The rate at which Americans are held against their will and forced to undergo mental health evaluations and state-ordered confinement has risen sharply over the past decade, outpacing population growth by a rate of three-to-one, on average, in recent years, a UCLA study finds. The study, which is the most comprehensive compilation of data on involuntary detentions to date, was made more challenging by the lack of a national data set and longstanding inconsistencies in reporting across states and jurisdictions.
“This is the most controversial intervention in mental health, yet no one could tell how often it happens in the United States,” says David Cohen, PhD, professor of social welfare at the UCLA Luskin School of Public Affairs.
While each state has its own laws governing these detentions, nearly all specify that people who have not been accused of a crime but who may pose a danger to themselves or others or can’t take care of themselves — because of mental illness or substance abuse — can be detained in an authorized facility, Dr. Cohen says. An initial evaluation can last several days, but detention can be extended at the discretion of mental health professionals.
Dr. Cohen and collaborators scoured health and court websites for all U.S. states and were able to pull data on involuntary detentions from just 25 for the period from 2011 to 2018. In those 25 states, they found, annual detentions varied from a low of 29 per 100,000 people in Connecticut in 2015 to a high of 966 in Florida in 2018. Twenty-two states had continuous data from 2012 to 2016. The authors found that during this span, the average yearly detention rate in these states increased by 13%, while their average population grew by just 4%.
“If you think that coercion is necessary in mental health, then a rise in detention rates may be welcome news, a sign that society is doing whatever it takes to help people,” Dr. Cohen says. “But if you think that coercion is punishment — that we need services to prevent or defuse crises in families and society before they get out of control — then a rise is a bad sign.”
One of the most common triggers for a detention is a threat of suicide, Dr. Cohen says. He noted that the detentions often involve law enforcement personnel. “The process can involve being strip-searched, restrained, secluded, having drugs forced on you. For people already scarred by traumatic events, an involuntary detention can be another trauma,” he says.
The authors stress that their study is not about whether or not involuntary psychiatric detention helps or hurts; it is about determining precisely how often it occurs in the U.S. They hope to spur a national discussion and the collection of more data, which “would not only lead to a better understanding of the epidemiology of psychiatric detentions in the U.S.,” says Gi Lee, a social welfare doctoral student and co-lead author of the study, “but it could help determine to what extent commitment is a last resort.”
— Les Dunseith
“Incidences of Involuntary Psychiatric Detentions in 25 U.S. States,” Psychiatric Services, November 3, 2020