When someone experiences a serious mental health crisis, their behavior might pose a risk to themselves or others. In California, a 51/50 hold is a legal tool that allows professionals to step in temporarily. But this process isn’t just about safety—it’s also about civil rights, medical care, and ethical responsibility.
In this article, we break down how 51/50 holds work, who’s involved, what happens during those 72 hours, and how society tries to protect everyone involved—while respecting individual freedom.
What Is a 51/50 Hold?
A 51/50 hold refers to California’s Welfare and Institutions Code Section 5150. This law allows certain licensed professionals or law enforcement officers to detain someone with a mental health disorder for up to 72 hours for evaluation and crisis treatment.
This isn’t a punishment. It’s an emergency measure. It exists to help individuals who are in such a severe mental state that they may:
- Be a danger to themselves (e.g., suicidal thoughts or behaviors).
- Be a danger to others (e.g., making violent threats or actions).
- Be gravely disabled, meaning they can’t care for their basic needs due to mental illness.
Who Can Place Someone on a 51/50 Hold?
Only specific individuals are authorized to initiate a 51/50 hold. This includes:
- Law enforcement officers (police, sheriffs)
- Licensed mental health clinicians, including therapists, psychiatrists, or social workers
- Designated county crisis teams
Family or friends can’t directly place someone on a 51/50 hold. However, they can contact police or a mental health crisis line if they believe someone is at risk.
What Happens During a 51/50 Hold?
Once the individual is placed on a 51/50 hold, they’re taken to a psychiatric facility or hospital with an emergency psychiatric unit.
Here’s what happens next:
Initial Assessment
A psychiatrist or mental health team evaluates the individual to determine if they meet the criteria for involuntary treatment. The goal is to assess safety, mental state, and treatment needs.
Observation and Treatment
The person may receive medication, therapy, or other forms of psychiatric care. The focus is stabilization—ensuring the individual is no longer in immediate danger.
Outcome of the 72 Hours
There are three likely results:
- Release: If the person no longer poses a risk, they are discharged with a care plan or referrals.
- Voluntary Treatment: They may choose to stay in the hospital and continue treatment.
- Extension (5250 Hold): If they’re still in crisis, the facility may apply for a 14-day involuntary hold, called a 5250 hold. This process requires a hearing and more documentation.
Understanding Patient Rights Under a 51/50 Hold
Even during involuntary holds, patients don’t lose all their rights. In California, individuals on a 51/50 have the right to:
- Know why they’re being held
- Be treated respectfully and humanely
- Contact a lawyer or patient advocate
- Challenge an extended hold if it’s applied
- Have access to basic personal care
Facilities must document all actions and decisions taken during the hold to protect both the patient and the institution legally and ethically.
Why 51/50 Holds Are Controversial
While 51/50 holds can be life-saving, they also raise important ethical and legal questions.
Civil Liberties vs. Public Safety
Involuntary detention challenges a person’s right to make their own decisions. But if a person is severely impaired or dangerous, that right can be restricted for the safety of all.
Potential for Overreach
Some critics worry about misuse—where someone is wrongly detained due to bias, misunderstanding, or lack of proper mental health training among law enforcement.
Lack of Post-Hold Support
One of the biggest issues isn’t the hold itself—but what comes after. Once someone is released, they often lack continued care, housing, or therapy options, which can lead to repeated crises and re-entry into the system.
Data Snapshot: 51/50 Holds in California (Sample)
| Year | Total 51/50 Cases | Extended to 5250 Holds | Average Hold Duration |
|---|---|---|---|
| 2022 | 14,800 | 3,200 (22%) | 3.1 days |
| 2023 | 15,500 | 3,700 (24%) | 3.3 days |
| 2024 | 16,100 | 4,100 (25%) | 3.5 days |
This data is illustrative. It shows a growing trend in the use of 51/50 holds and a stable rate of those being moved to longer holds.
What Happens After a 51/50 Hold?
The 72 hours of a 51/50 hold are just the beginning. A solid support system and follow-up treatment are essential.
Here’s what might happen:
- Discharge with a plan to see a psychiatrist or therapist
- Connection to outpatient mental health services
- Referral to substance abuse programs (if applicable)
- Involvement of family, case managers, or peer support
Unfortunately, due to limited mental health resources, many people fall through the cracks. This can lead to a cycle of crisis, emergency holds, and relapse.
Common Questions About 51/50 Holds
- Is a 51/50 hold a criminal record?
No. It’s a civil action, not a criminal one. However, it may appear on medical or certain legal background checks. - Can someone refuse medication during a 51/50 hold?
Generally, yes—unless the person is deemed unable to make that decision or it’s court-ordered for safety reasons. - What is a 5250 hold?
It’s a 14-day extended hold following a 51/50 if the person still poses a risk. It requires additional evaluation and a hearing. - Can a 51/50 hold affect your job or professional license?
Possibly, depending on the profession. Healthcare, legal, or government roles may require mental health disclosures. - Can someone challenge a 51/50 hold?
The initial 72 hours cannot be appealed in court, but extended holds like a 5250 can be contested through a certification review hearing. - Does insurance cover the costs of a 51/50 hold?
Often yes, but it depends on the policy. Many plans cover emergency psychiatric services. - Can someone be held more than 72 hours?
Only if the 5250 process is started. Otherwise, the person must be released after the 72-hour limit. - How can families help during a 51/50 hold?
Provide information to the medical team, visit if allowed, and plan for aftercare support. - Can someone voluntarily go to a hospital instead of being placed on a 51/50?
Yes. Voluntary admission is always preferred when the individual is cooperative and safe to do so. - Does a 51/50 hold restrict gun ownership?
Yes. In California, being placed on a 51/50 hold prohibits the person from owning or possessing firearms for five years.
Conclusion
Understanding 51/50 holds is crucial not only for mental health professionals but also for families, communities, and the individuals involved. These holds are meant to be temporary crisis interventions—not long-term solutions. While they play a critical role in protecting people during their most vulnerable moments, the bigger picture lies in what happens before and after.
Balancing the safety of individuals and the public with the rights of those experiencing mental illness is complex. Better mental health resources, training, and legal safeguards are essential to ensure this balance remains fair and humane.
If you or someone you know is in a mental health crisis, contact local emergency services or a mental health hotline immediately.