It surprises many families to learn that a person on a psychiatric hold can still say no to medication. A hold limits where someone can be — it does not, by itself, take away their right to make decisions about psychiatric medication. When a patient refuses and the treatment team believes medication is needed, California uses a special process to resolve it: a capacity hearing, commonly called a Riese hearing, named after the court case that established the right.
If you've been told a Riese hearing is scheduled, here's what it is — and just as important, what it isn't.
A Riese hearing decides one narrow question: does this person currently have the capacity to make an informed decision about psychiatric medication? It does not decide whether the medication is a good idea, whether the doctors are right, or whether the person is ill. Capacity is about the decision-making process, not the decision itself — a person with capacity is allowed to make a choice their care team disagrees with.
In practical terms, the hearing looks at whether the person understands their situation, understands the benefits and risks of the proposed medication and its alternatives, and can weigh that information rationally to reach and communicate a decision.
Riese hearings are far less formal than a courtroom. They typically happen at the facility, often within a day or two of the refusal, before a neutral hearing officer. The treatment team explains why they believe the person cannot currently make an informed medication decision; the patient participates and is assisted by a patients' rights advocate at no cost. Hearings are usually brief — often under an hour — and the standard is high: the facility must present clear and convincing evidence of incapacity.
None of this prevents emergency treatment. If someone poses an immediate danger to themselves or others, clinicians can administer medication in the moment without waiting for a hearing. The Riese process governs the non-emergency question — ongoing, planned medication over a patient's objection.
Riese hearings apply specifically to psychiatric medication. Consent for other medical care — a blood draw, an X-ray, treatment for a physical condition — follows ordinary informed-consent rules, and being on a psychiatric hold does not erase those rights either. When someone genuinely cannot make a non-psychiatric medical decision, separate legal processes exist for that situation. A small number of treatments, such as electroconvulsive therapy (ECT), carry their own distinct and stricter consent and review protections under California law — a Riese hearing is not the pathway for those.
The hearing reflects a balance California law deliberately strikes: mental illness alone does not erase a person's right to direct their own medical care, and at the same time, people whose illness has genuinely taken away their ability to weigh a medical decision deserve treatment rather than abandonment. The hearing is the mechanism that sorts one situation from the other, person by person, with an independent decision-maker rather than the treatment team judging its own case.
A Riese hearing is not a trial and not a verdict on your loved one. It's a narrow, fast, protective check on one question — can this person make this decision right now? — with an advocate at the patient's side and a neutral decision-maker in the room. Understanding that shape helps families support the person through it, whichever way it comes out.