Examining racial disparities in fatal overdose, self-harm, and perpetrating assaults following law enforcement-mediated involuntary commitment

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Abstract Involuntary commitment (IVC)—also known as involuntary civil commitment or civil commitment—is a legal procedure in which a person thought to be at imminent risk of harming themselves or others is mandated by the courts to receive treatment for serious mental illness or substance use. The process typically starts when interested parties—often family members, medical personnel, or law enforcement (LE)—petition the court to issue an order for treatment. If the person of concern is not already in medical care, LE will apprehend the person in the community (which we refer to as LE-IVC) and transport to a local emergency department for evaluation. If medical personnel deem that the person is indeed at risk for harm to self or others, mandatory treatment is initiated. For those initiating LE-IVCs, the mechanism may be viewed as a ‘last resort’ in protecting individual and public safety. At the same time, the extreme nature of LE-IVCs—apprehending people from the community, depriving them of their autonomy, and forcing them to receive treatment—raises ethical and practical questions about the government’s role in peoples’ lives; patients’ post-IVC perceptions of treatment, treatment providers, and law enforcement; and the impact of IVC on risk of self-harm, overdose, and harming others. These issues take on added complexity within the context of historic and ongoing racial discrimination and inequalities in the US South, including the sometimes fraught relationships between Black persons and both the medical community and law enforcement. Further, the high profile incidents of Black people killed by police has raised concerns that they may be at particular risk for injury when being apprehended for a LE-IVC. Nevertheless, much remains unknown about racial differences in the use and relative effectiveness of LE-IVCs. In response, we propose to assess differences in the incidence, outcomes, and experiences of LE-IVCs across racial groups, focusing primarily on Black-White differences. In North Carolina, a large southern state, we will link statewide data (2017-2022) for emergency department visits, inpatient hospital stays, arrests and deaths, as well as gather qualitative interview data to accomplish the following aims: 1) To describe statewide trends in LE-IVCs by race and other socio-demographic and community characteristics; 2) To examine racial disparities in risk of overdose, self-harm, and perpetrating assaults following a LE-IVC; 3) To explore Black and White patients’ and family members’ perspectives on LE-IVCs. The role of LE-IVCs in perpetuating racial disparities remains largely unaddressed. Our research will inform public health leaders, behavioral health practitioners, law enforcement, and patient groups about the use and consequences of LE-IVCs and its possible role impacting racial disparities in health care access and outcomes. Our study findings will also inform ongoing public discussions about balancing public health interventions with individual autonomy in the context of racial disparities. More pointedly, findings will contribute to debates regarding whether and how law enforcement should participate in behavioral health interventions.