Los Angeles County supervisors have approved a pilot program that will let emergency room physicians at five private hospitals directly initiate involuntary psychiatric holds, a change aimed at freeing up mobile crisis teams currently spending roughly 1,100 hours a month stuck inside hospital emergency departments. The holds, commonly known as 5150s, apply to patients who may pose a danger to themselves or others. Under the new pilot, doctors at Pomona Valley Hospital Medical Center, Providence Little Company of Mary Medical Center in Torrance, Providence Saint John's Health Center in Santa Monica, UCI Health in Lakewood, and UCLA West Valley Medical Center will be trained to write the holds themselves rather than waiting for a county team to arrive.
The board action, reported by MyNewsLA.com, was introduced by Supervisor Janice Hahn and co-authored by Supervisor Lindsey Horvath. Currently, private hospitals lack physicians authorized to initiate these holds on their own, meaning patients must wait for one of the county's 71 around-the-clock mobile mental health crisis response teams to show up before they can be evaluated and, if warranted, detained for up to 72 hours. County officials say that bottleneck ties up crisis teams for roughly 1,100 hours every month just sitting inside private emergency rooms waiting to process 5150 evaluations.
Why ER Doctors Couldn't Do This Before
The pilot is only possible because of a 2025 state law that allows emergency room physicians at private hospitals to become certified to initiate 5150 holds, a category of professional previously excluded from that authority at most facilities. That law, Assembly Bill 416, was signed by Governor Gavin Newsom in October 2025 and took effect January 1, amending the Welfare and Institutions Code to require county behavioral health directors to include ER physicians among the disciplines eligible for county certification, according to a memorandum from the California Department of Health Care Services. The law also grants certified ER physicians statutory immunity from civil and criminal liability tied to actions taken by a patient released at or before the end of the 72-hour hold, the department's memo notes.
The California Hospital Association and emergency medicine organizations sponsored and pushed for AB 416, arguing it directly addresses severe ER overcrowding and cuts down on prolonged waits for psychiatric evaluations. Mental health advocacy groups took the opposite view: Mental Health America of California and the California Behavioral Health Planning Council formally opposed the bill, warning that expanding hold-writing authority could drive up involuntary commitments instead of building out voluntary, community-based crisis care.
The Math Behind the Pilot
The scale of the workload is part of what's driving the change. LA County's Department of Mental Health Psychiatric Mobile Response Teams conducted more than 24,000 in-person field responses for behavioral health crises last year, according to a county board agenda packet. Hahn's office framed the tradeoff bluntly, stating that “every hour our crisis teams spend inside an emergency room is an hour they aren't out in the community responding to someone who is having a mental health emergency in their home or on the street.” The pilot aims to let those teams spend more time responding to emergencies in homes and public places rather than idling in hospital hallways.
This isn't the first time LA County has tried something like this. Back in October 2016, the county tested a similar approach at Martin Luther King, Jr. Community Hospital in South Los Angeles, training non-designated ER staff to issue holds after the hospital's lack of an in-house psychiatric unit led to long delays waiting on mobile teams, according to LAist. The underlying legal framework hasn't changed since 1967, when California's Lanterman-Petris-Short Act first established that designated professionals or law enforcement can detain someone for up to 72 hours if probable cause shows danger to self, danger to others, or grave disability due to a mental health disorder, per Disability Rights California.
A Broader Population Now Qualifies
Demand on the system has also grown because of a separate 2023 change. Senate Bill 43 broadened the definition of grave disability to include severe substance use disorders and an inability to maintain personal safety or necessary medical care, a shift implemented by LA County and most California counties in 2024 and 2025. That expanded threshold means emergency departments are now seeing higher volumes of complex psychiatric patients, adding pressure to a system already strained by ER boarding delays.
The Los Angeles County Department of Mental Health has been directed to report back to the Board of Supervisors on the pilot's implementation, hospital participation, training protocols and barriers by December 9. The department has 120 days to deliver that report, and it's also been tasked with developing a plan to expand the training program to eligible private hospitals countywide by the end of 2027. The rollout adds to a string of recent county moves on behavioral health infrastructure, including Norwalk's mental health village conversion that Hahn and Horvath broke ground on in March, a $65 million project turning vacant buildings at Metropolitan State Hospital into 162 treatment and housing beds.
