5150 vs 5250: What’s the Difference?
A 5150 hold and a 5250 hold are both involuntary psychiatric holds in California — but they’re different in duration, criteria, and the rights they trigger. This guide breaks down the differences side by side, when a 5150 escalates to a 5250, and what to expect at each step.
Key Takeaways
- A 5150 is a 72-hour emergency psychiatric hold used to stabilize someone in a mental health crisis.
- A 5250 is an additional 14-day involuntary certification that follows a 5150 and requires probable-cause review.
- Only a patient already on a 5150 hold can be moved to a 5250 — it is the direct escalation path.
- During a 5250, patients retain the right to a Certification Review Hearing and legal representation.
- Both holds require the patient to meet one of three criteria: danger to self, danger to others, or gravely disabled due to a mental disorder.
5150 vs 5250: Side-by-Side Comparison
| Feature | 5150 (72-Hour Hold) | 5250 (14-Day Certification) |
|---|---|---|
| Duration | Up to 72 hours | Up to 14 additional days |
| Legal authority | Welfare & Institutions Code §5150 | Welfare & Institutions Code §5250 |
| Who initiates | Peace officer, mental health clinician, or designated professional | Facility staff after 5150 evaluation |
| Criteria | Danger to self, others, or gravely disabled (as a result of mental disorder) | Same three criteria continue to apply; must be certified by two clinicians |
| Patient consent | Not required | Not required |
| Review process | Clinical evaluation during the 72 hours | Certification Review Hearing (or “probable cause hearing”) within 4 days |
| Medication | Cannot be forced except in specific emergencies | Cannot be forced except under a Riese hearing outcome |
| Right to counsel | Limited (72 hours is short) | Yes — patient advocate plus attorney at review hearing |
| Discharge options | Voluntary treatment, release, or upgrade to 5250 | Voluntary treatment, release, or upgrade to 5270 (30-day) |
| Typical cost | Covered by insurance (parity laws) | Covered by insurance (parity laws) |
How a 5150 Escalates to a 5250
Not every 5150 becomes a 5250. In most cases, patients stabilize during the initial 72-hour hold and are discharged, transferred to voluntary treatment, or step down to a lower level of care. A 5250 is only initiated when clinicians determine that the patient still meets one of the three qualifying criteria — danger to self, danger to others, or grave disability — at the moment the 5150 is set to expire.
Certification requires two clinicians: typically the treating psychiatrist and one other qualified professional (a psychologist, social worker, or nurse authorized by the facility). Both must independently sign a certification form (MH 302 in California) documenting the ongoing clinical need for involuntary care. Without both signatures, the patient must be released or offered voluntary admission.
Timing matters. The 5250 must be initiated before the 5150 expires — there is no gap during which a patient becomes voluntarily held. If certification paperwork is not completed in time, the patient may sign a voluntary admission or leave the facility.
Once certified, the facility must give the patient a written notice explaining the reason for the 5250, the right to a Certification Review Hearing, the right to an attorney or patient advocate, and the right to habeas corpus review. This notice is legally required within a set window and is a common focus of patient-advocate audits.
What Happens at the Certification Review Hearing
The Certification Review Hearing (sometimes called a probable-cause hearing) must occur within four days of the 5250 being initiated. It is held on-site at the treatment facility and presided over by a neutral hearing officer — usually an attorney or commissioner appointed by the county.
Present at the hearing are the patient, a patient advocate (a trained non-attorney who represents the patient’s interests), a representative of the facility (typically the treating psychiatrist), and the hearing officer. The patient may also have an attorney if requested. The hearing is closed to the public but is legally recorded.
The hearing officer weighs the clinical evidence against the legal standard of “probable cause” that the patient still meets 5250 criteria. Possible outcomes: (1) uphold the 5250 — the patient remains hospitalized for the remainder of the 14 days; (2) release the patient — the hold is discontinued and the patient is discharged or offered voluntary status; or (3) the patient may choose to convert to voluntary admission at any point.
Patient Rights Under Both Holds
- Right to know why you’re being held, in writing and in language you understand
- Right to legal counsel and a patient advocate
- Right to refuse most non-emergency medications (challenged via a Riese hearing)
- Right to make confidential phone calls, including to an attorney
- Right to receive visitors, subject to reasonable clinical restrictions
- Right to challenge the hold at a Riese hearing (medication) or a Certification Review Hearing (5250)
- Right to humane treatment and freedom from unnecessary restraint or seclusion
Beyond 5250 — What Comes Next
If a patient still requires involuntary care after the 14-day 5250 expires, California law provides several escalation options depending on the clinical picture. A 5270 extends care by an additional 30 days for patients who continue to be gravely disabled. A 5300 is a post-certification hold of up to 180 days for patients who pose an imminent physical danger to others. In long-term cases, the county may petition for an LPS conservatorship, which places decision-making authority with a court-appointed conservator for up to one year at a time.
For a deeper look at the 14-day certification — including MH 302 paperwork, patient advocate procedures, and Riese hearings — see our complete guide to the 5250 hold. For a general overview of the 72-hour hold, its history under the Lanterman-Petris-Short Act, and family/next-of-kin questions, visit our 5150 resource hub.
Frequently Asked Questions
What’s the main difference between a 5150 and a 5250?
Duration and process. A 5150 is a 72-hour emergency hold that any qualified professional can initiate; a 5250 extends care up to 14 additional days and requires certification by two clinicians and a probable-cause review hearing within four days.
Can you refuse a 5250 hold?
You cannot refuse the hold itself — it is involuntary. But you can request a Certification Review Hearing, contest the clinical evidence with the help of a patient advocate or attorney, and file a writ of habeas corpus in superior court. You can also refuse most non-emergency medications unless a Riese hearing authorizes them.
Does a 5150 automatically become a 5250?
No. Most 5150s end in discharge, voluntary admission, or transfer. A 5250 is only initiated when two clinicians certify that the patient still meets qualifying criteria at the moment the 5150 expires.
How is a 5250 certified?
Two qualified clinicians — typically the treating psychiatrist plus a second professional such as a psychologist, LCSW, or authorized nurse — must independently sign the MH 302 certification form documenting continued need for involuntary care. Both signatures are required before the hold is legally in effect.
What happens if I’m still not stable after 14 days?
Options include voluntary admission, a 5270 extension (an additional 30 days for grave disability), a 5300 post-certification hold (up to 180 days for imminent danger to others), or referral for LPS conservatorship. The specific path depends on the clinical picture and available placements.
Do 5150 and 5250 exist outside California?
The section numbers are unique to California’s Lanterman-Petris-Short (LPS) Act. Other states have their own involuntary hold statutes with different durations, criteria, and terminology, but most follow a similar structure: a short emergency hold followed by an extended certification with judicial or hearing-officer review.