Mission Hospital Laguna Beach
Mission Hospital Laguna Beach ~ my 2005 “Alma Mater” as South Coast Medical Center

This morning I interviewed with Mental Heath Association of Orange County to be a volunteer Hearing Advocate representing clients placed on mental health holds (involuntary psychiatric hospitalization for 72-hours).

HEARING ADVOCACY – Advocates fill a legally state mandated role to ensure that involuntarily detained persons in a psychiatric hospital have the opportunity to express their views regarding hospitalization, advocates support them through the process.  Advocates review patient’s charts, interview patients, and attend probable cause hearings with the patient.


Tomorrow I start my training by shadowing an MHA advocate at Mission Hospital Laguna Beach Behavioral Health Services, where in February 2005 I spent two weeks voluntarily hospitalized. No doubt being taken to the hospital involuntarily is a quite different experience than going there by choice.

Room View of Pacific Ocean from Mission Hospital Laguna Beach
View of the Pacific from rooms redecorated since my stay in 2005

Yes, the rooms have incredible views of the Pacific, as the hospital sits on Pacific Coast Highway (PCH). As a voluntary patient, I appreciated the views but was not permitted to walk to the beach until I left the hospital and entered the partial hospitalization program. After eating lunch, as outpatients we had the freedom to walk down to the beach, which we often did together as a group. Laguna Beach is truly beautiful. Unfortunately, you need quite a bit of money to live there (and traffic is horrible on PCH).

Mental Health America of California offers this excellent summary of California law regarding involuntary hospitalization on its website:

72-Hour Mental Health Hold

If you need to get help for someone who may not want help but needs it immediately, you may need to arrange for involuntary hospitalization. This process is called a “72-hour Mental Health Hold.”

Under California law, only designated personnel can place a person in 72-hour hold, often called a “515O.” They can be police officers, members of a “mobile crisis team,” or other mental health professionals authorized by their county.

One of three conditions must be present for an individual to be placed on a 72-hour hold. The designated personnel believe there is probable cause that because of a mental disorder the individual is:

  • A danger to him or herself;
  • A danger to others; or
  • Gravely disabled (unable to provide for his or her basic personal needs for food, clothing or shelter).

The person placed in a 72-hour hold must be advised of his/her rights. The facility requires an application stating the circumstances under which the persons condition was called to the attention of the officer or professional; what probable cause there is to believe the person is a danger to others, a danger to him or herself, or gravely disabled (due to a mental disorder); and the facts upon which this probable cause is based. Mere conclusions without supporting facts are not sufficient.

What Happens During an Involuntary Hold?
When a person is detained for up to 72 hours, the hospital is required to do an evaluation of that person, taking into account his/her medical, psychological, educational, social, financial and legal situation. The hospital does not have to hold the patient for the complete 72 hours if the professional person in charge believes that the patient no longer requires evaluation or treatment.

By the end of the 72 hours, one of the following things must happen:

  • The person may be released;
  • The person may sign in as a voluntary patient;
  • The person may be put on a 14-day involuntary hold (a “certification for intensive treatment”).

Does the Person Being Held Involuntarily Have Any Rights?
Yes. A mental health patient being held involuntarily must be informed of the following rights in a language or manner he/she can understand:

  • To keep and use his/her own personal possessions including toilet articles and clothing;
  • To keep and be allowed to spend a reasonable sum of his/her own money (a conservator shall be appointed as required);
  • To have access to individual storage space for private use;
  • To see visitors each day;
  • To have reasonable access to telephones;
  • To have ready access to letter writing materials, including stamps & mail;
  • To receive unopened mail;
  • To refuse convulsive treatment;
  • To refuse psychosurgery;
  • To see a patients’ rights advocate;
  • To be assisted by an attorney at the certification review hearing.

In addition, the patient has the right to be informed fully of the risks and benefits of the proposed treatment and give his/her informed consent. A patient has the right to refuse medication unless there is an emergency condition or the patient is found to lack capacity to make an informed decision after a judicial hearing. If, at that hearing, the patient is found to lack capacity to consent to medication, the patient may appeal the decision to the Superior Court.

Within four days after the patient is placed on a 14-day involuntary hold, there must be a certification review hearing (a “probable-cause hearing”). The hospital must present evidence as to why the patient needs further treatment. The patient, assisted by a patients’ rights advocate, can explain why he/she believes there is no need for further hospital stay. A hearing officer, court-appointed commissioner or referee will decide whether or not there is probable cause to keep the patient in the hospital against his/her will for a period not to exceed 14 days.

If the hearing officer decides there is not probable cause to hold the patient, the patient may request to remain in the hospital on a voluntary basis. If the hearing officer decides there is probable cause and the patient disagrees with the decision, he/she has the right to request a Writ of Habeas Corpus and have a hearing in the Superior Court of the county where the patient is being held.



30 responses to “Full Circle”

  1. […] to balance work with motherhood, I failed miserably, and ended up hospitalized in a psychiatric unit with rapid cycling and mixed symptoms of bipolar disorder. After months of […]

  2. […] hospitalization was so different from Dyane Leshin-Harwood’s, and unfortunately the superb program I enjoyed a decade ago no longer exists. Even that experience could have been improved if my […]

  3. […] years ago, two weeks preceding and including Valentine’s Day, I was hospitalized. Twenty years ago, I experienced a psychotic break during the same season: this season – the […]

  4. […] had ten years of success. Trying to balance work with motherhood, I failed miserably, and ended up hospitalized in a psychiatric unit with rapid cycling and mixed symptoms of bipolar disorder. After months of […]

  5. Honestly, your comment was GREAT. You could post it as is or edit it as you like.

  6. thank you Kitt.
    I’m trying to put the post together right now.
    It will be mostly this comment. 🙂 I don’t feel prepared, but I can tell you believe in me, so I’m going to get this out!

