Involuntary Hospitalization Increases Risk of Suicide, Study Finds

New study finds that people who felt they were coerced into being hospitalized were more likely to attempt suicide later.

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A new study suggests that the common practice of forced hospitalization for mental health concerns may be doing more harm than good. People who felt they were coerced into being hospitalized against their will were more likely to attempt suicide after being released from the hospital. This was true even after controlling for other factors that might influence suicidality.

The research was conducted by Joshua T. Jordan and Dale E. McNiel at the University of California, San Francisco, and published in the journal Suicide and Life-Threatening Behavior, the journal of the American Association of Suicidology.

Photo credit: Jaclyn Cosgrove

Previous research has found similar results. A 2017 article in JAMA Psychiatry found that risk of suicide was 100 times greater than average immediately after being released from a hospital, and a 2016 report suggested that “adverse experiences associated with hospitalization” were responsible for the high number of post-discharge suicide attempts. Involuntary hospitalization was associated with increased risk of suicide both during the hospitalization itself and afterward.

The United Nations (UN) Special Rapporteur on the right to health, Dainius Pūras, has denounced the practice of involuntary treatment. In addition, the UN Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment called for a ban on forced psychiatric interventions explicitly warned member countries, including the US, that the practice of involuntary hospitalization is “prohibited” and should be “abolished” since it consists of the restraint and imprisonment of people who have neither been accused of nor convicted of a crime. The UN group clearly stated that this infringes on the rights of people with psychosocial disabilities:

“As long as mental health laws allow for the involuntary deprivation of liberty, forced treatment and forced medication of persons with disabilities, those laws are contrary to the Convention, including the right of persons with disabilities to legal capacity.”

However, this remains a common practice, especially in the US. Many mental health professionals and policymakers argue that it is necessary, if regrettable, to detain people against their will to prevent possible future harm to themselves or others.

In the current study, Jordan and McNiel looked at 905 people who were in a psychiatric hospital and followed them for a year after they were discharged. The data came from the MacArthur Violence Risk Assessment Study, which occurred between 1992 and 1995.

They found that fully two-thirds (67%) of the participants felt that they were forced into hospitalization, and 19% went on to attempt suicide after being released from the hospital. This data alone calls into question the idea that forced hospitalization is an effective treatment in preventing suicidality.

Interestingly, those who were forced into treatment were more likely to be young white women. They were also less likely to have a violent history than those who saw their treatment as voluntary.

The researchers adjusted for various potential confounding factors, such as whether they had a history of self-injury or suicide attempts, and whether they received mental health “treatment” after discharge.  The finding remained significant. Even when all these other factors were considered, being forced into hospitalization was associated with an increased risk of suicide attempts after being released.

“Some patients may feel violated, disrespected, humiliated, or dehumanized by the experience of coercion,” they write.

Despite their results, Jordan and McNiel lend support to the practice of involuntary hospitalization in their article: “The results of this study do not question that psychiatric hospitalization can be necessary for the safety of individuals and to the public, even when patients perceive it as coercive.”

A tension exists between a disability rights approach, called for by service users and human rights groups, and the preference of certain mental health professionals to retain the use of forced treatment. The results of this study call into question the effectiveness of forced treatment and add further empirical support suggesting that violating service users’ rights in this way increases suicidality.

 

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Jordan, J. T., & McNiel, D. E. (2019). Perceived coercion during admission into psychiatric hospitalization increases risk of suicide attempts after discharge. Suicide and Life-Threatening Behavior. doi: 10.1111/sltb.12560 (Link)

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24 COMMENTS

  1. I was effectively kidnapped and held against my will in a Canberra (Australia) hospital. After an initial period of around 72 hours they had to let me go as I showed no signs of being a danger to myself or others. Indeed, never in my life had I even had a parking ticket or been in any trouble with the law, or shown any sign of or tendency towards violence.

    As I was getting ready to leave, the head shrink asked me what I thought of the facility.
    Being naive (it was my first ever brush with mental health services…age 50), I said I thought it would have been good to be able to have camomile tea, and thought that as a long term vegetarian who always marked the menu for meat free meals, I was often disappointed to receive a plate full of meat. I was quiet and respectful as I wanted to just get home and feel safe.

