Has someone called and given information about threatening
behavior from the patient?
Has the patient called and made threats?
Have the threats ever been acted on?
Has there been previous circumstance where the threats were
OVERVIEW OF THE PROBABLE CAUSE HEARING PROCESS
When a patient is hospitalized in a psychiatric hospital
against his or her will, he or she is placed on a 72 hour hold
(WIC 5150). At the end of the 72 hours or any time during the
72 hours, the doctor may decide to discharge the patient, have
the patient sign into the hospital as a voluntary patient, or
place the patient on a 14 day hold (WIC 5250). The doctor may
place the patient on a 14 day hold if he or she feels the
patient is a danger to self, danger to others, or gravely
disabled (unable to provide food, clothing or shelter) due to
a mental disorder. At the end of the 14 day hold, the doctor
may place the patient on an additional 30 day hold (WIC
5270.15) if the doctor feels the patient remains gravely
disabled and requires further treatment.
When the patient is placed on a 14 day hold or a 30 day
hold, the hospital must notify the Superior Court, Mental
Health Counselor's Office immediately at(323) 226-2911.
Within the first four days of the 14 day hold or a 30 day
hold, a Probable Cause Hearing is scheduled at the psychiatric
facility. The Mental Health Hearing Coordinator will notify
the hospital of the date and time of the hearing. The hospital
will be notified the afternoon before the scheduled hearing
There are over 47 designated psychiatric treatment
facilities in Los Angeles County conducting over 1400 hearings
per month. It is
extremely important that you notify the Court when a patient,
who has not yet had a hearing, signs voluntary or is
Attempts are made to accommodate doctor's hours. If a
hearing is scheduled, a professional staff member must present
on behalf of the hospital.
At the probable cause hearing, present are a Patients'
Rights Advocate who is there to help the patient, the doctor
or a hospital staff person to present information on behalf of
the facility, and the Mental Health Hearing Referee. The
Court, when needed, also provides an interpreter for the
patient. It is
extremely important to notify the Court of the need for an
interpreter and the specific language needed.
Family members are discouraged from attending the hearings.
If the patient wishes to have a family member present, the
person may be admitted to the hearing as an observer. If the
family member wished to present information supporting the
hospitalization they are encouraged to give the information to
the hospital presenter and let them provide the information at
the hearing. This process helps alleviate any potential
hostility or alienation which might develop because of the
patient wishing to be released from hospitalization and the
family member feeling they should remain in the hospital for
further treatment. If the family member has information
supporting the release of the patient from the hospital, they
should give this information to the Patients' Rights Advocate
who will present the information at the hearing. The offer by
a family member or other person to provide food, clothing or
shelter to a patient is required to be in writing by WIC
5250(d)(2). This requirement also may be satisfied by the
Patientsí Rights Advocate talking to the family member or
other person and obtaining an Affidavit from that person over
the telephone to present at the hearing.
The probable cause hearings are administrative hearings.
This means that they are much less formal than judicial
hearings and formal legal rules, such as the rules of evidence
(i.e., hearsay information) do not apply. The purpose of the
hearing is to gather as much information as possible so the
hearing referee can decide whether probable cause exists to
believe that the person is a danger to self, danger to others,
and/or gravely disabled.
It is the responsibility of the hospital presenter to
explain to the hearing referee: (1) the events and the
patient's behavior leading up to the patient's
hospitalization; (2) the patient's behavior during
hospitalization which illustrates his or her mental disorder
and his or her dangerousness or grave disability; (3) previous
psychiatric history; (4) living arrangements before
hospitalization and plans after discharge; (5) the patientís
diagnosis; and (6) the medications currently prescribed and
whether the patient is taking these medications.
It is the responsibility of the Patients' Rights Advocate
to present the patient's point of view. It is the job of the
advocate to attempt to gain the patient's release from the
hospital if the patient desires release, even if the release
may not be in the patient's best interest. This is the
advocate's job no matter what they feel personally.
If the Mental Health Hearing Referee determines that there
is probable cause for the patient to remain in the hospital
based upon one or more of the certification criteria, he or
she will inform the patient of this decision and the reasons
for it. The referee will attempt to inform the patient in a
way that the patient will understand. The referee will also
indicate that the patient has other legal options open to him
or her, which the advocate will then explain. If the patient
desires to file a Writ of Habeas Corpus, the hearing referee
will prepare the Writ for the patientís signature, serve a
copy of the Writ on the facility, and file it with the Court.
If the hearing referee determines that there is no probable
cause to believe the patient meets one or more of the
certification criteria, he or she will inform the patient and
hospital representative of this decision and will explain the
reason for it. If the hospital and the patient agree, the
hospital then may accept the patient as a voluntary patient.
If not, the patient must be discharged from the hospital.
PRESENTATION INFORMATION FOR PROBABLE CAUSE HEARINGS
Click here to download a form
which can be used by the facility representative when
presenting information at the probable cause hearing.
- 72 hour/14 day hold
- Additional 14 day hold
- Additional 30 day hold
- 180 day post certification
THE CONDUCT OF RIESE HEARINGS INFORMATION BOOKLET FOR
DOCTORS AND HOSPITALS
Click here to view "The
Conduct of Riese Hearings Information Booklet for Doctors and
MEDICATION CAPACITY PETITION
Click here to view the Petition
and Declaration Regarding Capacity to Give Informed Consent to
Medication (Riese Petition).