Citation

Swartz MS. Psychiatr. Serv. 2020; 71(12): e1211.

Copyright

(Copyright © 2020, American Psychiatric Association)

DOI

10.1176/appi.ps.711202

PMID

unavailable

Abstract

This month's report by Feeney et al. (1) from Dublin, Ireland, documents the rising proportion of involuntary commitments initiated by law enforcement. Although not the focus of the study, the finding of rising law enforcement involvement in involuntary commitment is a disturbing trend, which is likely underestimated if law enforcement transport during involuntary commitment is also considered. At a critical time when stakeholders in the United States are rethinking the role of law enforcement as first responders, a focus on civil commitment is clearly overdue. People from racial-ethnic minority groups, the authors point out, are more likely than nonminority whites to access mental health services through law enforcement involvement, and in the United States there are persistent racial-ethnic disparities in such involvement and in involuntary commitment. Specifically, people who are Black are far more likely to access services via involuntary commitment. As the field struggles with addressing systemic racism, a tangible first step is to commit to minimize law enforcement involvement in mental health crises and involuntary commitment. When law enforcement officers are the first responders in a large proportion of mental health crises, something has badly gone awry. And, as recently documented by the Treatment Advocacy Center, law enforcement members spend considerable time in commitment transport. When clinicians involuntarily commit patients in order to obtain cheap and secure transportation by law enforcement, racial justice is implicitly sacrificed on the altar of cost containment and defensive medicine. To be concrete: a key performance measure for state and local mental health authorities should be the proportion of mental health crises that rely on law enforcement.

Law enforcement encounters with persons of color during involuntary civil commitment all too often lead to violence. With the exception of crisis intervention training, police and law enforcement receive scant training in working with persons with mental illness, and because of racial discrimination, stigma, poverty, and lack of insurance coverage, persons of color are disproportionately subjected to involuntary civil commitment. Reducing law enforcement encounters with persons of color under commitment is achievable and is one tangible step toward reducing potentially tragic law enforcement interactions...

Language: en