A 5250 hold is a California law that allows a psychiatric facility to keep someone involuntarily for up to 14 days of intensive treatment. It can only happen after a person has already been held on a 5150 (the initial 72-hour psychiatric hold) and evaluated by professional staff who determine that the person still meets criteria for involuntary detention. The 5250 is sometimes called a “14-day certification” because it requires a formal certification process, not just a clinician’s decision.
How a 5250 Differs From a 5150
A 5150 hold is the entry point into California’s involuntary psychiatric hold system. It lasts up to 72 hours, and a range of authorized individuals (police officers, certain clinicians) can initiate it. A 5250 is the next step. It can only be placed after a 5150 (or a court-ordered evaluation) has already occurred and the person has been evaluated during that initial hold.
The key difference is the level of scrutiny involved. A 5150 requires a reasonable belief that someone meets the criteria. A 5250 requires professional staff at the facility to formally certify that the person needs continued treatment, and the facility must be specifically designated by the county to provide intensive treatment. The person must also have been offered voluntary treatment and either refused or been unable to accept it.
The Three Legal Criteria
To certify someone for a 5250, the treatment team must determine that the person meets at least one of three criteria as a result of a mental health disorder or chronic alcoholism:
- Danger to others: The person poses a substantial risk of physical harm to other people.
- Danger to self: The person poses a substantial risk of harming themselves.
- Gravely disabled: The person cannot provide for their own basic needs: food, clothing, or shelter.
One important nuance: a person is not considered gravely disabled if they can survive safely with the help of family, friends, or others who are willing and able to assist with those basic needs. If you have a loved one on a 5250 who has a stable support system waiting at home, this distinction matters and is worth raising during the hearing process.
As of 2024, California’s SB 43 expanded the definition of grave disability. Previously, it applied only to people with a mental health disorder. The updated law also covers people with a severe substance use disorder, or a combination of both, who cannot meet their basic personal needs.
What Happens During the 14 Days
The 14-day clock starts when the 5250 certification is signed, not when the original 5150 began. During this period, the person receives what the law calls “intensive treatment” at a county-designated facility. This typically involves psychiatric medication, therapy, and stabilization. The facility is required to provide active treatment, not simply hold the person.
The person can be released before the 14 days are up if the treatment team determines they no longer meet the criteria. A 5250 sets a maximum, not a minimum.
The Certification Review Hearing
Within four days of a 5250 being placed, the person is entitled to a certification review hearing. This is an informal proceeding, not a courtroom trial, but it carries real weight. A hearing officer (not a judge) presides, and the facility must present evidence justifying the hold. The burden of proof is on the facility, not the patient.
The people typically present are the patient, a Patients’ Rights Advocate who represents the patient’s interests, the hearing officer, and a facility representative. The patient has the right to attend the hearing unless they waive that right, and they can hear the hearing officer’s decision at the conclusion. All evidence presented is kept confidential.
If the hearing officer finds no probable cause for the hold, the patient is ordered released. This hearing is the most immediate way to challenge a 5250, and the Patients’ Rights Advocate assigned to the case can help prepare for it. These advocates are independent from the facility and are specifically tasked with protecting the patient’s rights throughout the process.
Challenging a 5250 Through the Courts
Beyond the certification review hearing, a person on a 5250 can file a petition for a writ of habeas corpus. This is a formal request asking a court to order the facility director to bring the patient before a judge and demonstrate a legal basis for continuing to hold them. The court can then order the patient’s release or remove restrictions on their rights. California courts provide a specific form (HC-002) for people held under the state’s mental health laws to file this petition.
What Happens After the 14 Days
When the 5250 expires, the facility must release the person unless one of a few specific legal pathways is activated. The system is designed as a series of escalating holds, each with its own requirements.
If the person is considered gravely disabled at the end of the 5250, the facility can place a 5270 hold, which extends involuntary hospitalization for up to 30 additional days. This hold is intended for people expected to stabilize with roughly a month of additional treatment, and it essentially replaces what would otherwise require a temporary conservatorship. If the person is deemed a danger to others specifically, a 5300 hold can authorize detention for up to 180 days, though this requires a court petition.
Adding these holds together, the maximum detention through this pathway without a conservatorship is 47 days: 72 hours on the 5150, 14 days on the 5250, and 30 days on the 5270. After 47 days, the person must be released unless a full conservatorship is established or a 5300 petition for danger to others is filed with the court.
Who Pays for a 5250 Hold
Involuntary psychiatric holds can generate significant hospital bills. If the person has private insurance or is enrolled in Medi-Cal (California’s Medicaid program), those plans generally cover inpatient psychiatric care, though co-pays, deductibles, and out-of-network costs can still apply. County mental health systems often absorb costs for uninsured individuals, but billing practices vary by county and facility. If cost is a concern, asking the facility’s billing department and the county behavioral health department about financial responsibility early in the process is worthwhile.