    She said, “you seem angry, that means you get to stay longer”. After being put before the kangaroo court that was the “Mental Health Tribunal” the hospital was granted an involuntary treatment order that allowed them to keep me in and drug me with Olanzapine and Mertazapine, Stilnox (Ambien in the US) and whatever else they wanted for another few months. After release they could also force me to take their drugs. The time inside was pure hell…vicious nurses, male patients being sexually threatening towards me, witnessing violence between patients and between patients and staff and being refused access to even paper and pencil. I had had committed no crime and showed no signs of being dangerous, and simply could not believe I could be locked up like that. I was an educated, high achieving executive.

    I got out after a truly terrifying and traumatising 6 weeks. Being effectively kidnapped, stripped of all my human rights and drugged had a profound effect on me. My mother couldn’t accept I had been locked up with “druggies and hopeless nut cases” and was “dangerous to self and others” and disinherited and disowned me. Over 15 years down the track we still have no contact…she is almost 90 and I don’t expect I’ll see her again.

    Totally traumatised and having been advised by my private shrink it’d be fine to just stop taking the meds without tapering, within a month or two of discharge I had made a serious attempt at suicide and ended up inside again…more drugging…but this time I was smarter and pretended to be very compliant, tonguing the meds and spitting them out ASAP when ever I could.

    I have now been psych drug free for a decade and totally shrink free for about 5 years. Slowly, ever so slowly, I am becoming more my usual self…intelligent, interested in life, able to sustain normal friendships, and creative.

    Never again will I discuss my feelings/thoughts with a doctor of any shape or form…the damage they can do on a whim and “for your own good” is absolutely appalling. They must be stripped of the power to detain and torture human beings.

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    • Heh Mik, I’m glad you made it, and didn’t commit suicide. Hang in there.
      I had a friend tell me how coming out of an involuntary commitment left her so depressed, and she said this in a really calm logical way to explain why she had ever tried it before.
      Then she got committed again, I warned her mother stating that if you have her committed you’ll lose her, and that’s what happened. Then I had to tell her “friends” that also involved having her committed to stop bothering me, who would come up to me like it was some tragedy, while I had warned ALL OF THEM about what they were doing when they had her committed. They were extremely hostile towards me when I was trying to warn them, and then they’d come up to me afterwards, after she had died, like I was going to feel sorry for them as if it was still some tragedy they were trying to prevent, rather than being instrumental in causing it. And their behavior was WAY more inappropriate than anyone labeled as “psychotic” could even be. How non reality based it was: just the way you describe the psychiatrist diagnosing because you politely stated that you were vegetarian but would still get meat with your meals after checking that you wanted meat free meals.

      I imagine that there probably were a whole list of things that they had already put down, other things that you in the same quiet respectful way told them you felt could be different. They have real problems with anyone that articulate, I think. And from what I’ve seen feel free to make up whole alarmist scenarios based on false interpretations of just about anything they can use for such purposes.

      It’s a really scary situation. If you’re not appeasing their paranoia about alarmist ideas, they feel free to make out there’s some danger.

      I’m glad you learned how not to even try to respond to them.

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  2. Absolutely, force treatment is all about making people feel “violated, disrespected, humiliated, [and]/or dehumanized.”

    “those who were forced into treatment were more likely to be young white women. They were also LESS likely to have a violent history than those who saw their treatment as voluntary.” You likely also forgot, well insured. It’s all about filling the beds with well insured, healthy, non-violent, women, for profit.

    One of my force treating doctors was finally convicted by the FBI, for having lots and lots of patients medically unnecessarily brought long distances to himself, “snowing” people, in the hopes of making them unable to breathe, so unneeded tracheotomies could be performed on people for profit.

    https://chicagoist.com/2013/04/16/chicago_hospital_owner_doctors_arre.php

    According to expunged court documents, and my medical records, my signature was forged on the voluntary commitment forms, which was illegal. I was admitted in to the hospital with a non-existent “chronic airway obstruction,” which was understandable, once his tracheotomy scam was exposed.

