Involuntary Psychiatric Commitment: An Enforced “Solution” that Makes the Problem Far Worse

     Critics of involuntary psychiatric hospitalization often focus on the violation of a patient’s constitutional rights and the unethical basis of forcing incarceration on a patient against his will. There are an estimated 1.2 million forced mental hospitalizations every year in America, and the rate of these incarcerations has grown three times faster than the growth rate of the overall population. There are currently 357 hospitalizations per 100,000 residents annually, a rate identical to the number of convicted criminals incarcerated in state and federal prison
each year.

     A study published last month shows there is a practical reason, as well, to curb these involuntary psychiatric incarcerations. The effects of involuntary commitment which are revealed in this study are far worse than has been previously known.

     A study of Allegheny County, Pennsylvania, involuntary hospitalizations published as a Federal Reserve Bank of New York staff report reveals not only the horrific financial costs of enforced commitment, but also the human toll taken, especially with “judgment call” cases. These are situations that do not clearly show the need for enforced hospitalization, but only the potential for “harm to self or others.” Of the Pennsylvania residents in the study, 60 percent were incarcerated in a psychiatric facility from an emergency room setting because they were deemed a danger to themselves or to others.

     The Federal Reserve study first specifies the financial inequity these incarcerations take. For the three years of the study, those involuntarily committed individuals accounted for one out of every four Medicaid dollars paid during that time period, even though those incarcerated made up only 1.5 percent of Medicaid enrollees. That bumped annual Medicaid spending up to $14,000 per person.

     Sadly, a far greater human toll was also uncovered. 20 percent of those individuals who were involuntarily committed died within five years of their commitment. That’s a much higher mortality rate even than for people living with severe mental health issues in general, than for those who have been released from jails, and than for those who are enrolled in homeless shelters.

     25 percent of those forcefully incarcerated in psychiatric facilities were charged with a criminal offense within one year after their evaluation. The Federal Reserve study also found that these “judgment call” patients — who not all doctors would incarcerate — are twice as likely, within just three months after their incarceration, both to be charged with a violent crime and to die by suicide.

     These are patients who would only be forced into hospitalization by some doctors, but not by others, because of only a possibility of harm to self or others. It’s a horrible irony that the incarceration itself doubles the actual violence committed to self and others.

     Concrete evidence of a mental health problem made far worse by this enforced “solution.”