Involuntary Psychiatric Detentions on the Rise, Raising Ethical Questions

Americans are increasingly being held against their will in psychiatric detentions, according to a new study published today.

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A pair of researchers from UCLA released research today on the incidence of involuntary psychiatric detentions in the United States. The data revealed that, over the past decade, the rate at which Americans are confined against their will under mental health laws had increased dramatically.

“This is the most controversial intervention in mental health — you’re deprived of liberty, can be traumatized and then stigmatized — yet no one could tell how often it happens in the United States,” said David Cohen, a professor of social welfare at the Luskin School, in a press release. “We saw the lack of data as a social justice issue, as an accountability issue.”

The study looked at data on an emergency or longer-term detention from 25 state health and court websites and found not only a huge range in emergency detention rates (from 29 per 100,000 residents in Connecticut to 966 in Florida) but also that the average rate increased from 273 in 2012 to 309 in 2016. Overall, the mean state rate increased by three times the mean state population increase.

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Involuntary commitment occurs when people who are not accused of a crime but are believed to be a danger to themselves or others due to ‘mental illness’ or substance abuse. This often results in the individual being seized, transported, or held in custody at an authorized facility such as a hospital before receiving examination and/or involuntary treatment.

Generally, individuals are held for 3-4 days, at which point the person agrees to be hospitalized, is released, or is held to await a hearing. Short-term detention can extend to long-term detention, however. Not surprisingly, there are many challenging ethical issues to contend with, not the least of which is that there is little to no data on how often this type of detention is employed.

The researchers found population rates of involuntary commitments for only three states, disparate data on length of stay, and only one national estimate of involuntary commitment, from survey data of 544 psychiatric and general hospitals. In short, data on the frequency of commitment is sparse.

The authors sought to use publicly available counts to fill this gap in the literature. Using state-specific Google searches, state department of mental or behavioral health websites, court or justice systems, journal articles, and a telephone request, the authors found data for 38 states. Thirteen of these states were excluded for varying reasons, ranging from imprecise terms with no definitions to mixed civil and criminal commitments. This left the authors with 25 state counts, of which 22 had six or more years of data. These states had data with a range of usability.

The researchers found that, of the 22 states with five or more years of data without gaps, there was an enormous range of commitments, from 29 per 100,000 people in Connecticut to 966 in Florida. The average rate in 2012 was 273.2, which rose to 309.0 in 2016.

Of the 22 states with six or more years of data, 15 showed a net count increase between the first and last year, and seven showed a decrease. When outliers were removed, the increased averaged 27.3% compared to the decreases, which averaged -3.8%.

Nevada had the largest increase in psychiatric detentions (139.2%), and Delaware had the largest decrease (-68.5%). Only eight states provided counts of longer-term detentions (which ranged from 25/100,000 to 159); only Vermont reported length of stay data; only Colorado reported separate counts of detentions and persons detailed (on average 10% were held more than once); only Florida provided estimates of unique persons (on average 22% of persons were held more than once).

The study did identify several limitations: differing definitions and mandates by state; a dearth of case definitions and dispositions; not having privileged access to more complete data; lack of length of stay data; inconsistency in the three relevant national databases and reports used to gather data; data mixing between emergency and longer-term commitments; and little to no information on case dispositions, missing data, sources of error, or results of efforts to improve data collection and validity.

“The discretionary rather than mandatory nature of commitment laws (i.e., an individual who meets a state’s commitment criteria may or may not be committed) reflects society’s ambivalence toward coerced care, and professionals and laypersons readily admit their mixed feelings on the subject,” conclude the authors.
“The vague way that many sources defined their counts may also reflect this ambivalence. However, from whatever ethical angle one views commitment, it has profound implications for society. Therefore, state and private agencies, lay and professional groups, and independent researchers should shed more light on involuntary psychiatric detentions, their correlates, and their outcomes.”

 

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Lee, G., Cohen, D. (2020). Incidences of Involuntary Psychiatric Detentions in 25 U.S. States. Psychiatric Services. (Link)

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14 COMMENTS

  2. 22 states out of 50! This dearth of knowledge is appalling. Psychiatric power and secrecy must walk hand in hand. When people’s lives are, as they so often are in commitment cases, at stake, there should be more accountability for sure.

    If we weren’t dealing with a basically unwanted population, we wouldn’t be having this problem. The power disparity is great, and the control factor intimidating.

