5150 Hold vs Residential Treatment and Stabilization

Most everyone is under significant mental strain in the days of Covid-19. Our mental stability is being tested daily as we attempt to process the swift changes in our world. For many of us, chronic stress may have sparked an increase in anxiety symptoms. For others, depression may have taken hold recently. And for some, they may have reached a breaking point.

Our mental health may be much more fragile than we might realize. It may not be revealed until we are really tested; we don’t know what our personal limits might be. There are multiple factors that help determine each person’s capacity to withstand stress and strife, each of us with our own reservoir and coping skills. When events begin to spiral, those reserves become depleted and any coping skills we might have can lose their power to manage the stress effectively.

When a mental health crisis develops it may surprise everyone. While sometimes there are signs of deteriorating mental health, other times the person may effectively hide their struggle from others. When a psychiatric emergency occurs, there is a choice in how to respond. Should the person be placed on a 5150 hold or should they enter a mental health program with acute stabilization services?

What is a 5150 Hold?

In the state of California, a Code 5150, section 5150 of the California Welfare and Institutions Code, designates an involuntary 72-hour psychiatric hold for individuals who exhibit certain signs of severe mental distress. This gives an officer the latitude to insist on taking this step where the individual is showing such psychological distress that they have become a danger to themselves or others. All states have their own variation of a 5150.

There are three conditions that provide the eligibility for invoking a 5150 3-day hold. Only one of the three needs to be present. These include:

1. The individual is a danger to him or herself.
2. The individual is a danger to others.
3. The individual is gravely disabled.

Once the peace officer has determined that the individual meets the criteria for an involuntary psychiatric hold, they will transport the person to a local hospital for acute stabilization. During acute stabilization, the individual will be evaluated and closely monitored. While in the 3-day hold, the individual will meet with mental health professionals including a psychiatrist to discuss the underlying issues. A caseworker

What is a Mental Health Emergency?

The CDC reported that in 2017 there were nearly 5 million emergency room visits due to a mental health disorder as the primary diagnosis. When looking at California data, it was found that 58% of these individuals were treated in the emergency room, 30% were admitted to inpatient care units, and about 6% were treated in ICU or other areas. When someone is taken in for a Code 5150 the majority of them will be sitting in an emergency department awaiting the arrival of psychiatric assistance. They may be waiting there for 2 of the 3 days, while getting no real treatment for their mental health condition.

Although a mental health crisis, such as a suicide attempt or a psychotic break, requires immediate intervention, the individual may not obtain the help they need in the hospital setting. Mental health professionals who work for the designated county may not be available to attend to the individual.

Are There Signs of an Emerging Psychiatric Event?

Recognizing the signs and symptoms of an impending mental health event can allow a loved one to be proactive in procuring treatment for them, which might deter a crisis that requires a 5150. These signs might include:

• Isolating behaviors
• Lack of interest in activities once enjoyed
• Lack of motivation
• Neglecting personal hygiene
• Avoiding social situations
• Feelings of anxiety, irritability
• Agitation
• Extreme mood swings
• Slowed movements or speech
• Absenteeism from work without explanation
• Feeling emotionally drained
• Physically exhausted for no reason
• Memory and concentration problems
• Insomnia or hypersomnia
• Unexplained somatic symptoms, aches and pains, gastric distress
• Thoughts of suicide, suicide attempt
• Paranoid thoughts
• Angry or violent outbursts
• Panic attacks
• Hallucinations
• Delusional thoughts

5150 Hold versus Acute Stabilization and Treatment

While true that there are times when a psychiatric crisis requires swift and decisive action. The 5150 is an example of the state, through law, taking control of a situation and securing the person so they don’t harm themselves or others. Through the interventions of a police officer, the individual’s life might be spared.

But there is another route that should be considered. Family members can also take proactive steps to obtain the immediate help there loved one needs. Instead of their family member sitting around for sometimes days waiting to be assessed and treated, they can have the individual admitted to a residential mental health treatment center. This should be a facility that offers acute stabilization services.

