NAMI Santa Clara County and the Santa Clara County Mental Health Department have co-authored the “AB 1424 Form”, to assist families in organizing and distributing vital information to authorities about the psychiatric condition of a loved one who is being considered for involuntary psychiatric treatment.
NAMI families have also found the AB 1424 Form (and/or the shorter Family Input Form) form useful in communicating with the Santa Clara County Jail and Court if their loved one has been arrested.

How The AB 1424 Form Can Help You Communicate About Your Family Member

Assembly Bill 1424 requires that all individuals making decisions about involuntary psychiatric treatment consider information supplied by family members. The forms provide a means for family members to communicate about their relative’s mental health history to psychiatric and court authorities, who must read the information and keep a copy in a Consumer’s health chart or court record. 

Below are listed printable versions of the AB 1424 and Family Input Forms:


Note: Older versions of the AB1424 Forms in Spanish, Chinese, Tagalog and Vietnamese (as well as English) are available from the 
Santa Clara County Behavioral Health AB1424 website

Instructions 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.  Authorities such as psychiatrists or judges are less likely to read carefully or take seriously a lengthy or overly emotional report, so keep your writing as factual, concise and reasonable as possible.  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.

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 heath 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”, or “they are a danger to themselves”, or (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”, or “keep them in the hospital because you cannot keep them safe at home”, or (if in Court) “send them to mental health court instead of jail.”

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 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.

Although privacy laws may prevent a psychiatrist, therapist, attorney or other authority from talking to you about your loved one, you do have the right to communicate to 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.

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 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.

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”.

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)
If you have any further questions or need assistance on the AB 1424 or Family Input form, contact the NAMI Santa Clara County Helpline Help Desk.