The Allegheny County Department of Human Services (DHS) conducted a study of the involuntary hospitalization program in the county. Involuntary hospitalizations occur when an individual undergoing a psychiatric episode is deemed to be a clear and present danger to themselves or others. The specific section that governs the intake process of an individual is Section 302 of the Mental Health Procedures Act (MHPA), and for that reason the entire program is sometimes called the 302 program.
Evaluations occur in a hospital setting. Following an upheld commitment individuals can initially be detained for up to 120 hours, with the potential for extensions. The county seeks to understand the system in detail and improve outcomes among individuals who go through this process.
What is this report about?
This report describes individuals who went through the involuntary hospitalization program from 2015-2022. The analysis profiles the individuals including their characteristics such as diagnosis, their usage of mental and behavioral health services, and their outcomes post release.
What are the takeaways?
- Involuntary hospitalizations are common, affecting over 3,700 residents each year. The most common source of referrals occur from friend / family (43%), police officers (19%), and physicians (14%).
- Individuals who are involuntarily hospitalized have poor outcomes upon release—within 5 years of their first evaluation, fully 20% of the population has died, a rate that is higher than that for clients exiting jail, enrolling in homeless shelters, or receiving food assistance (SNAP) as well as the rate for individuals with severe mental illness (SMI) diagnoses.
- We find worse outcomes among 302 individuals with a pre-existing substance use disorder (SUD)— 5% of those with SUD 18–50 years of age die within two years of intake, compared to 2.5% of the 18–50-year-olds without SUD. Of those with SUD, eighty percent (60%) of the mortality rate is attributable to drug overdose.
- We found similarly elevated risks for other adverse outcomes. Over 23% were charged with a crime within 5 years of release, and 60% used an emergency department (ED) within one year of release.
- Statistical methods can distinguish between riskier and less risky clients with high fidelity at the moment of the 302 evaluation.
- Those petitioned for involuntary commitment were disproportionately Black, although petition-upheld rates are similar across race. A similar picture emerges for gender—men were more likely to be petitioned, but upheld rates at the point of exam were similar for men and women.
How is this report being used?
The report serves as an initial analysis into the involuntary hospitalization process. The county is using this analysis, as well as planned subsequent ones that look at the impact of an involuntary hospitalization on a person’s outcomes, and input from clinicians and community members to develop recommendations to improve care for this vulnerable population. Ultimately the county is looking to improve both the process and the outcomes for individuals who experience an involuntary hospitalization.