Based on the severity of the mental health disorder, acute stabilization may involve isolating the individual in an area of the facility until they are stable. They would receive 24-hour care and monitoring during the acute stabilization phase. Once stable, the individual would transfer into the residential treatment program. These are intensive programs where a treatment plan is designed specifically for their particular needs. Taking this route, versus a 5150 3-day hold, allows for a more comprehensive approach to not only stabilizing the person, but then also getting them targeted treatment for their mental health disorder.

What is Best for Minors: A 3-day Hold or Residential Treatment?

When a minor is involved, it is a Code 5585. The 5585 can be initiated by concerned family members, school authorities, or other significant others associated with the minor. Symptoms a teen might exhibit that would warrant a possible 5585 3-day hold include:

• A loss of interest in activities once enjoyed
• Self-harming behaviors
• Extreme moodiness
• Victim of bullying
• Withdraws from family and friends
• Makes comments about feeling worthless or hopeless
• Sudden dramatic academic decline
• Substance abuse
• Family history of mental illness or suicide
• History of abuse or neglect
• Talks of wanting to die, or mentions suicide

These signs are serious and should never be ignored by parents. When noticing a cluster of the signs of emotional distress, a parent would obtain a better outcome for their teen in a residential mental health treatment program designed for teens.

5150 and Dual Diagnosis

A mental health disorder is often aggravated by the co-occurrence of a substance use disorder, which is referred to as a dual diagnosis. Regardless of whether the substance use disorder preceded the mental health issue, when both coexist each disorder amplifies the effects of the other. This is why a dual diagnosis is a serious condition. For example, if someone is already struggling with bipolar disorder and begins using methamphetamine, there could be severe mental health implications.

Many 5150s involve individuals struggling with a dual diagnosis. Alcoholism-fueled depression increases the risk of suicide, so threats of suicide would be a reason why an officer would decide to place someone on a 5150 hold. Someone with a mental health disorder who is also high on drugs may also pose a danger to others, possibly becoming violent.

Once these individuals are stabilized, they would benefit from a residential dual diagnosis program. These are integrated programs that provide psychiatric support in addition to the addiction recovery services. The dual diagnosis is best treated with both the disorders being treated simultaneously for the best recovery outcome.

Acute Stabilization and Residential Mental Health Treatment

Someone who is admitted into a hospital on a 5150 involuntary hold will usually not receive the comprehensive care they need. These individuals for sure require acute stabilization. These important services involve continuous monitoring, appropriate medications, possibly IV fluids, and the initial evaluation and preliminary diagnosis of the admitting psychiatrist. But the acute stabilization is only part of the treatment picture.

A residential mental health treatment program can also provide the acute stabilization aspect of care. Following stabilization, these programs provide a supportive environment that allows emotional healing while receiving needed mental health treatment. By retreating from the stressors into a therapeutic environment, the individual will be able to focus on and participate in the various therapies provided. There are a wide variety of proven psychotherapies to help individuals learn new behavioral approaches and coping skills.

One of the most effective therapies is cognitive behavioral therapy, or CBT.  CBT is an effective short-term therapy that helps the individual in distress to first identify the thoughts that are leading to a sense of lack of control in their life. Sometimes thought distortions can overblow the reality of a situation, resulting in overreacting or hyper-arousal response, which can lead to a psychiatric event. CBT helps the individual reframe the thoughts into positive, actionable behavioral responses that help them gain back a sense of control over their life.

Stress reduction and coping skills are a significant focus in residential mental health treatment for serious mental health conditions. Learning how to diffuse triggers by using deep breathing techniques and practicing mindfulness can help the individual better manage challenging or frightening situations.

Holistic therapies added to the program can also offer tools to help individual learn to manage stress.  These activities might include practicing yoga, art therapy, aromatherapy, acupuncture, therapeutic massage, or outdoor activities like swimming, hiking or cycling.

In summary, a loved one experiencing deteriorating mental health would be better served through the expert support of a residential mental health program, versus a 5150 hold.

The Treatment Specialist Provides Important Information About Mental Health Treatment Options

The Treatment Specialist is an online resource for informative articles on mental health conditions and treatment options for adults, teens, and families. For more information and guidance please contact the team at (866) 644-7911.