    Thank you for this report. Certainly conditions cannot be improving substantially when the commitment rates are increasing with such rapidity.

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    • One state we REALLY need to focus on is Florida. That’s obvious from the numbers in this great report. The key factor here is Florida’s Baker Act.

      Thanks to this state law it is alarmingly easy to be hospitalized against your will in Florida. Absolutely anyone can call the police and report that you have said something about harming yourself or others, or done something along those lines. Teachers, bosses, neighbors, concerned friends, frenemies — and doctors, of course. You can then be held for 72 hours while the hospital staff decides if this is the case. If not, they release you; if so, they file a petition to extend your hold.

      The Baker Act has played a big role, I am convinced, in attracting for-profit psych hospitals to Florida. Here’s the first of a series by the Tampa Bay Times on the subject:

      https://projects.tampabay.com/projects/2019/investigations/north-tampa-behavioral-health/

      This story is about adults–but they’ve also covered the explosive growth in “Baker Act holds” against young children, often for having a temper tantrum in school. The schools are not even required to inform the parents, let alone get their consent.

      Have we got any activists in Florida who could follow up? The injustice done to Floridians is bad enough. But the state is also becoming a laboratory of sorts for the real-life consequences of “treating” people against their will. My guess is, it’s not making anyone safer, and is probably helping drive the suicide rate up, not down.

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      • This is the kind of thing that we can all work at on the state level. In most places it’s still an educational problem. I wish I could do more to support the work in Florida, but at least I have seen some good educational videos about it.

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  3. Certainly, there is an ethical context to the individual as well as the organization’s process in the decision-making at the time of commitment. Can you elaborate any about the moral context at this time? If a law, or the emergent law that is written, followed by a policy that is written, that addresses the liability questions, then at what point, or where can the individual discover, what it means to be committed to surviving the atrocities of this painful experience.

    If the pro’s have mixed feelings that day and the potential patient is having a mixture of feelings in response to what is happening within the self AND the organizational thinking that surrounds the experience in an institutionalized manner, then at what point, can the Rights being understood and respected?

    Further, what does the summary data really mean in application/change to the operations? Does the granular nature of the sum void the individual experiences that many of us have encountered? When the papers are given to the individual for signature, is that moment ever conveyed as a “involuntary commitment that negates the necessity of being processed through a court ordered commitment”? And to begin to exercise choice while one’s medicated state is being played with, who has the courage of a Soteria Experience to articulate the realities of the experiences being encountered? Finally, as I re-read and read your final statements, I would ask if you are of the opinion that “society” has a mind, a collective understanding of what being a human means across the spectrum that is known?

    Therefore, would in the legal sense of trying to implement change, would the thought be stronger or weaker if the word “should” would be replaced by “shall”. (The should becomes a wiggling space while the shall invokes a more deterministic stance, that also has weights for the scales of mental health justice). Just my opinion. I do think you are at an intersect with this article.

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  4. There is no ethical dilemma.

    That would require working treatments. There are none. If there were working treatments, you’d get the dilemma of helping someone against their will. That’s not the case. Coerced psychiatry is harming people against their will, while under the delusion of helping. That’s abuse. It is the same thing abusive parents do, when they hit their child to “fix” it.

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  5. I agree, “state and private agencies, lay and professional groups, and independent researchers should shed more light on involuntary psychiatric detentions, their correlates, and their outcomes.”

    Especially since involuntary detentions are being abused by criminal doctors. I was medically unnecessarily shipped (due to a sleep walking/talking issue, one night ever in my life), not to the closest hospital that took my insurance, but a long distance to this now FBI convicted doctor. By doctors at a hospital which was no longer in my insurance group, because it’d been medically recommended my family switch insurance groups, due to prior malpractice.

    https://www.justice.gov/usao-ndil/pr/oak-brook-doctor-convicted-kickback-scheme-sacred-heart-hospital

    According to medical records, I was admitted with a “chronic airway obstruction,” a medical condition I did not have. And that is NOT a psychiatric diagnosis, thus I should NOT have been force treated.

    But what Kuchipudi was arrested for, was having lots and lots of people medically unnecessarily shipped long distances to himself. He would then have his psychiatric partner in crime “snow” his patients. That means drug them to the point that only the whites of the patients’ eyes show. The goal of this was to make the patients unable to breathe, so that Kuchipudi could then have unneeded tracheotomies done on people, for profit.

