August 1st, 2025
The Honorable Anna Caballero
Senate Appropriations Committee
State Capitol, 412
Sacramento, CA 95814
Re: Opposition to Assembly Bill 416 (Krell)
Dear Chair Caballero,
The undersigned organizations write in opposition to Assembly Bill 416 (Krell), legislation that expands eligibility for people who can place individuals on a 5150 psychiatric hold to include Emergency Room (ER) physicians.
We are a coalition of youth, peer, and community-based organizations that envisions a society in which all communities, families and individuals can enjoy full, productive, and healthy lives free from discrimination of all kinds regardless of current and past mental health or substance use challenges. Every person deserves access to appropriate, voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. When an individual is experiencing a crisis, their civil liberties should not be substituted for convenience.
Expanding 5150 designation to ER physicians would increase the number of patients placed on psychiatric holds, driving up state costs. The bill’s author has stated that the intent is to allow ER physicians to write holds and reduce overcrowding in emergency rooms. However, emergency room delays for psychiatric patients are caused primarily by delays in finding an appropriate placement. The bill would only exacerbate an already overburdened crisis system with an excessive number of individuals on a psychiatric hold requiring inpatient hospitalization.
For the fiscal years 2021-2022, just over 100,000 individuals were placed on a 5150 psychiatric hold.[1] The Department of Health Care Serivces (DHCS) reimburses Mental Health Plans for Specialty Mental Health Services (SMHS), which includes psychiatric inpatient hospital services. According to the SMHS Fee Schedules, this costs the state up to $15,000 per person for a 72-Hour psychiatric hold.[2] This amounts to an average of $306 million for psychiatric inpatient services for individuals placed on a single 5150 hold and does not include the cost of additional intensive treatments that may last weeks or months. Nearly 30,000 individuals required 14-Day Intensive Treatment after the 72-hour hold. These additional holds cost the state an average of $1.3 billion.
For comparison, Full-Service Partnerships (FSP) are designed to provide ongoing support and services to adults with serious mental illness. These programs cost taxpayers approximately $16,666 per person a year and served more than 60,000 people statewide in 2021, totaling approximately $960 million. Considering that FSP’s reduce hospitalization, homelessness, incarceration, and overall costs within California’s health and justice system, FSPs are far more cost effective.
Our behavioral health system should focus on reducing, rather than increasing, the number of costly 5150 holds, and prioritizing voluntary, community-based supports and services that can prevent individuals from experiencing a mental health crisis, reduce emergency department utilization, and are person-centered. These strategies help reduce systemic burdens and are more cost effective. For these reasons, the undersigned organizations oppose AB 416 (Krell) and respectfully request your “No” vote.
[1] DHCS – California Involuntary Detentions Data Report (IDR). (2024)
[2] DHCS – Medi-Cal Behavioral Health Fee Schedules Fiscal Year 2025-26
In Community,
Karen Vicari
Director of Public policy
Mental Health America of California
Danny Thirakul
Public Policy Coordinator
California Youth Empowerment Network
Anthony Garibay-Mena
Program Manager
LGBTQ+ Inclusivity, Visibility, and Empowerment (LIVE)
Lynn Rivas
Executive Director
California Association of Peer Run Mental Health Organization