Imperial County officials routinely keep people on psychiatric holds for longer than 72 hours, often in ill-equipped facilities and without a formal hearing that’s required by law, anData shows the county has continued to record dozens of such cases each year despite consultants warning officials about the risk of civil rights violations, andalso found that lax oversight of this practice statewide makes it impossible to determine how many other counties around the state allow it to happen.
Annual numbers show little consistency to how often the county has used serial 5150s: In some years, the count exceeded more than 100 cases, but it also dipped as low as 12 in fiscal 2010-11., which previously sued another county in the state over its serial holds and other violations, contends that the practice is illegal.
“ biggest concern is with the safety and well-being of that person and the protection of their life, and the lives of other people around them,” Cabrera said. “Where I’ve heard people really struggle around this concept of stacked holds is where they are struggling to find a bed. Involuntary holds involve several decision-makers. In Imperial County, law enforcement often initiates the 5150 when responding to mental health crises; medical providers decide if, and for how long, a person should be held; and county officials are involved in oversight that includes deciding whether to pursue conservatorship for people with serious mental illness who are gravely disabled.
Consultants said the people who stayed beyond 72 hours on a 5150 at emergency rooms were “likely individuals with exclusionary criteria who could not be treated at the , and may represent more challenging cases with a high level of need.” The county’s facility is limited not just by bed availability but by who the clinic serves: If a person is violent or aggressive or “has medical needs that require medical oversight, including substance use or intoxication,” they’re transferred to an emergency department.
Stacked holds were flagged by a 2015-16 grand jury in San Benito, a county of about 65,000 east of Monterey. Patients were often held for longer than 72 hours and “not infrequently” beyond a week, according to the, and some patients were being held in an emergency room for as long as 14 days. But people being put on serial 5150s may never be placed on a 5250 — and may not get that hearing, Pederson said.