Racial Disparities in Involuntary Psychiatric Admissions: Ensuring Justice in the Balance between Patient Autonomy and Safety

Abstract: When patients pose a threat to self or others, involuntary psychiatric admissions further safety at the expense of autonomy. Recognizing the long history of structural racism in both mental health care and the American legal system, discussions of such involuntary commitment must address race and racism. Despite increasing attention to the pathologization of cultural differences with misdiagnosis and coercive treatment of Black patients, little is known about racial inequities in state civil commitment systems. We address this gap with a retrospective chart review of involuntary psychiatric admissions at a large academic psychiatric hospital in the South. In preliminary analyses of 5,725 patients between 2014 and 2020, non-white patients were significantly more likely to be admitted involuntarily (37.7% vs 30.0%, p< 0.01). Additional work is in progress to assess the role of age, sex, discharge diagnosis, and insurance status. As medicine and society seek to reconcile the humanity of psychiatric patients with limitations in capacity and insight, bioethics must question the disproportionate, burdensome consequences for patients of color. Informed by these data, we advocate for more just civil commitment policies to limit disparities and provider/system bias in involuntary psychiatric admissions.

Bethany Bruno, MD, MA – Resident Physician, Obstetrics & Gynecology, Medical University of South Carolina; Bryan Tolliver, MD, PhD – Associate Professor, Psychiatry & Behavioral Sciences, Medical University of South Carolina