5150s, 5250s, and what changed under SB 43 — the essentials every psychiatric nurse should have on hand.
Updated for SB 43, statewide effective January 1, 2026
California uses a tiered system of involuntary psychiatric holds under the LPS Act. A 5150 is the initial 72-hour hold; a 5250 extends detention up to 14 more days if criteria still apply; and longer holds or LPS conservatorship follow if grave disability persists. Each stage requires its own criteria, certifying party, and, in most cases, a hearing.
| Hold | Duration | Core Criteria | Who Initiates |
|---|---|---|---|
| 5150 | Up to 72 hours | Danger to self, danger to others, or gravely disabled | Peace officer, or an LPS-designated/county-authorized clinician |
| 5250 | Up to 14 additional days | Same criteria continue to be met after the 72-hour evaluation | Treatment facility certifies; requires a Certification Review Hearing (probable cause hearing) |
| 5260 | Up to 14 additional days | Continued danger to self only, following a 5250 | Certifying psychiatrist |
| 5270.15 / grave disability | Up to 30 additional days | Gravely disabled and unwilling/unable to accept voluntary treatment | Facility petitions the court |
| LPS Conservatorship | Up to 1 year, renewable | Grave disability persists; least restrictive alternatives considered first | Court-ordered, following investigation |
SB 43 (effective statewide January 1, 2026) expanded the definition of "gravely disabled" under the LPS Act. It now includes:
In practice: more patients presenting primarily with substance use may now meet criteria for a hold than before SB 43 — evaluate against the full expanded definition, not the pre-2026 one.
Right to be informed, in writing, of the reason for detention and hold status
Right to access a patients' rights advocate
Right to a timely evaluation and, for a 5250, a Certification Review Hearing
Right to legal counsel and to petition for habeas corpus
Right to refuse most non-emergency treatment — a hold alone does not authorize involuntary medication
Right to the least restrictive appropriate level of care
A 5150 hold is an involuntary psychiatric hold of up to 72 hours under California's Lanterman-Petris-Short (LPS) Act. It can be placed when a person is a danger to themselves, a danger to others, or gravely disabled, and can only be initiated by a peace officer or an LPS-designated or county-authorized clinician.
A 5150 is the initial 72-hour hold. A 5250 extends detention up to 14 additional days if the same criteria still apply after the 72-hour evaluation — the treatment facility must certify the extension and hold a Certification Review Hearing (probable cause hearing).
SB 43, effective statewide January 1, 2026, expanded the LPS Act's definition of "gravely disabled" to include severe substance use disorder (alone or co-occurring with a mental health disorder), and added inability to provide for personal safety or necessary medical care alongside the original food, clothing, and shelter criteria.
No. A 5150 or 5250 hold alone does not authorize involuntary medication. Patients retain the right to refuse most non-emergency treatment; separate legal authorization is required to medicate someone against their will outside of an emergency.
Chart specific observed behaviors and direct patient statements rather than conclusory labels, record the exact date, time, and identity of the person who initiated the hold, confirm the patient was notified of their hold status and rights, and reassess whether criteria are still met at every shift, not just at intake.
Sources: California Welfare & Institutions Code §§5150, 5250, 5260, 5270.15; SB 43 (Eggman, 2023), effective statewide January 1, 2026. This page reflects our understanding of the law as of publication and is not a substitute for legal counsel. Questions or corrections: exec@calmnurses.org