Bill Would Let Therapists and Social Workers Decide When to Confine Mentally Ill Californians for Treatment

A mother’s hug was on California Sen. Aisha Wahab’s mind when she authored a controversial state bill that would allow social workers and therapists to decide when to confine someone against their will so they can be treated for mental illness.

Wahab was once a member of the Hayward City Council, and she’d just voted to create a local program that would send medical and mental health professionals to certain 911 calls in an effort to reduce police officers interacting as much with mentally ill people.

After the vote, a woman came up and embraced her. The woman, Wahab said, was the mother of a large Black man with autism, who often wore headphones. He doesn’t speak and gets agitated in tense situations. The mother told Wahab she was terrified of her son getting hurt or killed if the police — instead of mental health professionals — were ever called to detain her son.

“The problem here,” Wahab told CalMatters in an interview, “is that the individuals that are actually trained in this science, in this profession, in this industry, are not empowered enough to make the best decision for the people they work with the most.”

That’s the rationale behind Wahab’s Senate Bill 402, which passed out of the 40-member Senate on Monday. Republican Sen. Janet Nguyen of Huntington Beach cast the lone “no” vote.

The bill would expand those who can issue 72-hour involuntary confinements to psychiatrists, psychologists, clinical social workers, licensed marriage and family therapists and clinical counselors. In each county, a behavioral health director would have the discretion to choose which professionals could initiate involuntary detentions.

Under current law, police officers, members of mental health crisis teams, those in charge of treatment facilities and county-designated officials are allowed to decide when someone is such a danger to themselves or others that they need to be placed against their will in a mental health facility or hospital for a 72-hour mental health evaluation.

In most cases, the police end up initiating what’s known as a “5150” hold, named after a section of California’s legal code. Hospital emergency rooms are often where a mentally ill person is taken for initial assessment and treatment.

Wahab said community organizations that work with marginalized groups and immigrant populations increasingly have mental health professionals on staff who interact with mentally ill people and their families, so they know best when someone is starting to spiral out of control. They should be able to decide if someone needs to be placed into mandatory care — and without involving police as much in the process, said Wahab, an Afghan immigrant and a former board member of the nonprofit Afghan Coalition.

In the 2020–21 fiscal year, 120,402 adult 5150 holds were issued across the state, according to a report (PDF) from the California Department of Health Care Services.

Patients with behavioral health diagnoses accounted for one in five of all emergency room visits in 2021, according to the California Hospital Association. One Fresno hospital saw 6,100 patients last year for psychiatric holds, most of which police initiated, according to the bill’s legislative analysis.

Each state has a law that allows a mentally ill person to be detained for a period of time, but who can issue the holds and the rights of the person being held vary widely, according to researchers. For instance, at least 14 states allow social workers to issue holds.

Will threat of 5150 frighten those needing help?

The California Police Chiefs Association announced Monday the organization was supporting the bill, citing the benefits of more trained professionals interacting with the mentally ill instead of relying so much on officers.

“In many situations where an individual presents a danger to themselves or others, there will be a need for law enforcement, but it remains important to pass legislation like SB 402 to expand mental health professionals’ role during those events,” Alex Gammelgard, the association’s president, told CalMatters in a written statement.

However, disability rights activists oppose expanding involuntary confinement for the mentally ill. Last year, they objected to a bill Gov. Gavin Newsom signed that expanded who could be confined against their will to those whose substance abuse disorders were so severe they couldn’t care for themselves.

With this latest bill, the activists argue that it would discourage people from seeking help if they know the social workers and therapists they are interacting with have the power to lock them up.

In testimony earlier this month before the Senate Health Committee, Debra Roth, an advocate for Disability Rights California, also brought up logistical concerns.

“We don’t see how they’re going to transport a person who does not want to go to the hospital, to the hospital,” she told the committee. “And we think law enforcement is going to get called, and that’s how it will play out in real-time.”

Sen. Caroline Menjivar, a Democrat who’s a former domestic violence crisis therapist and emergency medical technician from Van Nuys, had similar reservations, though she eventually voted for the bill.

“Some of the concerns for me are the unintended consequences in terms of what happens in real life,” Menjivar told the committee. “If a therapist then puts me on a hold, do I then wait on the sofa? Who comes in? … Does the therapist then drive this individual to their local ER?”

California police free to use 5150

Wahab countered that the bill doesn’t prevent police from being called to detain someone, though the hope is they may not be needed.

“As for nonprofits, they can simply get a grant and retrofit a vehicle, a bus, a van, something like that,” she told the committee. “But we have also seen a lot of collaboration with the hospitals, with the ambulance service.”

The hope is that if a therapist, a case worker or a social worker whom a mentally ill person trusts institutes the hold, it can make the process less confrontational — and less dangerous — without needing to call police away from other duties, Wahab said.

And it’s not as if anyone can issue the holds, she said.

“We are also limiting it to people that are actually in this field,” Wahab told CalMatters. “So you could be a therapist and only work with children and never seek the ability to do a 5150 because that’s not your job. That’s not your area of interest. But there are other therapists that … work in mental-health institutions and facilities and nonprofits and so forth and their only goal is in the space. So we have been very, very narrow and focused in exactly what we are trying to do here.”