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AB 1424 Form

This form is for family members to communicate about their relative’s mental health history pursuant to California Assembly Bill 1424, which modified the Lanterman-Petris-Short Act (LPS Act), which governs involuntary treatment for people with mental illness in California.

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We call it the "AB 1424 Form" in reference to this law. It is designed to help families concisely provide their loved one's mental health history so that it can be considered in involuntary treatment and conservatorship decisions. There is also a shorter "Family Input Form" that you can include with the AB1424 if you would like to provide a longer narrative.

Submitting this form does not guarantee that your loved one's care team will follow any specific requests, but it can never hurt to have this information ready.

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Click here to download the AB 1424 Form (in English).


Click here to download the Family Input Form.

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Tips For Completing and Distributing The AB 1424 form

  • If at all possible, complete an AB 1424 form for your loved one before they have a mental health crisis, and become incarcerated or placed on an emergency involuntary psychiatric hold (5150).

  • Emphasize information that supports the conclusion or decision you want the reader to make.

  • Describe specific behaviors and events rather than general labels or feelings.

  • Keep your writing as factual, concise, and reasonable as possible. Authorities such as psychiatrists, judges, and attorneys are less likely (or will not have the time) to read carefully, or take seriously a lengthy or overly emotional report. It is for this reason that our form is only two pages long.

  • Update the content of your form after any significant incident or change in a family member’s situation. It helps if you keep a written or online daily journal of information, names dates, events and behaviors that you deem important.

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Include with the AB1424 form a Cover Letter that briefly and concisely states:

  • Who should receive a copy of the form:

    • If sending or taking the AB1424 to a mental health intake center or hospital, make at least 3 copies of the AB 1424 form, and specify:

      • One copy to the Psychiatrist

      • One copy to the Social Worker or Case Worker

      • One copy for the medical chart

  • The most important thing you are trying to convey about your loved one. For example:

    • They are too ill to care for themselves

    • They are a danger to themselves

    • (if in court) They have a mental illness and should receive treatment instead of jail time

  • What action you want the authorities to take. For example:

    • Admit them to the psychiatric hospital on an involuntary hold

    • Keep them in the hospital because they will not be safe at home

    • (if in Court) Send them to mental health court instead of jail

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If your loved one is being evaluated for psychiatric hospitalization, or is already hospitalized, you can use the AB1424 form to convey information about your loved one’s mental health history, and your wishes for their treatment, even if they have not given authorities consent to talk to you in person.

The history details in the AB1424 form should support your conclusions in the Cover Letter.  Once completed, you can fax the AB1424 form(s) and cover letter to a hospital, but make sure they allow it. It may be best to hand carry the form(s) to the facility or find out who the best recipient is before sending.

Although privacy laws may prevent a psychiatrist, therapist, attorney or other authority from sharing information with you about your loved one (without a release of information (ROI) ), you do have the right to share information with them, verbally or in writing, your own personal concerns about and knowledge of that person. The AB 1424 form helps you exercise that right in the most effective and persuasive way.

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Using the AB 1424 Form or Family Input Form for Jail or Court

If your loved one is arrested and taken to Jail or must go to Court, you can use the AB1424 Form, and/or the shorter Family Input Form to help persuade legal authorities to make decisions that consider your loved one’s mental health history.

Your cover letter may, for instance, request that they be provided with specific medications and other mental health services while in jail, or that their case be moved to mental health court (where they judge can assign people to psychiatric treatment rather than sentencing them to jail). 

*Note: For court hearings, if you do not have time to complete the AB1424 Form, you can alternatively complete and bring the simpler and more concise Family Input Form with you to court.

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Instructions for Completing the Family Input Form

  • Top of form: Enter the “defendant’s” name, DOB, Psychiatric Diagnosis (if known), and the PFN (Person File Number – if you don’t know this number, leave it blank).

  • Brief medical psychiatric history: Write a brief psychiatric history, including crisis incidents, hospitalizations, treating psychiatrist name/contact, etc.

  • Input relevant to charge:  Include information (“mitigating factors”) that shows the arrest was a result of existing mental health issues, such as paranoia, delusions, hallucinations, mania, dual diagnosis, etc.  Be specific (i.e., instead of “he was delusional”, write “He believed the FBI was following him and was afraid that police would kill him.”

  • Family request to court:  State what you would like to the Public Defender, Judge and/or District Attorney to do, such as “refer to Mental Health Court”, or “she/he needs treatment instead of jail time”.

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Instructions for Submitting the AB1424 and/or Family Input forms to Court

If sending or taking the AB1424 and/or Family Input Form to the Jail or Court, make at least 3 copies of the form(s). In court before the hearing, you may approach the Bailiff, and ask him or her to give:

  • One copy to the judge

  • One copy to the District Attorney

  • One to the Public Defender (or private attorney if there is one)

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If you have further questions about the AB1424 and/or Family Input forms, please contact Alameda County Behavioral Health (ACBH) Crisis Services helpline at (510) 891-5600, available Monday to Friday from 8am to 5:30pm. Visit the ACBH Crisis Services website at https://bhcsproviders.acgov.org/providers/crisis/index.htm

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Sources: NAMI Sonoma County, NAMI Santa Clara County

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