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The Lanterman–Petris–Short (LPS) Act (Cal. Welf & Inst. Code, sec. 5000 et seq.) regulates involuntary civil commitment to a mental health institution in the state of California. The act set the precedent for modern mental health commitment procedures in the United States. The bipartisan bill was co-authored by California State Assemblyman Frank D. Lanterman (R) and California State Senators Nicholas C. Petris (D) and Alan Short (D), and signed into law in 1967 by Governor Ronald Reagan. The Act went into full effect on July 1, 1972. It cited seven articles of intent:
- To end the inappropriate, indefinite, and involuntary commitment of mentally disordered persons, people with developmental disabilities, 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.
The Act in effect ended all hospital commitments by the judiciary system, except in the case of criminal sentencing, e.g., convicted sexual offenders, and those who were "gravely disabled", defined as unable to obtain food, clothing, or housing. It did not, however, impede the right of voluntary commitments. It expanded the evaluative power of psychiatrists and created provisions and criteria for holds.
Prior to 1987 it was assumed that the Act allowed involuntary treatment for those who were detained under an initial three-day hold (for evaluation and treatment) and a subsequent fourteen-day hospitalization (for those patients declared after the three-day hold to be dangerous to themselves or others or gravely disabled). However, in the 1987 case of Riese v. St. Mary’s Hospital and Medical Center, the California Court of Appeal declared that these patients had the right to exercise informed consent regarding the use of antipsychotic drugs, except in an emergency, and if they rejected medication "a judicial determination of their incapacity to make treatment decisions" was required before they could be involuntarily treated. This case was a class action suit brought in the name of patient Eleanor Riese by the California ACLU. Eleanor Riese's story is depicted in the movie 55 Steps.
LPS evaluation, detention and Conservatorship process
Under the LPS Act, individuals can be detained in to a locked psychiatric facility in the following process.
Under California Welfare and Institutions Code (WIC) 5150, an individual can be placed (involuntary) to a locked psychiatric facility, for an evaluation for up to 72 hours. A peace officer, registered nurse, medical doctor, or certain other categories of people may place the hold. Three criteria apply - the individual is assessed to be: a danger to themselves, a danger to others, or "gravely disabled" (per WIC 5008 - such is defined as an individual's lack of ability, due to their mental illness, to provide for their food, clothing, or shelter).
As the individual in question is likely in a state of distress (highly symptomatic), and likely also causing a disturbance in the community, it is not uncommon for police to be the party who places them on the 5150 hold and then takes the individual to the hospital for further assessment. Over the next 72 hours, the hospital / psychiatrist must determine the individuals need for further locked psychiatric detainment. If the individual's condition clears up and they are no longer a danger to others or themselves or gravely disabled, they are released from the hospital. If, however, they remain a danger to others or themselves or continue to be gravely disabled, the hospital/psychiatrist must then request a 5250 hold to thereby keep the individual in the hospital beyond the 72-hour limit of the 5150 hold.
- Largely because the production of many American movies and television programs are based in California, usage of the term "5150" has spread beyond its original location and user population. An album of the same name by the California hard rock band Van Halen was named directly for the code section, and several derivative uses followed.
If, after a 72-hour hold, an individual is deemed to still be a danger to others or themselves, or is gravely disabled, WIC 5250 permits for an individual to be involuntarily held (in a locked psychiatric hospital) for another 14 days.
Unlike a 5150 hold a 5250 hold requires that the individual served receive a court hearing within 4 days of being served to ascertain the validity of the hold. Court hearings are often held in hospital. Individuals are provided an attorney and a county court officer reviews the evidence for the hold presented by the hospital, hears the argument of the client and their attorney, and decides whether or not to uphold the 5250.
Just as with the 5150 hold, during the 5250 hold, the individual is continually being assessed by psychiatric staff. Again, if the individual is (at any time) deemed to be no longer a danger or gravely disabled, they are then released from the hospital.
