Write legibly. If your signature is not legible, then print your name along with the signature
ALL descriptions should be behavioral not diagnostic
Use behavioral quotes (see below for examples)
How did the person come to your attention?
Does the unusual behavior in fact present a danger to self or others? How? Why?
Use person’s words and actions to establish they are gravely disabled, suicidal &/or dangerous.
A person with a serious mental illness diagnosis who is not getting therapy and not taking medication CAN NOT be placed on a 5150 to get treatment for that alone. They still must meet 5150 criteria of danger to self (DTS), danger to others (DTO), or gravely disabled (GD).
If the individual is being held on danger to others (DTO), document the specific threats or attempts of bodily harm, along with dates, as well as, the NAME OF PERSON BEING THREATENED & Phone number (if known). This information can be useful if/when a
EXAMPLES OF BEHAVIORAL QUOTES:
- Running naked in the street
- Threatened neighbor with shovel
- Says he is going to kill himself by jumping off a bridge
- Pacing about room yelling
- Hearing voices that say…”___”
- Student expressed suicidal thoughts to school counselor
- Tells me the TV is speaking to him about things
- Person sees CIA agents about to attack him
- Feels he is married to Jennifer Lopez
- He is sure someone is watching him from the vents in his apartment
- Going to kill herself with an overdose because her boyfriend left her
- Individual has terminal/life threatening illness and says doesn’t feel life is worth living anymore
- Says voices are telling me to hang myself
- Says will kill his landlord if he does not stop putting evil thoughts into his head
- Believes she is Cindy Crawford and refuses to eat or drink for 2 weeks so she can lose weight for an audition
- Minor child says she will kill herself if she does not transfer schools
- Tried to run into the street, and then tried to smash car windows with a board yelling ‘demon cars’
- Was found sitting on his roof in rain, with aluminum on his head, saying he was communicating with aliens
Quotes from the individual are highly desirable.
Behavioral descriptions from reliable sources are often very helpful.