Mental Health

Mental Health · LPS Administrative Facility-Based Hearings

Lanterman-Petris-Short Act of 1967 - Legislative Intent

The legislative intent of the 1967 Lanterman-Petris-Short Act is:

To end the inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons and persons impaired by chronic alcoholism, and to eliminate legal disabilities;
To provide prompt evaluation and treatment of persons with serious mental disorders or impaired by chronic alcoholism
To guarantee and protect public safety;
To safeguard individual rights through judicial review;
To provide individualized treatment, supervision, and placement services by a conservatorship program for gravely disabled persons;
To encourage the full use of all existing agencies, professional personnel and public funds to accomplish these objectives and to prevent duplication of services and unnecessary expenditures;
To protect mentally disordered persons and developmentally disabled persons from criminal acts.

14-Day And 30-Day Certification Review Hearings
COMMONLY USED ABBREVIATIONS AND TERMS

LPS	The last name initials of the California legislators who wrote the California Mental Health Act of 1967: Lanterman, Petris, and Short; and the short-hand designation of the Act.

WIC	California Welfare and Institutions Code. The LPS Act is found at WIC 5000, et. seq.

LPS Hold	Also known as a mental health hold or psychiatric hold. Any holds defined in the Welfare and Institutions Code sections 5000 et. seq (listed below).

WIC 5150	Also known as 72 hour holds. "Detention of Mentally Disordered Persons for Evaluation and Treatment" for a period of 72 hours for persons alleged to meet the legal criteria of being a danger to self or others or gravely disabled due to a mental disorder (See WIC 5150 for more detail).

WIC 5250	Also known as 14 day holds. "Certification for Intensive Treatment" for a period of 14 days for persons alleged to meet the legal criteria of being a danger to self or others or gravely disabled due to a mental disorder (See WIC 5250 for more detail).

WIC 5260	Also known as additional 14 day holds. "Additional Intensive Treatment of Suicidal Person" certification for an additional period of 14 days beyond WIC 5250 (the first 14 days) for persons who are allegedly imminently suicidal due to a mental disorder (See WIC 5260 for more detail).

WIC 5270.15	Also known as 30 day holds. "Additional Intensive Treatment" for an additional period of 30 days beyond WIC 5250 (the first 14 days) for persons who were gravely disabled on the first 14 day hold and allegedly remain gravely disabled due to a mental disorder (See WIC 5270.15 for more detail).

Certification Review Hearing: WIC 5256.1
	Also known as Probable Cause Hearings. A facility-based hearing for persons on WIC 5250 or 5270 holds. The hearing is to determine if the psychiatric treatment facility has probable cause to detain the person for the remainder of the hold period. The facility is required to notify the Court (Mental Health Counselor's Office) when any person is placed on a 5250 or 5270 hold. The Certification Review Hearing is to be held within 4 days of the person being placed on the hold. A facility representative must present the probable cause information at the hearing. The representative of the facility must be a mental health professional designated by the director of the facility to present. The psychiatric treatment facility representative must show probable cause that the person is a danger to self or others or gravely disabled due to a mental disorder. The patient is usually represented by a Patients' Rights Advocate from the Los Angeles County Department of Mental Health but may be represented by a private attorney. The hearing is based upon the specific criteria certified on the hold (see above for hold criteria).

Mental Health Hearing Referee: WIC 5256.1
	Also known as a probable cause hearing officer or certification review hearing officer. A person meeting the requirements of this statute and designated by the Supervising Judge of the Mental Health Court to conduct Certification Review Hearings and file Judicial Reviews requested by persons on holds. Medication Capacity (Riese) Hearings are conducted by designated Mental Health Hearing Referees who are licensed attorneys (See Medication Capacity Hearings below).

Judicial Review WIC 5275 et. seq.
	Also known as a Writ or Writ of Habeas Corpus. "Judicial Review": A person may request one Judicial Review per hold of a Certification Review Hearing decision finding probable cause. Also, a person may choose to bypass the probable cause hearing for direct Judicial Review. The Mental Health Hearing Referee will prepare the Writ for the patient’s signature, serve the facility with a copy, and file the Writ with the Court for hearing. The Writ must be filed with the Court on the date taken and heard in Court within two judicial days.