    The psychiatrist who “snowed” me was never arrested, although she should have been. And she is a psychopath, who illegally listed me as her “outpatient” at a hospital I’d never been to for years, according to an insurance company. So she could get me medically unnecessarily (based upon a “medically clear” diagnosis) shipped to her a second time.

    And even after that, she continued to fraudulently list me as her patient, so I called to ask her to stop fraudulently listing me as her patient at a hospital I’d never been to before. She thought she was clever to then fraudulently start listing me as her “outpatient” at the hospital I first met her. But her lackies were embarrassed when they called to ask why I didn’t show up for an appointment. And I told them I no longer lived in that state, so of course I wasn’t making appointments with that psychopathic, criminal psychiatrist.

    Forced treatment should be made illegal. It’s being used for criminal reasons.

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  3. It’s of course WAY too simple for the authorities given the power (or should I say privilege to wield power) to have someone committed. And it’s they are just too comfortable with all of their excuses that it’s this special case where someone INDEED is in danger, that not only do the amount of people end up being committed that add up to the statistics shared, but the whole system stays in place to accommodate all these “special” cases where someone is in danger, to add up to it being that before they were committed, they WEREN’T! In danger that is.

    And all of the lying.

    And the gross amount of aspersions put on anyone saying there’s no danger, as well as what would happen would it simply be shown where the danger lies, to in the end it being turned around by AGAIN a choice few, full of exceptions and special vezzi bugiardi of viewpoints, insuring everyone that the suicides are a lack of treatment in general, rather than a result of it.

    And thus it continues.

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  6. Do you honestly need a study, or multiple studies for that fact, to come to the conclusion that forcing someone into an Asylum and using restraint, chemical torture and psychological mind-games would result in a negative result on the well being of an individual?

    You don’t need a study, you also don’t need personal accounts that suggest this would be the result, what you need is a working, functional brain that has empathetic values.

    And after the results are clear as day, they have the cheek to state they still support the involuntary commitment of individuals even though it will result in higher numbers of suicide.

    These people are morally corrupt.

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    • Totally agree. And it’s not just about involuntary hospitalization. Doctors think they can treat emotionally disturbed patients (I don’t call it “mental illness) any way they want.
      I have been involuntarily “admitted” once, but another time the doctor lied to me about voluntary admissions. He said I could go home if I felt better the next morning (I was having trouble dealing with a situation going on in my life). Little did I know that with this particular unit, once you voluntarily admitted yourself, they kept you for two weeks – no exceptions. Betrayal doesn’t begin to cover what I felt. I had no time to make arrangements for care for my pets, no time to prepare for hospitalization. No toothbrush, no toothpaste, no changes of clothing. And when you get out, you have a lot of stress playing “catch up with life” like bills, accumulated mail, etc. If you’re held for a hearing, you’re kept in isolation and staff doesn’t listen to you, they manipulate you. They don’t listen to you about non-prescription meds that you need. Every physical illness you have is called into question. Having to ask to sign agreements 3 times and waiting for HOURS before getting a response. That’s not “medicine” It’s emotional abuse.

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  7. Why does the suggestion that suicide must be prevented at any cost go unquestioned in most of the mental health industry? Is it allowed to even ask such a question?

    Suicide prevention is mostly motivated by selfish desires: to cover your ass; to feel good; so you can boast about “saving lives”; to prevent losing a person that you believe “belongs to you”, who in a sense you consider as a possession.

    When a person experiences constant, unrelievable and unbearable pain, as is the case with some mental health patients, suicide can make a lot of sense because it ends the constant, unbearable suffering. I’m not suggesting that it should be done in these cases; I’m simply saying that people should have the freedom to do it without intervention, and even receive assistance, should they so desire. How does this not make sense?

    Also, I see a risk of trading suicide for decades of silent suffering. Therefore, the suicide rate is a very crude and potentially misleading indicator of the mental well-being of a society.

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    • I’ve always found that people considering suicide have good reasons for feeling that way. Trying to “stop suicide” is a very short-sighted approach that leads to bad results. Finding out what the person is finding hopeless about his/her life and helping them regain some measure of real hope is a lot more effective.

