Referral for Court-Ordered Psychiatric Evaluation
Important Information: Please Read Before Filling Out

Note: This is not a referral for LPS Conservatorship which can only be submitted by a psychiatrist.

What Is a Court-Ordered Psychiatric Evaluation?:

Welfare & Institutions Code §5200 allows anyone to request that the Court require a person to have a psychiatric evaluation if the person is believed to have a mental disorder and is currently either an imminent danger to self, an imminent danger to others, or gravely disabled. The person must refuse to accept treatment voluntarily.

The Referral Process:

A written referral can be completed on this site or The Public Conservator's Office duty worker can be contacted at 858-694-3500, x 2 to screen the referral. Mental health clinical staff will review the information and determine if criteria is met to proceed with the evaluation.

If proceeding, a thorough investigation is completed by the Public Conservator's staff including an evaluation of the person of concern in order to verify the allegations in the statement as well as to refer for voluntary treatment. If there is probable cause in the allegations and voluntary treatment is refused, then a recommendation is made to the Court to issue an order requiring the person to appear for an evaluation. If the person does not appear, an order is initiated for the Sheriff to transport the individual to San Diego County Psychiatric Hospital , 3853 Rosecrans Avenue, San Diego, California 92110 for a psychiatric evaluation. If the person does not appear, he or she will be brought by the Sheriff's Department to the hospital for an involuntary evaluation by a psychiatrist. There is no guarantee as to what the outcome of the hospital evaluation will be.

Who Can Make a Referral:

Anyone with first hand recent knowledge can complete the referral form if he or she has a current first-hand account of the person's mental health symptoms, can provide facts about the person's dangerous behavior or inability to provide for or utilize food, clothing, or shelter, and that the person has been asked to seek a mental health evaluation or treatment and has refused. The referrer has to be willing to sign a statement or "petition" under penalty of perjury.

Please Consider Prior to Submittal

The Court-ordered psychiatric evaluation is not a substitute for emergency care and may take seven to fourteen days to complete. If there is a mental health emergency, call 911 or the local police or sheriff. Ask if they have a Psychiatric Emergency Response Team (PERT).

The Court-Ordered Psychiatric Evaluation is NOT appropriate under the following conditions:

  • The presenting behavior appears to be as a result of primary alcohol or substance abuse as opposed to a primary mental disorder
  • The presenting behavior appears to be a result of an intellectual disability as opposed to a primary mental disorder
  • The presenting behavior appears to be a result of a primary anti-social or other personality disorder
  • It appears there may be an ulterior motive for initiating a petition (e.g., a landlord seeking to evict a tenant, domestic disputes, revenge, etc.)
  • The person is already receiving mental health treatment or there is no new information since last evaluated by a psychiatrist or other mental health professional.
Petitioner Your information here.
Referral The person you are referring for psychiatric evaluation.
(mm/dd/yyyy)
Yes No (Yes if this person lives with other People)
Yes No (Yes if this person has dangerous pets, weapons, or other known risks)
Yes No (Yes if family or friends can provide additional information)
Enter any Health Insurance information for this person.
Are there any known Psychiatric Diagnoses for this person?
Enter any prescribed Psychiatric Medication for this person.
Enter names and phone numbers for anyone providing psychiatric treatment for this person and the date of last contact.
Enter the date of last contact and specific details about the last time you saw or spoke to this person.
Enter specific details about any psychiatric treatment you've suggested, and how this person responded to those suggestions.
Enter specific details about any mental health symptoms you've witnessed including statements made by this person or actions you've observed.
Yes No (Yes if they have made statements or taken action to harm themselves)
Yes No (Yes if they have made statements or taken action to harm others)
Yes No (Yes if they're unable to provide or utilize food, clothing, or shelter)
Yes No (Yes if they suffer from alcohol or drug abuse or have a history of such abuse)
Enter names and phone numbers of family members or any other reliable contact who can confirm the information you've provided.
Provide any additional information that would be helpful for this referral.