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--是一种法律形式。 被认为有伤害自己或他人的迫在眉睫的危险的人由 法院有权接受严重精神疾病或药物滥用的治疗。该过程通常在以下情况下开始 利害关系方-通常是家庭成员、医务人员或执法部门(LE)-向法院请愿 下达治疗命令。如果受关注的人尚未接受医疗护理，LE将逮捕 社区中的人员(我们称为LE-IVC)并将其送往当地急救部门 评估。如果医务人员认为此人确实存在伤害自己或他人的风险，则强制 治疗开始了。对于那些发起LE-IVC的人来说，该机制可以被视为保护的“最后手段” 个人和公共安全。与此同时，LE-IVCS的极端性质--从 社区，剥夺他们的自治权，强迫他们接受治疗--提高了道德和实用性 关于政府在人们生活中的作用的问题；患者在下腔静脉手术后对治疗、治疗的看法 提供者和执法；以及IVC对自我伤害、过量用药和伤害他人风险的影响。这些 在历史上和正在进行的种族歧视和不平等的背景下，问题变得更加复杂 在美国南部，包括黑人和医生之间有时令人担忧的关系 社区和执法部门。此外，备受瞩目的黑人被警察杀害的事件也引发了 担心他们在因LE-IVC被捕时可能面临特别的受伤风险。尽管如此，很多 关于LE-IVCs的使用和相对有效性的种族差异仍不清楚。作为回应，我们 建议评估不同种族群体LE-IVC的发生率、结果和经历的差异， 主要关注黑人和白人的差异。在南部大州北卡罗来纳州，我们将在全州范围内连接 2017-2022年急诊科就诊、住院、逮捕和死亡数据，以及收集 定性访谈数据以实现以下目标：1)按种族描述全州范围内的LE-IVC趋势 和其他社会人口和社区特征；2)检查过量用药风险的种族差异， 自我伤害，以及在LE-IVC之后实施攻击；3)探索黑人和白人患者及其家人 成员对LE-IVC的看法。LE-IVC在维持种族差异方面的作用在很大程度上仍然存在 未寻址。我们的研究将向公共卫生领导人、行为健康从业者、执法部门、 和患者群体关于LE-IVCs的使用和后果及其可能影响种族差异的作用 在卫生保健机会和结果方面。我们的研究结果也将为正在进行的公众讨论提供信息 在种族差异的背景下，平衡公共卫生干预与个人自主权。更有针对性的是， 调查结果将有助于关于执法部门是否以及如何参与行为的辩论 健康干预。

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.