5250 Hold in California: The 14-Day Certification Explained

This article is informational only and is not medical or legal advice. If you or someone you love is in immediate danger, call or text 988 (the Suicide and Crisis Lifeline) or dial 911.

When a California 5150 hold isn’t enough time to stabilize a psychiatric emergency, the treating team can request a 5250 hold — a 14-day involuntary certification that extends inpatient care under California’s Lanterman-Petris-Short (LPS) Act. Families searching for what is a 5250 hold in California after 5150 are usually in the middle of the most frightening week of their lives: their loved one has just been placed on a 72-hour 5150 psychiatric hold, and the hospital has told them the hold is being extended. This page walks through the statute, the criteria, the hearing, and what treatment usually looks like after the certification ends.

5250 hold California 14-day psychiatric certification after 5150

What Is a 5250 Hold?

A 5250 hold is a 14-day involuntary psychiatric certification authorized by California Welfare and Institutions Code § 5250. It is the second step in the LPS Act’s involuntary-treatment ladder and it can only begin after a patient has already completed a 72-hour 5150 evaluation. The certification is a clinical judgment — not a criminal charge — issued by an LPS-designated treating facility, and it is subject to review by a hearing officer within four days.

Unlike the 5150, which is initiated in the field by a peace officer, county-designated clinician, or emergency room physician, the 5250 is initiated inside the receiving hospital. It reflects the treating team’s judgment that 72 hours was not enough time to stabilize the psychiatric crisis or to safely discharge the patient. For a broader view of how California compares to other jurisdictions, see our state-by-state guide to involuntary psychiatric holds.

Criteria for a 5250 Certification

WIC § 5250 uses the same three criteria as the 5150, but the standard of proof is higher and the certifying clinician must document that continued inpatient care is the least-restrictive appropriate option. The three grounds are:

Danger to self. Suicidal ideation with plan, intent, recent attempt, or observable behavior indicating imminent risk.
Danger to others. Homicidal or assaultive ideation or behavior directed at an identifiable person or group.
Grave disability. Inability, as a result of a mental health disorder, to provide for basic personal needs — food, clothing, or shelter — such that safety is at risk.

The certifying clinician must reference specific behavior, statements, or clinical findings observed during the initial 5150 window. Vague concerns are not enough; documentation must connect a diagnosable mental health disorder to a present-day inability to be safe in the community.

Who Can Initiate a 5250 Hold

Only staff at an LPS-designated facility can initiate a 5250. In practice, this means the psychiatrist or licensed clinician on the receiving inpatient unit — typically at a general hospital’s behavioral health wing, a psychiatric hospital, or a designated crisis stabilization unit. The certification requires:

Written certification signed by the treating physician (usually a psychiatrist) and a second qualifying professional (physician, licensed psychologist, LCSW, MFT, or registered nurse with psychiatric training, depending on the facility).
Notification of the patient in writing, in a language they understand, including the reason for the hold and their rights.
Notification of the county-designated patient advocate so a certification review hearing can be scheduled.
Where relevant, notification of the patient’s attorney, conservator, or nearest relative — subject to the patient’s HIPAA preferences.

Patient Rights During a 5250 Hold

The LPS Act guarantees a specific set of rights during involuntary treatment. Disability Rights California and county patient advocates enforce these rights. During a 5250 the patient retains:

The right to a certification review hearing within four days of the start of the hold.
The right to a patient advocate or attorney at the hearing, free of charge.
The right to refuse antipsychotic medication in non-emergency situations unless a separate Riese hearing finds them incapable of informed consent.
The right to communicate with visitors, counsel, and family (subject to reasonable clinical limits).
The right to see and receive copies of their treatment records, request a second opinion, and know the identity of their treating team.
The right to file a habeas corpus petition in superior court challenging the hold itself.