    I was “snowed,” willy nilly, put on and taken off of huge drug cocktails of 9 or so different psychiatric drugs a day, which is not prescribing according to guidelines. Thankfully I was healthy enough that I was able to avoid the unneeded tracheotomy.

    The “snowing” psychiatrist, who committed this malpractice, had wanted to have my insurance company pay for me to be institutionalized for life, to cover up her and Kuchipudi’s crimes, in addition to the previous malpractice and crimes committed against me and my family by other doctors, pastors, and child molesters, of which medical proof had already been handed over. But I was fortunate that my private health insurance company refused to pay for any more than 2 weeks of this horrendous maltreatment.

    I did the mandated aftercare with a different psychiatrist, closer to my home. I was eventually able to embarrass him into weaning me off the psych drugs by quoting my oral surgeon. Who stated the common sense reality that, “Antipsychotics don’t cure a mother of concern of the abuse of her child,” especially after the medical evidence of the abuse had been handed over.

    Two years later, I was lying in a public park, Millennium Park in Chicago, looking at the clouds, trying to come to grips with the magnitude of the medical and religious betrayal, with which my family had dealt. And the fact that I had found the medical proof that both the antipsychotics and antidepressants, can make people “manic” and “psychotic,” via the central symptoms of anticholinergic intoxication syndrome, aka anticholinergic toxidrome. And all doctors were taught this in med school. So all my doctors had lied incessantly through their teeth to me, for years.

    My car, unfortunately, was towed. I had gone to the park to watch the sun rise, but cars were apparently not allowed to be parked there, as the sun was rising, so it was towed. Around 11am a police man came and asked me to come with him, for no good reason. I did. He took me to a hospital, where I was given an unneeded physical.

    I had politely declined medical care, and did not sign HIPPA forms. The unneeded physical resulted in a “medically clear” diagnosis. But I was not allowed to leave. And instead, I was shipped in the middle of the night, a long distance, back to Saiyed. The chances of that happening, without the doctor breaking HIPPA laws, and illegally looking into my past medical history, in a metropolitan area the size of Chicagoland, is basically zero. And that hospital did eventually confess their $5000 physical charge was illegal, once the crimes of their doctors were pointed out.

    The second time Saiyed had me medically unnecessarily shipped a long distance to her, and force treated me. I told her I was allergic to her drugs, and that it was against my religion to take them (I’d changed religions). She did not listen to me, force treated me instead, resulting in my pounding my fists on my chest in angst. Saiyed had a group of psychiatrists in training with her, who all witnessed this. One of the nurses said she’d never witnessed such an adverse reaction to the drugs.

    I asked the crowd, in a rather stern mother tone, if anyone there spoke English. A bunch of hands eagerly went up. No doubt this was embarrassing for Saiyed, since she had been telling these people she was my psychiatrist, and touting the “revolving door theory.” But obviously if I doubted whether she even speaks English proficiently, I was not actually her client.

    My “diagnosis” then changed to having a UTI, again not an illness I had, and not a psychiatric diagnosis. Thus, again, this was not a legal forced treatment. I was then forced to take a very powerful anthrax drug, which is known to cause “psychosis.” I loudly announced, in front of the other patients, that that drug was making my heart feel like it was going to stop, since that’s what it did feel like. So I was only forced to take that unneeded pill twice.

    I was finally let out a week later, with a diagnosis of “adjustment disorder.” But not before one of the nurses insisted I take a bible. I’m guessing I was the only patient she’d ever witnessed leaving that place, not drugged up.

    When I picked up the expunged court documents from the first involuntary commitment, I learned that my signature had been forged on the voluntary committed documents. So the doctors could avoid giving me my day in court, which was illegal, of course.

    But that “snowing” psychiatrist, Humaira Saiyed, did not stop there. I learned from a health insurance company a few years later that Humaira had been inappropriately listing me as her “outpatient” at a hospital where I’d never been, for years.

    I called Humaira, and asked her to stop fraudulently listing me as her “out patient” at a hospital that agreed with me, that I’d never been there. Humaira thought she was clever, so unbeknownst to me initially, she started listing me as her “outpatient” at the hospital at which I’d had the misfortune of meeting her.

    In the meantime, I’d been dealing with a lot of family issues, including the death of my husband, and cleaning up a financial mess he had created, prior to his untimely death. I was also fighting an illegal firing from a job. I did win that battle, since I had luckily handed over proof that that employer had tried to steal from me, and they had no evidence that I had stolen or tried to steal from them whatsoever. But I was dealing with lots of other corporate crimes as well.

