§ 5157 - W&I Code

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Information to be Given at Time of 5150
Involuntary 72 Hour Hold

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§ 5157. Information to be given person taken into custody;
contents; record of advisement

(a) Each person, at the time he or she is first taken into custody under provisions of Section 5150, shall be provided, by the person who takes such other person into custody, the following information orally. The information shall be in substantially the following form:

My name is__________________________________.
I am a_______________________________________
(peace officer, mental health professional)

with _____________________________________.
(name of agency)

You are not under criminal arrest, but I am taking you for examination
by mental health professionals at_____________________________.
(name of facility)

You will be told your rights by the mental health staff. If taken into custody at his or her residence, the person shall also be told the following information in substantially the following form: You may bring a few personal items with you which I will have to approve. You can make a phone call and/or leave a note to tell your friends and/or family where you have been taken.

(b) The designated facility shall keep, for each patient evaluated, a record of the advisement given pursuant to subdivision (a) which shall include:

(1) Name of person detained for evaluation.

(2) Name and position of peace officer or mental health professional taking person into custody.

(3) Date.

(4) Whether advisement was completed.

(5) If not given or completed, the mental health professional at the facility shall either provide the information specified in subdivision

(a), or include a statement of good cause, as defined by regulations of the State Department of Mental Health, which shall be kept with the patient’s medical record.

(c) Each person admitted to a designated facility for 72–hour evaluation and treatment shall be given the following information by admission staff at the evaluation unit. The information shall be given orally and in writing and in a language or modality accessible to the person. The written information shall be available in the person’s native language or the language which is the person’s principal means of communication. The information shall be in substantially the following form:

My name is ________________________________________.

My position here is__________________________________.

You are being placed into the psychiatric unit because it is our
professional opinion that as a result of mental disorder, you are likely
to:

(check applicable)

harm yourself ______
harm someone else ______
be unable to take care of your own food,  clothing, and
housing needs ______

We feel this is true because__________________________________
(herewith a listing of the facts upon which the allegation of dangerous or gravely disabled due to mental disorder is based, including pertinent facts arising from the admission interview.)

You will be held on the ward for a period up to 72 hours. This does not include weekends or holidays.

Your 72–hour period will begin _________________________________
(day and time.)

During these 72 hours you will be evaluated by the hospital staff, and you may be given treatment, including medications. It is possible for you to be released before the end of the 72 hours. But if the staff decides that you need continued treatment you can be held for a longer period of time. If you are held longer than 72 hours you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided free.

(d) For each patient admitted for 72–hour evaluation and treatment, the facility shall keep with the patient’s medical record a record of the advisement given pursuant to subdivision (c) which shall include:

(1) Name of person performing advisement.

(2) Date.

(3) Whether advisement was completed.

(4) If not completed, a statement of good cause. If the advisement was not completed at admission, the advisement process shall be continued on the ward until completed. A record of the matters prescribed by subdivisions (a), (b), and (c) shall be kept with the patient’s medical record.