Laws on 72 Hours of Mental Observation

Whether you've experienced emergency mental health hospitalizations in your own family or heard the subject broached while binge-watching your crime shows, laws on 72-hour psychiatric holds have permeated the public legal discourse. A whole lot of hearsay and an often nebulous understanding of how these laws actually work comes with that sort of exposure.

California's "5150" law, named for its section in the state's Welfare and Institutions Code, is perhaps the most well-known because it has formerly held celebs like Kanye West and Amanda Bynes under the criteria of being a danger to themselves or others. But the 5150 is not alone – every state has some version of a 72-hour psych hold law, although the specific details can vary somewhat by state.

As civil commitment statutes grew and evolved during the late 1960s and early 1970s, states across the U.S. began to implement new laws regarding involuntary hospitalization. These laws commonly stated that persons affected by mental illness and determined to be either a danger to themselves, a danger to others, or considered gravely disabled would be placed on an emergency hold before any sort of long-term commitment proceedings could occur. These are the laws you've probably heard referred to as a 72-hour hold, psychiatric hold, involuntary hold, pick-up, temporary detention, emergency commitment or emergency petition.

These holds are typically initiated when a concerned party fills out an affidavit or delivers testimony to a judge regarding the potential mental illness of the person to be held, though these aren't requirements across all states. They're also sometimes initiated by police officers. In contrast to civil inpatient or outpatient commitment – which can last weeks in some cases – this short, temporary detention usually anticipates a commitment proceeding. Under an involuntary hold, you still have the constitutional rights of due process and autonomy. Per the Supreme Court decision of O'Connor v. Donaldson in 1975, states cannot involuntarily commit a non-dangerous person simply because he has a mental illness.

Despite the term "72-hour psychiatric hold," not all emergency holds last for three days. Of the 50 states, 44 require a court order to hold someone for a duration ranging from 23 hours to 10 days, or in some cases, for an unspecified period of time. North Dakota has the most stringent laws, requiring a court order for even a 23-hour hold. On the flip side, Georgia, Hawaii and Iowa don't require a court order for a 48-hour hold, while no court order is necessary for a 72-hour hold in Louisiana, New York, Tennessee, Vermont and Washington. The most common maximum holding length is – you guessed it – 72 hours.

Police across the country are able to detain those who are considered to be an imminent danger, but only 38 states allow police officers and parole officers to actually initiate the temporary detention process. Mental health practitioners have this power in 31 states. Any interested person can initiate the process in 22 states. Arizona even allows friends to do so with no requirements, while Hawaii widens that scope to attorneys and clergy members.

Reasons for detention see a similar range. Although 45 states adhere to the "danger to themselves or others, or gravely disabled" due to a mental disturbance code, five states allow holds on people who are a danger to themselves, whether they're mentally ill or not. Five states also allow emergency holds for people who have recently attempted suicide, while Georgians can be involuntarily held simply if they are deemed to be in need of treatment.

Some states impose age limits on holding laws, such as the 18-year-old minimum in Illinois. Likewise, West Virginia limits the law to adults. Because state laws on the subject don't often feature clear language on age, a 2018 study published in the Western Journal of Emergency Medicine notes that "the number of patients of any age placed on involuntary psychiatric holds annually in the U.S. is not reliably known."

So, what happens during a 72-hour psych hold – or a 23-hour psych hold, or any other state-mandated duration? As the phrase implies, the detained person is confined to a health care facility for the specified amount of time, usually after the reporting party fills out paperwork stating why she believes the held person is a danger to himself or others.

It's legal to involuntarily hold someone for purposes of observation, treatment and stabilization in all states and the District of Columbia, and medications are sometimes administered. Paperwork regarding the patient's evaluation goes to a judge, and a trained mental health professional or designated examiner then interviews the patient to assess his stability before release.