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    • I’ve wondered about that too. There’s money to be made, for one thing. CDC once offered a grant to whoever submitted the best community-basedproposalm for getting so-called schizophrenics to quit smoking. I went to the web site of the organization that won the grant and tried to figure out what they hd done with their $90,000. It was quite a while until I realized that Web site was their entire work product. As a group they didn’t “do” anything. They “did” a WordPress-template-based brochure-ware site that listed “community resources” and a bunch of incorrect, self-contradictory dogma about smoking and schizophrenia.

      The 15-year director of their parent org is resigning (to become a professor of psychiatry at Columbia University, naturally (Jeffrey Lieberman, Andrew Solomon). She mused over the accomplishments of her career:

      “And, committed to improving care, we championed Certified Community Behavioral Health Clinics (CCBHCs). Like Federally Qualified Health Centers, CCBHCs get cost-based reimbursement that goes up as more patients are welcomed, staff is added and technology adopted. ”
      Irony at work: Slowly kill people with antipsychotics. Take away their one pleasure because it might kill them sooner than your method will.

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  10. While this is interesting, I don’t see it as convincing evidence that forced hospitalization leads to more deaths (or even as proof that forced hospitalization doesn’t save lives.)

    The problem is, this study doesn’t seem to have a way to rule out the possibility that those who were forcibly hospitalized were a group that had gotten to a place, pre-hospitalization, where they were way more likely to kill themselves, and so hospitalization may have reduced the suicide rates but wasn’t effective enough to prevent all of the suicides.

    A more effective study would randomize acutely suicidal people to either get forced hospitalization, or simply be offered treatment on a voluntary basis. Then we could compare outcomes between the two groups. This would be a difficult group to get approval for (since those who believe in forced hospitalization would see it as unethical to not forcibly hospitalize people who seemed to be at high risk of suicide, while those who are opposed to it would see it as unethical to do even as part of a study like this.)

    Anyway, I just want to see all of us on MIA being careful about our logic, and to avoid convincing ourselves we have proof of something when we aren’t quite there yet.

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    • It certainly suggests to me that at the minimum, psych hospitalization doesn’t appear to reduce suicidal acts. And from a scientific viewpoint, it’s the responsibility of the “treaters” to prove their treatment works. Saying they are worse to start with and that’s why so many kill themselves afterwards suggests that “Treatment” has had no positive effect.

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      • Steve, I think you are jumping to a conclusion that this study doesn’t support, when you say the study suggests the treatment has no positive effect. The study’s outcome could also be a result of the treatment having positive effect, but insufficient positive effect to prevent all of the suicides that might otherwise result.

        It’s very hard to convince people that forced hospitalization never has a positive effect, when there are so many stories of people who were about to kill themselves, but got hospitalized and in the hospital quit being suicidal and then got out and weren’t suicidal anymore.

        what many of us wonder about though is the bigger picture. Is it possible that the dragnet of forced treatment pulls in many more people who wouldn’t have committed suicide if they hadn’t been hospitalized, but who as a result of the trauma of forced treatment, do end up committing suicide? I think we can agree that we need an answer to this question, but I don’t think we yet have data that can answer it.

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        • I would agree that the conclusions from this study are very limited, but there doesn’t seem to be any evidence that hospitalizations the way we do them is decreasing the suicide rate. Again, it is the responsibility of those advocating for more hospitalizations to prove that they DO reduce suicidality, not the responsibility of those opposed to prove it does not. There is no evidence here that a reduction is taking place, therefore, the scientific conclusion must be that to date, we can’t say that hospitialization is an appropriate action to prevent suicide, at least as it is done. This doesn’t mean that certain individuals might not choose not to commit suicide if they are kept alive a while longer, but there is no data to suggest that the “treatment” is anything more than simply preventing a person from acting upon impulse and giving them time to consider their decision in a new light.

          What I am uncomfortable with is starting from the assumption that hospitalization DOES reduce suicidal behavior and forcing someone to prove that hypothesis wrong. We should assume that it DOES NOT until those in favor of it prove otherwise, just as a drug has to be proven effective against placebo or it is assumed that it is not effective.

          Hope that is clearer.

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