The Certification Review Hearing Explained

The certification review hearing is often called a “probable cause” hearing. It is also the main opportunity to challenge the hold — see how to get someone released from a hold. It is held on the hospital unit or by videoconference, usually within four days of the start of the 5250. Attendees typically include:

The patient
A hearing officer or court-appointed commissioner (a neutral decision-maker, not the treating team)
A patient advocate or attorney representing the patient
The treating psychiatrist or a designated clinician presenting the certification
Occasionally, family members if the patient consents

The hearing officer reviews the certification documents, hears from the clinician, and gives the patient (through counsel) the chance to respond. Possible outcomes are (1) the hearing officer upholds the 5250 and treatment continues, (2) the hearing officer terminates the hold and the patient is discharged or offered voluntary admission, or (3) the patient agrees to voluntary treatment mid-hearing, which usually ends the involuntary certification.

What Happens After a 5250 Hold Expires

When the 14 days end, one of four things typically happens:

Discharge. The patient is stable, safety-planned, and released — often with an outpatient referral.
Voluntary continuation. The patient agrees to remain inpatient on a voluntary basis to complete the treatment plan.
5270 hold. If the patient remains gravely disabled, the facility may certify an additional 30-day involuntary hold under WIC § 5270.
Referral for LPS conservatorship. For patients who remain gravely disabled long-term, the county may petition the court to appoint a conservator.

Detailed guidance on the transition home is in our companion article, what happens after a 5150 hold.

When a 5250 Leads to Long-Term Mental Health Treatment

A 5250 signals that a single crisis-stabilization admission is not enough. Families and treating teams typically use the 14-day window to plan a longer runway of care, which can include:

Residential mental health treatment — 24-hour supervised care for 30-90 days for continued stabilization. See our overview of mental health treatment options.
Partial hospitalization program (PHP) — 5-6 days per week of intensive daytime treatment, patient sleeps at home or in supportive housing.
Intensive outpatient program (IOP) — 3-4 half-days per week; see our intensive outpatient program overview.
Outpatient psychiatry and therapy — weekly or twice-weekly appointments, medication management, and family therapy.

To talk through options for a loved one currently on a 5250 (or a step-down after one), call 1-866-570-6674 for a confidential consultation. You can also revisit the pillar article, the 5150 hold explained, for a full picture of the code family.

Common Questions About the 5250 Hold

How long is a 5250 hold?

A 5250 hold is a 14-day involuntary psychiatric certification under California Welfare and Institutions Code § 5250. It begins immediately after a 5150 hold expires and the treating facility certifies that the patient still meets criteria for danger to self, danger to others, or grave disability due to a mental health disorder.

Can a 5250 hold be extended?

Yes. If a patient continues to meet criteria at the end of the 14 days, the facility can pursue a 5260 (additional 14 days for suicidal patients) or a 5270 (additional 30 days for gravely disabled patients). In some cases the county may petition for LPS conservatorship for longer-term care.

What is the certification review hearing?

The certification review hearing is a legally required probable cause hearing held within four days of the start of the 5250. A neutral hearing officer or court-appointed commissioner reviews whether the criteria for continued involuntary treatment are met. The patient has the right to a patient advocate or attorney.

Can the patient refuse medication during a 5250?

Involuntary medication cannot be forced during a 5250 unless there is a psychiatric emergency or a separate Riese hearing has been held. A Riese hearing determines whether the patient has the capacity to refuse antipsychotic medication; if the court finds the patient lacks capacity, the treating psychiatrist may administer medication over objection.

Who pays for a 5250 hold?

Costs are typically billed to the patient’s health insurance (private, Medi-Cal, or Medicare). If the patient is uninsured, the county mental health system usually covers care at a designated facility. Families should contact the facility’s billing department and the patient’s insurer within the first 48 hours to confirm coverage.

Does a 5250 hold go on my record?

A 5250 hold is a medical record, not a criminal record, and it is protected by HIPAA. However, under California law and federal law, a 5250 can trigger a five-year firearm prohibition. Employment or licensing implications depend on the specific field; most jobs do not have access to mental health records without written consent.

Getting Support

Watching a loved one go through a 5150 or 5250 is one of the hardest experiences a family can face. You are not alone. In addition to the treatment team at the hospital and the patient advocate, national resources like NAMI California offer free family support groups and helplines. If you are in crisis, call or text 988.

Editorial note: This article is informational and educational — it is not a substitute for medical, legal, or clinical advice. Laws and clinical practices can change. If you have specific legal questions about a 5250 hold, consult a California mental health attorney or your county’s patient advocate office.