  7. Wendy, your story shows how important it is that we implement reforms in mental health care, health care, and insurance. No one should have to declare bankruptcy due to health care costs. Access to health care is a human rights issue, really. I’ve had incredible nightmares trying to untangle insurance messes. I am glad that you found your hospitalization therapeutic in spite of the simultaneously traumatic aspects of the experience.

    Tomorrow is Blog Action Day (blogactionday.org). This year’s theme is Inequality. Your comment here is quite thorough would make a great piece on your blog tomorrow about inequality and access to mental health care and health care. With your chronic illnesses, you have a voice of experience that would add to the conversation.

  8. I was involuntarily committed to a psychiatric facility at one point. Really I wanted to be, but officially it was involuntary. My insurance would pay for inpatient treatment easier that way. However, once I got in, I wasn’t told my rights.

    I wasn’t treated badly. I actually had a good stay for the most part. My view as a far cry from yours. I saw a thick metal screen, it was more like a prison. But it was a nice atmosphere for the most part, and it was clean and the people were good. and they had really good food!! The patients were very supportive of each other.

    My biggest problem was the psychiatrist they made me see. He made me very uncomfortable. I was a rape victim and he gave me the creeps. He also insisted on being in the room alone with me. I complained and complained and I couldn’t get this resolved. He said I had Borderline Personality Disorder and my complaints were part of my disorder. (I’m Bipolar)

    My second problem was…that part about after 4 days…well I didn’t get that. (I’m not in CA, but we have that in NC too.) Since I didn’t get that, my insurance didn’t want to pay for the rest of my stay. Well I had no way to leave. They wouldn’t let me. They didn’t get approval from my insurance for the rest of my stay.

    This stay ended up making me almost declare bankruptcy. did it help me mentally? Yes. Mainly because it got me in the system and I was able to continue treatment.

    I did end up not having to pay for the psychiatrist outrageous bill he tried to saddle me with because of the complaints I had made against him and the many request to have him removed from my case. I also had most of the bill from the hospital dropped because they didn’t get it authorized, and since I was involuntarily committed I couldn’t be held legally obligated to the papers I signed when I was admitted. I wasn’t of “sound mind”.

    but I lost my job. I couldn’t pay my bills when I got out. I was single and alone. If I hadn’t been so determined to get better, and stay the course, I would easily have stopped taking my medications….I had a hard time affording them. I would have stopped going to therapy and to a psych doc….again it was very had to pay for it. However, I wanted to be more normal. A lot of Bipolar people really miss the highs…I did. I’m an artist, and I will say, I feel I haven’t created anything as good as I did before. But I will not jeopardize my health.

    Just some things I wanted you to think about. these are trials I had and I was really there because I wanted to be. I didn’t have an advocate. I wish I had. There were a lot of things going on with my case that no one told me about.
    If I had not been so eager to want to get better, I don’t know if I could have done it.
    The system is so very far from perfect!
    I worked so hard. I still work hard at it.
    many people who are involuntarily committed won’t be committed to working at it.

    good luck!! I hope you find this very fulfilling! They really need great people!!

  9. […] be attending group therapy. As I was sick last week, my activity with MHA of Orange County as a Hearing Advocate trainee will be […]

  10. Thank you, Jennifer. I must say that their PR photo is nicer than the actual furnishings. The views are awesome, but somewhat obscured by scaffolding for earthquake retrofitting.

  11. Thank you. Yes, this facility is about the best around. Other facilities are worse.

  12. Thank you. Yes, they are gorgeous views. Unfortunately, they had earthquake retrofitting scaffolding and screening up. Not sure if it was permanent, but it did partially obscure the view.

  13. Yes, I must protect myself, my heart. I had a client once, back when I was in my late 20s, who said that I was too soft hearted. She was a teenager with a borderline IQ (very low), but wise beyond her years, beyond her IQ, and beyond her severe diagnosis.

  14. Yes, it truly is divine. I really enjoyed going there today to shadow an MHA hearing advocate.

  15. Wow, what an interesting post. I’m impressed by the regulations set in place with regard to mental health. And that view is just divine

  16. Thank you and will do.

  17. Sounds like a wonderful opportunity for you! Keep us posted on how or goes. Best of luck!

  18. Good luck, and I hope your training goes well!

    This place sounds a far cry from some of the places I’ve heard of (second-hand; it’s not happened to me, but I have spoken about the experience with relatives and friends who have been involuntarily detained in psych wards and/or hospitals). As you say, involuntary hold must make a huge difference to the process… but I’m guessing at least a couple of the people I know would have preferred to be have been held in the above facility!

    You’ve also made me curious re: state law, now. I might have to go research how Georgia compares to California, on the issue of involuntary detainment. Really interesting post 🙂

  19. Those are gorgeous views! I hope things go well for you . . . take care of yourself.

  20. It will help that you’re already familiar with the facility and had a positive experience there. But assisting involuntary patients will be heart-breaking. Please take care of yourself and be sure your support system is close around you.

  21. Hope you’ll keep us posted

  22. Yes correct – My mother was impressed of not being typical and extensive!

  23. I shall see whether serving as an advocate helps.

  24. Their program was fabulous when I stayed there. Not typical.

  25. Thank you very much. I’m both looking forward to it and quite nervous.

  26. Hope it works as much in practice 🙂

  27. Kitt – this is one of the top hospitals. I had the honor to visit the hospital with my mother who is a doctor. I was impressed!

  28. That’s so so good.

  29. This is an incredible thing you’re doing, Kitt! And I must say, that is the nicest looking psychiatric hospital room I’ve ever seen!

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