How Many People Are Subjected to Involuntary Psychiatric Detention in the U.S.? First Verifiable Population Estimates of Civil Commitment

Background/Purpose: All states employ involuntary psychiatric detentions, yet the number of people detained nationally has never been reliably estimated. For Miller and Hanson, “Given the loss of liberty, the personal distress, and the stigma involved, this lack of data is astounding” (Committed, Johns Hopkins U Press, 2016, p. xvii). To inform public discussion, we aimed to provide population-based estimates of how many people in the U.S. in 2013-2015 were subjected to civil (non-criminal) emergency detentions for diagnosis or examination (≤ 3 days) and subsequent court-ordered inpatient commitments (4 days ≥ 1 year, renewable).

Methods: Between 04/2014–02/2018, we identified, examined, and extracted data from three national databases: State Profile System of National Association of State Mental Health Program Directors’ National Research Institute (NRI, using data provided by some states); FBI’s National Instant Criminal Background Check System (NICS), gathering states’ data on people prohibited from purchasing firearms under the Gun Control Act of 1968, including people “adjudicated as a mental defective” or “committed to a mental institution”; and SAMHSA’s National Mental Health Services Surveys of all U.S. mental health facilities in 2010 and 2014. Via Internet searches and contacting officials, we identified eight states (comprising 35 percent of the U.S. population) releasing yearly counts of psychiatric detentions (California, Texas, Florida, Virginia, Massachusetts, Colorado, Connecticut, Vermont). We extrapolated from these states to the U.S. and calculated rates of emergency detention per 100,000 using U.S. Census Bureau’s 1-Year Estimates. Each author extracted data from each source, both authors corrected errors.

Results: Across the eight states, 477,419, 496,752, and 442,107 people in 2013-2015, respectively, were detained on emergency, extrapolating to the country as 1.39, 1.44, and 1.27 million, with longer civil commitments (extrapolated from five states reporting) for 381,950, 381,400, and 174,500 people, respectively. The rate of emergency detentions for all ages varied between 2013-2015: 439, 450, and 396 per 100,000 individuals.

Neither national database allowed reaching conclusions about the prevalence of civil commitment. NRI’s state-level data was incomplete and inconsistent with published counts from the eight states. NICS’ 5,226,026 active “mental health” records as of 1/31/2018 did not separate adjudications from commitments and gave no dates for either. SAMHSA reported only 1-day point prevalence estimates of patients’ legal status, unusable for annual estimates.  

Conclusions/Implications: Until this first verifiable estimate, calls to increase or decrease recourse to involuntary commitment occurred in a data vacuum. Astonishingly, rates approach those for admittedly longer criminal imprisonment (1.52 million, 458 per 100,000 in 2015), which has abundant yearly data. Large drops in California numbers alone account for the prevalence drop between 2014-2015. Obvious need exists for research and efforts from concerned agencies to monitor commitments and other involuntary treatment procedures and report comparative data. States with yearly reports should be commended, other states should be studied to understand why they do not release figures regarding such major rights-restrictive procedures. Our results also signal the much more important absence of population-based data on outcomes of civil commitment.