According to section 5257 of the act, the individual must be released after 14 days, unless, they agree to further treatment on a voluntary basis; they are certified for an additional 14 days of intensive treatment; they are certified for an additional 30 days of intensive treatment; they are the subject of a conservatorship (commonly known as a Temporary LPS Conservatorship) petition or they are the subject of a petition for postcertification treatment of a dangerous person.
5350 hold / Temporary LPS Conservatorship
A 5350 hold, otherwise known as a Temporary LPS Conservatorship (under W&I Code § 5352.1), is initiated at the end of 5250 / 14-day hold. Such is initiated by the individual's treating psychiatrist and co-signed by the medical director of the psychiatric facility to the Public Guardian Office in the individuals county of residence. The basis for the LPS Temporary Conservatorship is that the individual (due to their mental illness, even after ~17 days of involuntary psychiatric detention) remains "Gravely disabled"
As there are 58 counties in California, there exist 58 Public Guardian Offices statewide. Unlike other conservatorship process in California (Probate / Older adult or Limited / Developmentally disabled) - a LPS Conservatorship cannot be initiated by the public at large. Codified in the WIC - the individual must go through the 5150 - 5250 process and from there the county Public Guardian is the only authorized party to be able to request for a LPS Conservatorship. The legislative intent for such was that prior to the LPS act, it was felt individuals were often psychiatrically committed for subjective (if not outright punitive) reasons. To combat such potential abuses, the county Public Guardian, seen as an impartial, third party was designated as sole party.
Once the individual is on a LPS Temporary Conservatorship, they are no longer legally on a "hold," but now, legal consent to treat and continue to detain the individual (now known as the "conservatee") lies with the Public Guardian office.
A Temporary LPS Conservatorship can last a maximum of 180 days. As the county superior court has direct oversight of LPS Conservatorship matters, typically the conservatee is afforded court hearings (for status) every 30 days. Unlike other conservatorship hearing, LPS Conservatorship matters / records are NOT open to the public.
Again being there are 58 counties and 58 Public Guardian Office and 58 Superior Courts - legal administration of LPS Conservatorship is interpreted and practiced 58 differing ways. In general, all conservatees are appointed legal counsel (typically the public defender office) and during the course of their LPS Conservatorship they can ask for a series of writs and hearing or even a full jury trial to contest their detention and overall LPS Conservatorship. It is not uncommon for a psychiatrist to conversely declare the conservatee is no longer gravely disabled. Indeed, during the course of the LPS Conservatorship if the conservatee stabilizes and can thereby be discharged to the community - a psychiatrist can request that the LPS Conservatorship be dismissed (for lack of legal support).
As of the Public Guardian office, during a Temporary LPS Conservatorship, it is their general duty to ensure the conservatee is properly cared for and that all reason efforts are ruled out, that the conservatee continues to require locked psychiatric care.
During the LPS Temporary Conservatorship, it is indeed the Public Guardian, not the conservatee, who consents to treatment and placement. A common way to understand such is parent to child - in that a minor child cannot consent to medical care. The same goes for the conservatee - in that the Public Guardian consents to their psychiatric treatment and placement.
If during the LPS Temporary Conservatorship, the Public Guardian feels the conservatee will (for the foreseeable future) need to remain in locked psychiatric care - they can then seek to have the LPS Conservatorship changed from Temporary to General (also referred to a "Permanent" but this can be a misnomer as it is not permanent / indefinite). With the appointment of a Permanent LPS Conservatorship (approved by the court) - the conservatee is now under the auspice / authority of the LPS Conservator for exactly 1 year. It is with a Permanent LPS Conservatorship that then the public (family / friends) can now become involved. If family / friends request and with court approval, (unlike the Temporary LPS Conservatorship) they can be appointed as the General / Permanent LPS Conservator for the conservatee.
The 1-year duration for a General / Permanent LPS Conservatorship was again codified into the LPS act as to combat past abuses. This ensures that no individual is indefinitely detained in locked psychiatric care and that every year justification to continue the LPS Conservatorship is brought before the court. This too is another difference between LPS conservatorship and Probate or Limited Conservatorship - both which have no implicit expiration date. Indeed, if the LPS Conservator does not submit a request (to the court) to renew the LPS Conservatorship, by default it expires. Renewal of the LPS Conservatorship basically requires that 2 MD / Psychiatrists / Psychologist formally declare that the LPS Conservatorship still remains appropriate.
