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

摘要 非自愿承诺（IVC）-也称为非自愿民事承诺或民事承诺-是一种法律的 一个人被认为有伤害自己或他人的紧迫危险， 法院接受治疗的严重精神疾病或物质使用。该过程通常在以下情况下开始 利益相关方-通常是家庭成员，医务人员或执法人员（LE）-向法院请愿， 开个治疗的单子如果有关人员尚未接受医疗护理，LE将逮捕 社区中的人（我们称之为LE-IVC）并运送到当地急诊科， 评价如果医务人员认为该人确实有伤害自己或他人的危险， 开始治疗。对于那些启动LE-IVC的人来说，该机制可以被视为保护 个人和公共安全。同时，LE-IVC的极端性质-逮捕来自 社区，剥夺他们的自主权，并强迫他们接受治疗-提出了道德和实际的 关于政府在人们生活中的作用的问题;患者对IVC后治疗的看法， 供应商和执法;以及IVC对自我伤害，过量和伤害他人风险的影响。这些 在历史上和目前的种族歧视和不平等的背景下， 在美国南部，包括黑人和医疗机构之间有时令人担忧的关系， 社区和执法部门。此外，黑人被警察杀害的高调事件已经引起了人们的关注。 担心他们在因LE-IVC被捕时可能面临特别的受伤风险。然而，许多 LE-IVC的使用和相对有效性的种族差异仍然未知。作为回应，我们 建议评估不同种族LE-IVC的发病率、结局和经历的差异， 主要关注黑白差异。在北卡罗来纳州，一个南方的大州，我们将全州范围的 数据（2017-2022年）的急诊科就诊，住院，逮捕和死亡，以及收集 定性访谈数据，以实现以下目标：1）描述全国范围内的趋势，在LE-IVC的种族 以及其他社会人口统计学和社区特征; 2）检查过量风险的种族差异， 自我伤害，并在LE-IVC后实施攻击; 3）探索黑人和白色患者及其家人 成员对LE-IVC的看法。LE-IVC在延续种族差异方面的作用在很大程度上仍然是 没有地址我们的研究将告知公共卫生领导人，行为健康从业者，执法部门， 和患者群体关于LE-IVC的使用和后果及其可能影响种族差异的作用 在卫生保健的获取和结果。我们的研究结果还将为正在进行的公众讨论提供信息， 在种族不平等的背景下，平衡公共卫生干预与个人自主。更尖锐地说， 调查结果将有助于辩论执法是否以及如何参与行为 卫生干预措施。

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.