WIC 5300	Also known as a 180 day Postcertification. "Postcertification Procedures for Imminently Dangerous Persons" for a period of 180 days beyond WIC 5250, the first 14 day hold, for persons who allegedly have made a serious threat of substantial physical harm or attempted or inflicted physical harm on another due to a mental disorder (See WIC 5300 for more detail).

Application for Conservatorship: WIC 5352
	Also known as an LPS or Mental Health Conservatorship. A mental health conservatorship begins with an application for conservatorship completed by a person designated to write LPS holds and filed with the Public Guardian's Office. No applications for mental health conservatorship will be accepted from family or friends.

Medication Capacity Hearing WIC 5332
	Also known as a Riese hearing or antipsychotic medication capacity hearing. A facility-based hearing to determine if a person on any of the LPS holds, other than a temporary conservatorship or conservatorship, has the capacity to refuse psychiatric medications. Hearings for persons on temporary conservatorship must be requested through Public Guardian/County Counsel and the hearing is held in Department 95A. If the person is on conservatorship, the conservator should be notified and advised to request a hearing with the Court which will be held also in Department 95A. The initial Riese hearing for LPS holds must be held at the facility. The treating physician must file (FAX) a petition to the Mental Health Counselor's office. The hearing must be scheduled within 72 hours. The decision of the Mental Health Hearing Referee may be appealed to the Court by either the patient or the treating physician. The current treating physicianmust present the evidence at both the facility-based hearing and any subsequent Court hearing.

Conservatorship: WIC 5350, et. seq.	Also called a LPS conservatorship or mental health conservatorship. These sections define the process of requesting conservatorship for a person who is alleged to be gravely disabled due to a mental disorder. Conservatorship lasts for a period of one year. The conservator may petition the Court for reappointment each year. Failure to request reappointment as conservator before expiration of the current appointment requires the Court to end the conservatorship "by operation of law."

Temporary Letters of Conservatorship: WIC 5352.1.
	Also known as a TCON. The Court may issue a temporary letter of conservatorship when a petition for conservatorship is filed by the Public Guardian's Office. The temporary letter of conservatorship permits the Public Guardian to authorize continued involuntary treatment for a period of 30 days (NOTE: may be extended up to 6 months).

Public Guardian	Also known as PG.

WIC 5351	All applications for mental health conservatorships must be filed with the Public Guardian. The Public Guardian may serve as conservator if the Court finds a person to be gravely disabled and there are no family members or friends willing and able to be the conservator.

Deputy Public Guardian
	Also known as DPG. A deputy public guardian conducts the investigation to determine if conservatorship should be established or may carry a caseload of persons on conservatorship under the Public Guardian.

Public Defender	Also known as PD.
	May represent the patient in any type of mental health case.

County Counsel	Also known as CC.
	Represents the Public Guardian on all conservatorship cases.

District Attorney	Also known as DA.
	Represents the State's interest on most mental health cases.

LPS HOLDS CHART

Click here to view the LPS Holds Chart.

BEHAVIOR VARIABLES TO CONSIDER

The basis for holding a person in a Designated Psychiatric Treatment Facility is not a medical model. It is a legal model. The law and the Courts have consistently held that personal freedom is the most important right we possess.

The Court is looking at behaviors that lead you to believe that a person is a Danger to Self, Danger to Others, and/or Gravely Disabled due to a mental disorder. Simply stating the diagnosis without behaviors does not meet the criteria. Simply believing the person is very sick and in need of psychiatric treatment does not meet the criteria. The burden of proof is on the Treatment Facility to show that the person meets the legal criteria to be held involuntarily. The following symptoms and behaviors should be assessed and the information should be presented by the Treatment Facility representative in all hearings.

Auditory Hallucinations

Is the person telling you they are having auditory hallucinations or does the person appear to be responding to internal stimuli?
When asked if the person is having auditory hallucinations, does the person answer?
If the person answers:
Are the auditory hallucinations sounds or words?
If they are words, is it someone they know?
Are the words saying good things or bad?
Are they commanding the person?
Are they telling the person to hurt self or others?
Are they telling the person to not eat or to not take medications?
Has the person heard the voices in the past?
If so, did the person act on the voices or did the the voices cause the person to do anything?
If they do not answer, describe any behaviors that seem indicate that the person is responding to internal stimuli.
Do the auditory hallucinations help you establish that the person meets the legal criteria of being a Danger To Self, Danger To Others, and/or Gravely Disabled? If so, how?

