Involuntary commitments to public mental institutions: Issues involving the overrepresentation of Blacks and assessment of relevant functioning.

Abstract

This article contributes to the debate in the mental health and legal systems concerning involuntary commitments to mental hospitals. The focus is on issues involving the overrepresentation of Black people among adults committed to U.S. public mental institutions and issues involving the assessment of relevant behavioral functioning in particular. Empirical findings, legal principles and procedures, and methodological limitations are reviewed to identify problems in current practice and relevant evidence bearing on those problems. Special emphasis is placed on the possible explanations for the overrepresentation of Blacks and on dependable assessments of relevant functioning that are needed to justify the state's coercive power to involuntarily confine people, regardless of race. The article concludes with a summary and recommendations for research and practice.

Unemployment and civil commitment: a test of the intolerance hypothesis

“…Minority persons, especially men [Hacker, 1995], with severe mental illness reportedly fall into this category [Garland et al, 1998;Lindsey and Gordon, 1989;Rosenfeld, 1984;Snowden, 1999].…”

Culture and DSM-IV: Diagnosis, knowledge and power

“…Although the full implications of these data are not known, the inappropriate prescription of some medications (such as neuroleptics) and the failure to prescribe potentially effective medications (such as antidepressants) appears to be all too common. Misdiagnosis is almost certainly associated with inordinately high rates of involuntary confinement of African American men and with poor care in outpatient settings, inpatient units, and substance abuse treatment centers (see Lindsey andPaul 1989, Nordhoff andBates 1989). If the evidence that supports these claims is indeed valid, the cultural gulf between many clinicians and their clients, a divide formalized in apparently trivial issues of wording in the DSM, may turn out to be very crucial for the integrity of psychiatric practice.…”

Reducing Disparities in Mental Health Care: Suggestions from the Dartmouth–Howard Collaboration

“…Barrio and colleagues (Barrio et al 2003) found that, among patients with schizophrenia, the use of case management services was significantly lower among African Americans and Latinos compared to Euro-Americans. Among African Americans with severe mental illness who do receive services, there is also a greater likelihood of being involuntarily hospitalized, using crisis services, entering emergency treatment through law enforcement, and dropping out of treatment than EuroAmericans (Rosenhan 1984;Lindsey and Paul 1989;USDHHS 2001;Snowden 2001;Jarvis et al 2005;Barnes 2004;Snowden 2007;Atdijan and Vega 2005). These findings have persisted for decades and the situation does not appear to be improving (Hu et al 1991;Snowden and Cheung 1990).…”