Helping During A 5150

As a community mental health worker in the mid 2010s, I found myself in the position several times of supporting individuals and their families through the beginning of the involuntary hospitalization process, often referred to as a 5150. My experiences have been exclusively in Alameda County, and primarily with John George Psychiatric Pavilion and Herrick Hospital. Obviously, this process is very unique based on the individual and their location, but here are some patterns I've seen over the dozens of involuntary hospitalizations I've worked on.

First off, if you know someone involved in a 5150, you have my well-wishes and condolences. This can be an incredibly frightening and overwhelming time, but you can absolutely help.

An Overview
A 5150 is an involuntary 72 hour hold placed on a person when they are an immediate danger to themselves, an immediate danger to others, or gravely disabled. Grave disability means a person cannot provide for their food, clothing, and shelter due to mental health symptoms. When we 5150 a person, we are taking their rights away, which means that mental health professionals and law enforcement will not proceed with a hold unless absolutely necessary. The first step in the 5150 process is medical clearance to ensure that the person doesn't need a medical condition managed before their mental health.

Psychiatric Emergency Services
From there, most folks in Alameda County will be taken to John George Psychiatric Pavilion's Psychiatric Emergency Services. Once someone arrives at PES, they’re supported by JGPP staff - nurses, social workers, and the occasional therapist - but are often discharged directly from PES because their symptom acuity isn't high enough. Sometimes this is true! Many who have fallen on hard times in Alameda County have found that PES is a shortcut to a soft surface to sleep on, a meal, and medication. PES frequently has over 100 people waiting to be assessed, and not all of them need the level of care provided in inpatient services. The waiting room can be crowded and overwhelming.

Inpatient Lock Units
If a person's symptom acuity is high enough and they need additional support, they will be admitted to a unit. Usually, when someone is admitted to a unit, their status is converted to a 5250, which is a 2-week involuntary hold. This will give that person up to two weeks to stabilize on medications and receive supportive services. If their symptoms don't stabilize during that time, a temporary conservator may be appointed by the county and the person may be transported to a locked inpatient psychiatric facility. Like a 5150, a 5250 takes a person's rights away.

When To Help
As a supportive friend, partner, or family member, the best place you can intervene is when the person is still at PES. You can help the worker develop a discharge plan if your loved one isn't going to be admitted to the unit, or even advocate for them to be admitted to the unit if you feel it's necessary. At all stages of this process, remember that we are taking someone's rights away for the duration of their stay, so this is truly for the most severe moments in a person's life.

PES staff include a number of social workers and therapists, who serve as the gatekeeper between PES and the unit. If you know that someone has gone to PES, reach out to their worker by phone. They may not be able to share any information with you because of patient privacy, but they can listen to the information you can provide. If you can, the most useful thing to do is to write a one-page note about the precipitating factors for their hospitalization and fax it to JGPP at 510-346-7517 (Last verified: 2014). You may not have all the information and that's okay, but when you talk to the worker, here are some items to highlight:
 

• If you've seen a consistent history of decompensation ("losing it", "going crazy", "having breakdowns") that they have been unable to resolve, despite community supports (psychiatry, primary health care, day programs, therapy) and natural supports (friends, family, partners, pets)

• Any symptoms they have displayed on an ongoing basis that have recently escalated to the point of involuntary hospitalization (feeling suicidal, threatening others, not eating for several days, hearing voices that issue commands or tell them what to do, etc.)

• Any life goals they have not been able to work on due to lack of symptom management (housing stability, interpersonal skills, symptom management, taking medications, anger management, etc.)

• The date of when you last saw each other and how they were doing

• Their medication regimen (names and dosages) and whether they're taking those medications as prescribed

• Everything you know about their substance use prior to admittance. You can advocate for JGPP staff to complete a toxicology screen and consider a referral to Cherry Hill, the community detoxification center on the same campus. JGPP will not admit someone to a unit if they feel the person's symptoms are exclusively the result of alcohol or drug use.

• How to contact you to coordinate care on an ongoing basis

You shouldn't exaggerate their symptoms, but if you're an optimist, now is the time to realistically look at why this person has been hospitalized and what JGPP staff can do to support their stabilization and recovery. Be on the phone with the worker often. If the worker says JGPP is going to discharge them from PES, make sure that you know what the discharge plan is - where are they going? Who will be there? Is someone picking them up? If JGPP doesn't know what supports the person has available, they will sometimes discharge someone to the street with a bus pass.

On The Unit and After Hospitalization
If your loved one is admitted to a unit and is open to company, you can visit. Security will take your picture and give you a visitor's badge. You'll be wanded. Expect to leave everything - bags, keys, pens, phones - in a locker before entering. Then, you can enter the unit, find your person, and be together. If you plan ahead, you can often meet with their worker and discuss how they're doing and what the plan is. The more present you are, the more likely it is that the worker will think of you when planning for the person's discharge.

If a person has had ongoing mental health issues that they've been struggling to manage, it's possible that a higher level of outpatient care, like case management services, would be helpful. The individual's history of accessing services - of being admitted to a unit or locked facility, not just coming to PES - is a major determining factor in how successful you will be in advocating for that person to receive a higher level of care down the line.

If the person has MediCal, they can connect to services through Alameda Behavioral Health ACCESS at 800-491-9099. Service teams range in level based on symptom acuity. Level I is reserved for those managing the most severe symptoms, including psychosis, suicidality, and assaultive behaviors. Level II services provide a lower level of care, often working with depression, anxiety, trauma, and substance use. Level III teams usually help folks transition to community care by connecting them to nearby supports like psychiatry or primary care. If at all possible, try to get these referrals made while they're still hospitalized so the new team can be involved in discharge planning as well. If your loved one has stabilized enough to be discharged from JGPP but is not yet ready to reenter the community, there are crisis residential facilities where folks with mental health challenges can spend up to 2 week stabilizing while in crisis. Bay Area Community Services runs Woodroe Place and Amber House and Telecare runs the Jay Mahler Recovery Center. They feel in many ways like a group home - shared meals, groups, support counselors, chores - but my experience has been that a stay in crisis residential really gives people a place to breathe. Crisis residential programs receive many of their referrals from JGPP, so that's something else to explore with your worker there. Crisis residential programs are voluntary, so the person needs to be willing and able to consent to them.

If your person does not have MediCal, it's harder to know where to begin. Private pay inpatient treatment is unfortunately incredibly hard to come by, and other options are controlled by insurance companies. If the individual has private insurance, ask them if you can call their insurance on their behalf to explore available options, like intensive outpatient treatment (IOP) or a partial hospitalization program (PHP). Often a patient can call their insurance company and say "My roommate is handling this for me so it's okay to talk to them." Helping a recently hospitalized person navigate the stress of insurance can be very valuable.

Take Care Of Yourself
Like I talk about in my Amateur Crisis Counseling article, it's really easy to take on the stress of another person and feel like their problems are our responsibility. This process is difficult to navigate in the best of circumstances and, well, if you're navigating it, it's probably not the best of circumstances. Make sure that you're eating, sleeping, exercising, and doing things that restore you.

Connect With Metaphor Therapy
My name is MacKenzie Stuart and I'm part of Metaphor Therapy. We might have a good psychotherapist for you or your loved one. Learn more about our team and reach out.