Delusions

What type of delusion is the person having?
How do you know that it is a delusion?
Is the delusion such that it would lead the person to cause harm to self or others?
Has the person had the delusion in the past and has it caused the person to do anything?
Does the delusion prevent the person from providing for food, clothing and/or shelter? If so, how?

Seriousness Of Precipitating Events

Present all of the information specified on the 5150 (72 hour) hold.

How serious were the circumstances that brought the person into the hospital?
Who reported this information to you?
Was the situation serious and the person is dismissing it as nothing?
Did something happen physically or was it merely words?
Has the person done similar things in the past?
How does the precipitating event lead you to believe that the person continues to be a Danger to Self, Danger to Others, and/or Gravely Disabled at this time?

Thought Disorders

What is the nature and type of the thought disorder?
Have you considered cultural differences?
Is the thought disorder global, does it affect every part of their thinking, or just a selected area?
If it is a selected area, how does it impact on Danger to Self, Danger to Others, and/or Grave Disability?

Recent Discharge From Psychiatric Hospital

When was the person last in a psychiatric treatment facility?
What were the circumstances of the release or discharge?
Was the release or discharge against medical advice?
Did the person elope or AWOL from the facility?
Does the person have a pattern of not complying with outpatient treatment plans?

Support System In The Community

Is the person homeless?
If homeless, is the person able to maintain adequately on the streets?
Does the person know how to get food and clothing?
Does the person know how to utilize homeless shelters?
What income does the person have? Specify the types of income and amounts.
What other resources, if any, does the person have?
Is the person employed?
Does the person live independently?
Is the person current on rent or mortgage payments?
Is the person able to live safely at home currently?
Does the person live with family or others?
Are the family or others willing and able to assist the person with food, clothing or shelter at the current time in the person’s current condition?
Is the person in long-term placement and can the person be cared for at that level of placement in the person’s current condition?

Motivation To Take Medications

Does the person take their prescribed medications regularly while in the facility?
Does the person have a pattern of repeated out-patient medication noncompliance and repeated hospitalizations resulting from this noncompliance?
Does the person drink alcohol or take illegal drugs?
Is the person’s living situation such that the person can take medications properly and have the prescriptions refilled?
Does the person have a problem with side effects from medications?
Does the person need any special ongoing test to be on the medication?
Is the person taking more or less than the prescribed amount of medications?
Are there any physical reasons that interfere with the person taking psychiatric medications?
Does the person understand the reasons for taking the medications?
If the person recently stopped taking the medications, why?
Did someone take the person’s medications away or tell the person not to take them?
Does the person feel medications have helped in the past?
Does the person see any reason for taking the medications?

Who Is At Risk - Patient's Proximity To, And Contact With This Person

Has the hospital done a Tarosoff?
Is there a restraining order?
Is it an identified person?
Is it any person who fits a certain description?
Has someone called and given information about threatening behavior from the patient?
Has the patient called and made threats?
Have the threats ever been acted on?
Has there been previous circumstance where the threats were carried out?

OVERVIEW OF THE PROBABLE CAUSE HEARING PROCESS

When a patient is hospitalized in a psychiatric hospital against his or her will, he or she is placed on a 72 hour hold (WIC 5150). At the end of the 72 hours or any time during the 72 hours, the doctor may decide to discharge the patient, have the patient sign into the hospital as a voluntary patient, or place the patient on a 14 day hold (WIC 5250). The doctor may place the patient on a 14 day hold if he or she feels the patient is a danger to self, danger to others, or gravely disabled (unable to provide food, clothing or shelter) due to a mental disorder. At the end of the 14 day hold, the doctor may place the patient on an additional 30 day hold (WIC 5270.15) if the doctor feels the patient remains gravely disabled and requires further treatment.

When the patient is placed on a 14 day hold or a 30 day hold, the hospital must notify the Superior Court, Mental Health Counselor's Office immediately at(323) 226-2911.

