One of the most common sources of confusion for families is a simple question: can someone in a mental health crisis refuse medication? The short answer is usually yes — a diagnosis or a hospitalization does not, by itself, take away a person's right to make decisions about their own medical care. Here's how California's rules actually work.
Under California law, a mentally competent adult has the right to accept or refuse medical treatment, including psychiatric medication — even while hospitalized, and even while on a psychiatric hold. Being on a 5150 or 5250 hold controls where a person can be for evaluation and treatment; it does not, by itself, authorize forced medication.
For a voluntary patient (someone who agreed to be admitted), ordinary informed-consent rules apply, just as they would for any hospital patient: the care team explains the diagnosis, the proposed medication, the risks and benefits, and reasonable alternatives, and the patient decides.
For a patient on an involuntary hold, the same general right to refuse applies — but if the treatment team believes medication is medically necessary and the patient continues to refuse, California uses a specific legal process, called a capacity hearing or "Riese hearing," to resolve the disagreement.
None of this applies in a true emergency. If a person poses an immediate danger to themselves or others in the moment, clinicians can administer medication without a hearing or advance consent. This emergency exception is narrow — it covers the immediate crisis, not ongoing or planned treatment over a patient's objection.
A person doesn't need to be symptom-free to have capacity to consent — capacity is about whether they can understand this information and reason through it, not whether their choice matches what the care team recommends.
ECT is treated differently from medication under California law, with its own stricter consent and review requirements — including, in most cases, a formal court process regardless of capacity. A Riese hearing does not authorize ECT; it applies specifically to psychiatric medication.
California law tries to strike a balance: mental illness alone doesn't erase someone's right to direct their own medical care, but the law also provides a path forward when a person's illness has genuinely taken away their ability to make that decision. Knowing which situation applies helps families understand what's actually happening — and what their loved one's rights still are.