Almost three days after being put on a psychiatric hold , Amanda Bynes could be released from a California hospital on Thursday evening (July 25).
After setting a fire on a stranger's driveway in Thousand Oaks, California on Monday night, the actress was taken in under a 5150 hold, a California code that allows doctors or law enforcement officials to detain a person involuntarily for 72 hours if they are deemed a danger to themselves or others or display a grave disability that renders them unable to provide for their own food, clothing and shelter.
But what happens during a 5150 hold? MTV News spoke to Dr. Jody M. Rawles, a psychiatrist and the Vice Chair of Clinical Affairs in the psychiatry department at the University of California Irvine for some insight into the three-day hold.
Rawles, who does not have first hand knowledge of the Bynes case and was speaking in general terms about his extensive experience with 5150 cases, said emergency room physicians, psychiatrists, police officers and some social workers are among those who have the ability to request a hold. "If you are setting fires on someone else's property and are disorganized and give answers to questions that don't make sense, a peace officer might put in for a 5150 on all three [criteria]," said Rawles, who runs the acute inpatient unit at UC-Irvine.
The 72 hours begins as soon as the officer writes the 5150 request, after which the patient is transported to an emergency room, where blood and urine screens are done to make sure the patient has not overdosed on drugs and does not have a critical medical problem. Once they are medically cleared, they are admitted to the psychiatric inpatient unit.
"We start by interviewing the patient and I like to ask 'when did you get here?' which is an easy, friendly question that is about orientation," he said. "If they say they've been there for days, I know they're confused." Then, assuming the patient gives consent, doctors can gather information from other sources, including family. If the patient refuses to grant permission, though, doctors are not allowed to contact family or others who know the patient.
After the interview, Rawles will provide medications if the patient is willing to take them, noting that if that person is harming themselves he has the right to force medications. "If they're banging their head against the wall repeatedly you can medicate them against their will, but if they're just speaking gibberish you can't," he said. The initial intake usually takes around 12 hours, which leaves Rawles just two-and-a-half days to evaluate and treat.
Sometimes, it is clear that the incident that spurred the 5150 is drug related, so Rawles will counsel the patient about the dangers of drug abuse and stage what he referred to as a "bedside intervention."
By the second day, if it's possible to make a diagnosis of schizophrenia, bipolar disorder or a similar serious psychiatric condition that might benefit from medication, Rawles will counsel that psychotherapy might work, but that the gold standard is a combination of talk therapy and medication. "I'll talk about the risk and benefits of medication and the side effects and try to get them started on [medication]," he said. "I'll also tell them this is the best place to do that so if there is a side effect we can monitor it and adjust the meds."
The goal is to get the medication started and make the patient realize that they feel better on it. "Sometimes they won't remember what they did and you have to show them pictures or police reports because they don't believe you," he said. There are also cases, he noted, when it takes several 5150 holds, in addition to DUI's or other police interactions, for a patient to realize they have a problem.
By the third day the person can either be released with no strings if they seem stabilized and no longer a danger to themselves or others or they can voluntarily agree to further inpatient treatment. A third option is a request for a 5250, which allows doctors to hold them for an additional 14 days if they feel the patient is still a danger or unable to take care of themselves.
"But after that 14 days, 17 total, if you're looking down the road and she's not getting it and it looks like you're just going to release her?" he said. "There's nothing else you can do." At press time there were unconfirmed reports that Bynes' doctors might be requesting a 5250 to allow time for further treatment.