Within the first four days of the 14 day hold or a 30 day hold, a Probable Cause Hearing is scheduled at the psychiatric facility. The Mental Health Hearing Coordinator will notify the hospital of the date and time of the hearing. The hospital will be notified the afternoon before the scheduled hearing date.

There are over 47 designated psychiatric treatment facilities in Los Angeles County conducting over 1400 hearings per month. It is extremely important that you notify the Court when a patient, who has not yet had a hearing, signs voluntary or is discharged.

Attempts are made to accommodate doctor's hours. If a hearing is scheduled, a professional staff member must present on behalf of the hospital.

At the probable cause hearing, present are a Patients' Rights Advocate who is there to help the patient, the doctor or a hospital staff person to present information on behalf of the facility, and the Mental Health Hearing Referee. The Court, when needed, also provides an interpreter for the patient. It is extremely important to notify the Court of the need for an interpreter and the specific language needed.

Family members are discouraged from attending the hearings. If the patient wishes to have a family member present, the person may be admitted to the hearing as an observer. If the family member wished to present information supporting the hospitalization they are encouraged to give the information to the hospital presenter and let them provide the information at the hearing. This process helps alleviate any potential hostility or alienation which might develop because of the patient wishing to be released from hospitalization and the family member feeling they should remain in the hospital for further treatment. If the family member has information supporting the release of the patient from the hospital, they should give this information to the Patients' Rights Advocate who will present the information at the hearing. The offer by a family member or other person to provide food, clothing or shelter to a patient is required to be in writing by WIC 5250(d)(2). This requirement also may be satisfied by the Patients’ Rights Advocate talking to the family member or other person and obtaining an Affidavit from that person over the telephone to present at the hearing.

The probable cause hearings are administrative hearings. This means that they are much less formal than judicial hearings and formal legal rules, such as the rules of evidence (i.e., hearsay information) do not apply. The purpose of the hearing is to gather as much information as possible so the hearing referee can decide whether probable cause exists to believe that the person is a danger to self, danger to others, and/or gravely disabled.

It is the responsibility of the hospital presenter to explain to the hearing referee: (1) the events and the patient's behavior leading up to the patient's hospitalization; (2) the patient's behavior during hospitalization which illustrates his or her mental disorder and his or her dangerousness or grave disability; (3) previous psychiatric history; (4) living arrangements before hospitalization and plans after discharge; (5) the patient’s diagnosis; and (6) the medications currently prescribed and whether the patient is taking these medications.

It is the responsibility of the Patients' Rights Advocate to present the patient's point of view. It is the job of the advocate to attempt to gain the patient's release from the hospital if the patient desires release, even if the release may not be in the patient's best interest. This is the advocate's job no matter what they feel personally.

If the Mental Health Hearing Referee determines that there is probable cause for the patient to remain in the hospital based upon one or more of the certification criteria, he or she will inform the patient of this decision and the reasons for it. The referee will attempt to inform the patient in a way that the patient will understand. The referee will also indicate that the patient has other legal options open to him or her, which the advocate will then explain. If the patient desires to file a Writ of Habeas Corpus, the hearing referee will prepare the Writ for the patient’s signature, serve a copy of the Writ on the facility, and file it with the Court.

If the hearing referee determines that there is no probable cause to believe the patient meets one or more of the certification criteria, he or she will inform the patient and hospital representative of this decision and will explain the reason for it. If the hospital and the patient agree, the hospital then may accept the patient as a voluntary patient. If not, the patient must be discharged from the hospital.

PRESENTATION INFORMATION FOR PROBABLE CAUSE HEARINGS

Click here to download a form which can be used by the facility representative when presenting information at the probable cause hearing.

Medication Capacity

72 hour/14 day hold
Additional 14 day hold
Additional 30 day hold
180 day post certification

THE CONDUCT OF RIESE HEARINGS INFORMATION BOOKLET FOR DOCTORS AND HOSPITALS

Click here to view "The Conduct of Riese Hearings Information Booklet for Doctors and Hospitals".

MEDICATION CAPACITY PETITION

Click here to view the Petition and Declaration Regarding Capacity to Give Informed Consent to Medication (Riese Petition).