Involuntary psychiatric holds were more commonly associated with minors diagnosed with psychosis (OR 3.63, 95% CI 2.43-5.44), substance misuse (OR 1.87, 95% CI 1.05-3.30), and intellectual disability (OR 3.33, 95% CI 1.33-8.34).
Perceived risk of harming oneself or others was also related to roughly double the occurrence of involuntary hospitalization, reported Susan Walker, MRCPsych, of University College London, and colleagues in The Lancet Child & Adolescent Health.
The study also found associations between involuntary hospitalizations and being 12 years or older (OR 3.57, 95% CI 1.46-8.73) and being a Black child or adolescent (OR 2.72, 95% CI 1.88-3.95).
However, researchers noted that only seven of the 23 studies included in the systematic review from 11 different countries in Europe and North America mentioned the ethnicity of children and teenagers who were detained against their will, as compared to a 2019 systematic review of compulsory psychiatric detention among adults that included 71 studies detailing racial and ethnic disparities.
This, the authors wrote, is just one more piece of information that can be added to the already confusing puzzle of discrepancies in the existing research on the role that race plays in youth mental health treatment. Although previous research from both the U.K. and the U.S. has shown higher rates of mental health reports and diagnoses among Black youth, studies have shown that “young people from Black and minority ethnic groups are more likely than young people from White ethnic groups to be referred to mental health services via the criminal justice system or social care, rather than through less coercive routes, such as a family doctor,” researchers stated.
The limited amount of literature containing detailed demographic data on involuntary psychiatric hospitalizations in youths was acknowledged by the authors as a major limitation to their review.
Nev Jones, PhD, an assistant professor of mental health law and policy at the University of South Florida who was not involved in this study, echoed the same concerns, cautioning readers not to overlook the serious lack of adequate information on this issue, specifically in the U.S. It should also be noted that both American studies included in this recent meta-analysis were published over a decade ago, one from 1995 and another from 2010.
“It’s very questionable to what extent we would want to generalize any finding from outside the U.S. to the U.S. because of our fragmented healthcare system,” Jones told MedPage Today, emphasizing that even the most basic demographics aren’t available to researchers in the U.S., and laws on involuntary psychiatric holds for children and teenagers varies by state. “It’s very hard without centralized, state-level data collection to get a reliable picture of what’s happening here.”
There are 25 states in the U.S. that have publicly available data on psychiatric commitments; only five of those states have released any figures on youths, according to professor David Cohen, PhD, of the University of California Los Angeles’ Luskin School of Social Work.
Certain states like Florida, though, are collecting and sharing more detailed demographic data about the children and adults who have been involuntarily committed under the Baker Act. Studies on this data have shown that the Baker Act is used disproportionately more frequently on Black children; a report from the Southern Poverty Law Center cited that 25% of all children who were Baker Acted in Florida between 2016-2017 were Black, even though Black youth make up 15% of the state’s under-18 population.
Jones expressed hope that, with the collection and publicization of more detailed data on involuntary psychiatric hospitalizations among children and adolescents, researchers will also be able to learn more about the widespread impact these detentions have on minors. In her own qualitative research on this subject, many of the youth she interviewed described being so traumatized by their experiences of being held involuntarily that they would lie to their parents and healthcare providers about any future suicidal feelings so as to not be sent back.
“Even to see that in the majority of that qualitative sample of 40 was very disturbing,” Jones said. “But we have to know if that would hold across a larger sample.”