“….By their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness…”

Emergency and involuntary psychiatric holds exist to protect individuals in mental health crises and to ensure the public’s safety. At least, that’s the intention. The reality of addressing psychiatric and mental health concerns rarely aligns with this conceptual approach.

Imagine that you are held against your will and subjected to a battery of tests, treatments, and medications that you did not consent to. It sounds like a violation of civil and human rights because it is unless these acts fall within the carefully crafted loophole of involuntary commitments and psychiatric holds.

This isn’t to say that forced treatment is never necessary or that committing someone against their will is always a gross overstep. The truth is that emergency psychiatric treatment is a lifesaver for many people. The estimated number of emergency psychiatric holds that are placed each year in the United States is somewhere around 1 million. To say that all of those are unwarranted would be absurd.

Involuntary commitment is sometimes the right choice, but it should not be treated as the only choice or the default in every situation, and therein lies the issue.

   
   
   
How Far Has Mental Health Treatment Come?

It is no secret that society’s history involving the care and treatment of people with mental illness is deplorable. The horrifying conditions that these vulnerable individuals were subjected to in the past stand in stark contrast to today’s standards of care. Or do they? While lobotomies may be a thing of the past, there are still many barbaric and inhumane practices that continue to plague the world of mental health treatment.

The United States has a long history of forced sterilization among populations considered undesirable, and people with actual and alleged mental illness were among those groups. Dozens of states still have laws that allow the forced sterilization of people with disabilities. In fact, in 2022, only two states — Alaska and North Carolina — had laws that explicitly banned this form of eugenics.

Psychiatrists and mental health facilities also continue to use electroshock procedures. Electroconvulsive therapy (ECT), often referred to as electroshock therapy, has been administered to psychiatric patients since the 1930s. A study conducted in 1951 found that people who had been treated with ECT had worse outcomes than those who had not received ECT. Suffice it to say that medical treatments of any kind would make significant strides toward increased efficacy after nearly a century of use, but ECT continues to be controversial at best.

The World Health Organization and the United Nations issued guidance on the use of ECT and how governments should approach legislation involving this treatment. Their recommendation is that ECT should never be performed without the patient’s consent, nor should it be used on children or adolescents. Research published in the Ethical Human Psychology and Psychiatry journal claims that the risks outweigh the benefits and that the use of ECT should be suspended immediately. The Citizens Commission on Human Rights also disagrees with the continued use of ECT therapy and has called for a ban on the procedure.

Despite damaging side effects like brain damage and a lack of conclusive evidence that ECT works, mental health practitioners in the United States continue to use this treatment.

   
The Harm in Involuntary Commitment and Temporary Psychiatric Holds

Another relic of psychiatric approaches from the past is the involuntary commitment of people with mental illness and disabilities. Holding someone involuntarily presents significant legal implications and human rights violations. Despite states making their own laws and regulations governing involuntary commitment, there are Constitutionally protected rights at risk. The U.S. Congress outlines how psychiatric holds impact a patient’s Fourteenth Amendment right of due process, which grants protection against laws that limit a person’s life, liberty, or property. Congress has established that involuntary commitments and forced outpatient treatment can constitute a deprivation of a patient’s rights in some situations.

To reiterate, involuntary commitment can be the safest option for some people who are experiencing a mental health crisis. The issue is that the process for determining who will benefit and who will not is deeply flawed.

Reform is overdue. People with mental disorders continue to be ignored, discriminated against, and abused in a system that was never created to respect them.

When bias and discrimination permeate the fabric of the system, how can the outcomes be trusted? In other words, if the rights of people with mental illness are disregarded, can they really be expected to benefit from whatever decisions are made on their behalf? According to researchers at the University of California, the answer to this question is no. Their study found that forced hospitalization for psychiatric concerns is harmful, and people who are involuntarily committed or hospitalized are more likely to experience suicidality after being released. Despite the prevalence of patients reporting feeling humiliated, violated, and dehumanized by coerced treatment and involuntary commitment, it continues to be an allowed practice in all 50 states.

The fear and stigma associated with mental health diagnoses have a negative impact on the care that psychiatric patients receive during involuntary commitments. Rather than protecting these individuals and creating a safe space for them during their time of need, forced inpatient hospitalization often has an unfavorable outcome.

   
Involuntary commitment perpetuates the fallacy that mental health patients are dangerous. This harmful misconception does little to improve the quality of care these patients receive during their mandatory stays.

Many patients report being traumatized by the restraint and control imposed upon them by hospital staff. Further, around 31% of psychiatric patients report they experienced physical assault during their hospitalization, with 8% reporting sexual assault and more than 50% having witnessed a traumatic incident. These numbers only represent the patients who reported their experiences, which is likely the minority.

The negative impact of involuntary psychiatric treatment extends far beyond the direct consequences of commitment, and it includes repercussions involving voting rights, gun ownership, and the ability to testify in court hearings.

Being branded as someone with a psychiatric disorder or mental illness does not carry the same damaging weight it once did, but the burden is still felt heavily by the many people victimized by involuntary commitments.