Involuntary Mental Health Commitment

Age and race influence who is committed
Photo by Matt P. | Flickr April 28, 2016 April 28, 2016
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Teenagers and African Americans face the greatest risk of being involuntarily committed to mental health facilities in Allegheny County, a recent study reports.

Some 37,750 people were involuntarily committed for mental issues from 2002 through 2013, according to the Allegheny County Department of Human Services (DHS) study.

An involuntary commitment occurs when someone is found to be a danger to himself or herself or to others due to symptoms of mental illness. Most start with petitions filed by health care, social service and law enforcement workers. During the period of the study, nurses filed 32 percent of petitions in Allegheny County, social workers filed 30 percent and police filed 24 percent.

Only .6 percent of petitions to involuntarily commit someone to a mental health facility were filed by family members. Others filing petitions include doctors, caseworkers and therapists.

Although the rate of involuntary commitments in the county increased steadily from 2010, the 444 per 100,000 population rate in 2013 was still lower than the rate reported in 2002.

However, the lack of uniform reporting standards across the state and nation denies researchers a precise count of involuntary commitments. Not all petitions in Allegheny County, for example, are reported to DHS, leading officials to believe that the numbers are higher than what the data in their study suggest. And without uniform reporting standards, involuntary commitment trends and rates cannot be accurately compared with other counties in Pennsylvania and the nation.

Despite the limitations of the data, the Allegheny County report presents a picture of involuntary commitment that is consistent with national studies on the topic.

Higher rates for some

Men, for example, had higher rates of petitions of involuntary commitment than women of the same race. While DHS officials are reluctant to make a direct correlation, they point out that there is a link between involuntary commitments and suicide risk. National studies and Allegheny County medical examiner data both suggest men are at greater risk of committing suicide.

The highest rates of involuntarily commitment were found among teenagers and young adults. The DHS study notes that such trends are consistent with the known prevalence of first psychotic episodes. The American Psychological Association’s Manual of Mental Disorders reports the average age for a first psychotic episode to be in the early to mid twenties for men and mid to late twenties for women.

The study also shows that African Americans are involuntarily committed beginning at an earlier age and at a higher rate than whites. From age 15 to 54, for example, the rates of involuntary commitment among African Americans are at least twice as great as those for whites.

The data do not explain the disparity and DHS officials interviewed were reluctant to speculate. But national studies find such disparities occur across the U.S. and provide some insight into factors that might contribute to them.

Researchers, for example, report disparities among races in access, treatment and quality of mental health care. Studies suggest African Americans appear in hospital emergency rooms for mental health issues much more frequently than whites and other ethnic minority groups and that use of emergency services is a marker of poor quality care and a gateway to psychiatric hospitalization. Studies also suggest that African Americans are more likely to be brought to emergency rooms by police and that how they are presented may contribute to the disparities in rates of involuntary commitment.

Julia Fraser

Julia Fraser is a Pittsburgh Today staff writer and research specialist.

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