Racial and Ethnic Inequities in Inpatient Psychiatric Civil                     Commitment

Shea, Timothy; Dotson, Samuel; Tyree, Griffin A.; Ogbu-Nwobodo, Lucy; Beck, Stuart; Shtasel, Derri

doi:10.1176/appi.ps.202100342

Cited by 16 publications

(7 citation statements)

References 25 publications

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“…4. Addressing any inequalities of access to services and reducing racial discrimination and disparities appears to be a key issue to address across several mental health systems (21, 22, 74, 75). Service users from minoritised ethnic groups reported experiences of racism and unfair treatment, thus efforts to promote equality, diversity and inclusion and anti-racist practice are needed, a recent example of which is the Patient and Carer Race Equality Framework in England and Wales (76).…”

Section: Discussionmentioning

confidence: 99%

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A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

Bartl,

Stuart,

Ahmed

et al. 2024

Preprint

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Background Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service usersʼ and carersʼ experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. Methods We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service usersʼ or carersʼ experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. Results Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. Conclusions Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences.

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Section: Discussionmentioning

confidence: 99%

“…Disproportionally high rates of involuntary admissions of people from marginalised groups is also an increasingly recognised issue, reported internationally (8), including in the UK and US (21, 22). In England, people from Black ethnic groups are 3.5 times more likely to be detained than White British people (23).…”

Section: Introductionmentioning

confidence: 99%

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

Bartl,

Stuart,

Ahmed

et al. 2024

Preprint

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“…34 Racially and ethnically oppressed patients are also at a greater risk of being placed in restraints in hospital settings, even when they do not differ from White patients in terms of histories of violence or number of violent acts committed. 35,36,37 These findings are significant, given that racially and ethnically oppressed groups are also overrepresented in a number of criminal justice settings. 38,39,40,41 Extreme safety measures in inpatient psychiatry may include bleak sterile environments, artificial lighting, limited windows, limited privacy, lack of access to personal belongings, and even bolted down beds in rooms with concrete or padded walls; as a result, some psychiatric facilities may resemble carceral settings more than hospital settings.…”

Section: Frequency Of Adverse Eventsmentioning

confidence: 97%

How Inpatient Psychiatric Units Can Be Both Safe and Therapeutic

2024

AMA Journal of Ethics

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Inpatient psychiatric units should be therapeutic environments that support dignity and recovery. When adverse outcomes (eg, self-harm, violence) happen in these settings, clinicians and administrators can face litigation and other pressures to prioritize risk management over supporting patients' access to personal belongings, exercise equipment, and private spaces. This article describes these downward pressures toward sparser, controlling environments in inpatient psychiatric settings as a safety funnel and suggests strategies for balancing safety, humanity, and recovery in these contexts.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Evolution of Inpatient Psychiatric UnitsInpatient psychiatric units are supposed to offer therapeutic environments for patients to recover from severe psychiatric symptoms. As far back as 1847, Thomas Story Kirkbride, a US physician, published "Remarks on the Construction and Arrangements of Hospitals for the Insane." 1,2 This treatise focused on all aspects of the design and organization of hospitals for people with mental illness, 2,3 such that, as Tomes argues, "every detail, from the design of the window frames to the table settings in the ward dining rooms, had to be arranged to sustain the impression that here was an institution where patients received kind and competent care." 1,3 Long-term psychiatric hospitals in the United States and elsewhere, often referred to as asylums, occasionally had sprawling facilities with acres of land, gardens, chapels, or other amenities for engendering tranquility among the inhabitants. 4,5,6 Although large, often state-run, facilities played a considerable role in the care of people with mental illness into the 20th century, by mid-century, increased public awareness of the conditions inside certain facilities, growing emphasis on patients' rights, and other developments led to a shift away from these types of facilities toward community-based care. 7,8 In parallel, the goal of psychiatric hospitalization shifted from long-term psychiatric and custodial care to short-term stabilization. 7,9 The evolution of inpatient psychiatric settings toward brief stays has coincided with increased clinical and legal emphasis on promoting safety and preventing adverse events. This article describes the Citation

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“…Individuals who identify as Black, multiracial, or another race other than White are significantly more likely to be subjected to involuntary psychiatric hospitalization than those who identify as White. 27 The risk of being involuntarily hospitalized is also positively associated with individual-level and community-level economic deprivation. 28 More broadly, scholars have argued that the standards and procedures used to determine who should be considered for involuntary hospitalization "reinforce the systems, structures, practices, and policies of structural oppression and white supremacy."…”

Section: States' Legal Authority To Involuntarily Commitmentioning

confidence: 99%

“…It should not be surprising that the risks associated with involuntary commitment are not spread equally among all segments of society. Individuals who identify as Black, multiracial, or another race other than White are significantly more likely to be subjected to involuntary psychiatric hospitalization than those who identify as White 27 . The risk of being involuntarily hospitalized is also positively associated with individual‐level and community‐level economic deprivation 28 .…”

Section: Benefits and Risks Of Involuntary Commitmentmentioning

confidence: 99%

Holding the Guardrails on Involuntary Commitment

Coleman

2024

Hastings Center Report

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In response to the increasing number of mentally ill people experiencing homelessness, some policy‐makers have called for the expanded use of involuntary commitment, even for individuals who are not engaging in behaviors that are immediately life‐threatening. Yet there is no evidence that involuntary commitment offers long‐term benefits, and significant reasons to believe that expanding the practice will cause harm. In addition, these proposals ignore research showing that most people with mental illness have the capacity to make medical decisions for themselves. Rather than expanding the use of involuntary commitment, policy‐makers should support approaches proven to decrease the prevalence of homelessness, such as supportive housing. In addition, states should reevaluate their commitment standards for persons who pose no risk of harm to others. One promising approach is Northern Ireland's Mental Health Capacity Act of 2016, which establishes a uniform standard for imposing nonconsensual health care interventions, without any distinction between mental illnesses and other conditions in which capacity might be compromised.

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Racial and Ethnic Inequities in Inpatient Psychiatric Civil Commitment

Cited by 16 publications

References 25 publications

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

How Inpatient Psychiatric Units Can Be Both Safe and Therapeutic

Holding the Guardrails on Involuntary Commitment

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