    I was eventually sent documents stating I was party to something like 60 to 70 class action law suits, by criminal corporations. My research indicates that people call this being a “targeted individual.” I also had to move my children and I out of our home, just after my husband’s death, due to an illegal foreclosure.

    Proof of the fact that that bank did not even have my mortgage, the note, nor the date of assignment of my mortgage to them. Since it never was legally assigned to them, was eventually sent to me. After I’d short sold my home, helped a family by selling them my home for $100,000 less than it’s true value, financially screwed that unethical bank, and moved. Obviously, this was during the aftermath of the housing/foreclosure crisis. But it was a shame “all the Kane County judges are bought out by the banks,” according to all the lawyers I’d tried to hire.

    Humaira eventually had a couple of her lackeys call an old phone number of mine, which was a cell phone that I had since given to my mother. I had moved closer to my parents, to help them downsize, and move into a retirement community. My mom handed me the phone, the lackeys asked me why I missed an appointment with Saiyed. I told them that they were going to look like fools and criminals, if Saiyed did not stop fraudulently listing me as her patient, since I no longer even lived in Illinois.

    I do not know if I was made a “targeted individual” because the ELCA religion wanted to cover up the abuse of my child, or if it related to Saiyed’s crimes at an ELCA hospital, or likely both. This book, written by an ELCA insider, implies it may have been due to the ELCA religion’s systemic desire to cover up child abusing ELCA pastors’ crimes. I’d be one of the likely many “widows” mentioned in the Preface of this book.

    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    I have no doubt that psychiatry and psychology, not to mention the information age, are being used by corporations and industries to harm innocent people. I was attacked one more time by another ELCA psychologist, after he saw my work, because it “too truthfully” documents the crimes, to which my family had been subjected, by the ELCA religion, and their Jewish and Muslim psychiatrists.

    According to the classic thievery / “art manager” contract he wanted me to sign. That Lutheran psychologist wanted to steal all profits from my work, my work, and my story. He wanted to take control of all my money, my lawyers, and accountants. I was appalled by his contract, and had to tell him I would not sign it about 10 times. Since that likely 60 aged psychologist acted likely a spoiled child, who’d never heard the word “no” before.

    It is staggering the lengths the corrupt ELCA religion, and their many “mental health” minion, will go to cover up the abuse of a person’s child, in this country where covering up child abuse is illegal. I now have medical evidence of 14 attempted murders, all via various forms of anticholinergic toxidrome poisonings. Plus, the legal proof of the attempted thievery.

    But profiteering off of covering up child abuse is the number one actual societal function of both the psychological and psychiatric industries. And now also the Lutherans in my church, who entered into a faustian deal with the systemic child abuse covering up psychologists, psychiatrists, and all their “mental health” and social worker minion. And it’s all by DSM design.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/
    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    Absolutely, forced psychiatric treatment should be made illegal. Since it is being utilized by criminal doctors and religions, for nefarious purposes. And, truly, America as a whole does NOT benefit from having a group of, primarily child abuse covering up, scientific fraud based, “mental health” industries. Whose systemic child abuse covering up crimes, also function to aid, abet, and empower child molesters and child sex traffickers. Resulting in us all now living in a “pedophile empire,” where pedophilia and human trafficking are running amok.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT

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  7. “I had politely declined medical care, and did not sign HIPPA forms. “. I’m sorry this has happened to you. I am fighting a similar battle in retaliation for complaints i filed. What I learned is that HIPAA is not so much about privacy, it is about sharing information electronically, and it doesn’t matter whether you sign the form. There are state and federal laws that are much more concerning, and these laws allow sharing information if a person has been diagnosed with a “SMI” — a serious mental illness. Public law 99.319 “PROTECTION AND ADVOCACY SYSTEMS” cited as “Protection and Advocacy for Mentally 111 Individuals Act of 1986″ – or PAIMI, which provides funding to disability rights agencies in states. The privacy rights of health records for persons labeled by the “system” are being grossly misused. This is not protection and advocacy, it is a gift to the drug companies and others who want to coverup crimes by controlling individuals under the guise of “coordinating care”, which can mean “coordinating fraud”. Good luck.

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  9. The future is now!
    At least we have some questioning this as an “ethical dilemma.”
    That it is a total abomination seems still lost to most.
    I could point to other sectors of society that are having similar lapses in good sense…

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