During the course of a General / Permanent LPS Conservatorship, the conservatee is most likely held in long-term, locked psychiatric care. Although California State Hospital still exist and are in use, a most LPS Conservatees are placed at local (county level) locked psychiatric hospitals. Nothing though in the LPS act precludes a conservatee being under a LPS Conservatorship and living in the community. No time frame is quantified in the LPS act (as matters vary from conservatee to conservatee), but it is generally practiced (amongst the 58 county Public Guardian Offices) that if a conservatee has been living in the community for an extended period of time - the legal justification to thereby continue the LPS equally diminishes and from there they are bound to dismiss the LPS Conservatorship. As such there is no common duration for a LPS Conservatorship. It can indeed vary from a conservatee being under a single LPS conservatorship continuously for 30 years to others undergoing multiple Temporary LPS Conservatorship over the course of a single year.
A common growing theme, especially among family of mentally ill individuals is the LPS act favors the individual's civil rights too much when weighed against their self-evident need for treatment. It can be very difficult for their family member to be placed on a 5150 hold or on a LPS Conservatorship. Again per the LPS act - "grave disability" is primarily codified with food, clothing, or shelter. Thus an individual may indeed be highly symptomatic - displaying paranoia, delusions, mania, etc. but if they can present a cogent plan to care for their food, clothing, or shelter - they may very well be released from psychiatric care. Many have argued that revisions should be made to thereby make it easier for individuals to be detained, lessening the restrictions made under the LPS act. In 2018 SB 1045 was signed into CA Law - establishing a pilot program in San Francisco, Los Angeles, and San Diego counties if the counties approve, creating a conservatorship for a person who is unable to care for their own health and well-being due to serious mental illness and substance use disorder. SB 1045 would providing the least restrictive and most clinically appropriate alternative needed for the protection of the person who is incapable of caring for the person's own health.
- California Mental Health Services Act
- Lanterman Developmental Disabilities Act
- Community Mental Health Act (of 1963)
- Disability rights movement
- "5-1-5-0", a song by American country music artist Dierks Bentley about the policy
- Community Mental Health Act
- Emergency psychiatry
- Florida Mental Health Act (also known as the "Baker Act")
- Medically indigent adult
- Political abuse of psychiatry
- Section 135/136 of the Mental Health Act, a similar policy in England and Wales
- "Conservatorship of Susan T. (1994)". Justia Law. Retrieved 21 July 2018.
- "Involuntary medications: Riese v. St. Mary's Case Summary - Mental Illness Policy Org". Mentalillnesspolicy.org. 2018-09-20. Retrieved 2018-09-29.
- "Riese V. St. Mary's Hospital Medical Center | Cal. Ct. App. | Judgment | Law". CaseMine. Retrieved 2018-09-29.
- "'55 Steps' Based on the True Story of Eleanor Riese". The Mighty. 2017-09-14. Retrieved 2018-09-29.
- "Why is it so hard to get mentally ill Californians into treatment?". CALmatters. 2018-08-30. Retrieved 2018-12-20.
- California Welfare and Institutions Code, Section 5150
- California Welfare and Institutions Code, Section 5008 (h) definition of gravely disabled
- California Welfare and Institutions Code, Section 5008 (m) emergency defined
- California Welfare and Institutions Code, Section 5256: Certification Review Hearing defined
- California Welfare and Institutions Code, Section 5332: Capacity Hearing defined, involuntary medication
- California Welfare and Institutions Code, Section 5325-5325.2: Patients' Rights
- American Psychiatric Association, Definition of Crisis Behavior & A Mental Disorder by DSM-IV (Diagnostic & Statistical Manual of APA), & Crisis Management
- California Code of Regulations (C.C.R.), Title 9 & Title 22, Licensed psychiatric hospitals in California are governed by CCR Title 22
- California Health & Safety Code, on seclusion and restraint