Article

Racial Disparities In Involuntary Outpatient Commitment: Are They Real?

Psychiatry and Behavioral Sciences, Duke University School of Medicine in Durham, North Carolina, USA.
Health Affairs (Impact Factor: 4.97). 05/2009; 28(3):816-26. DOI: 10.1377/hlthaff.28.3.816
Source: PubMed

ABSTRACT

In this paper we explore racial disparities in outpatient civil commitment, using data from Kendra's Law in New York State. Overall, African Americans are more likely than whites to be involuntarily committed for outpatient psychiatric care in New York. However, candidates for outpatient commitment are largely drawn from a population in which blacks are overrepresented: psychiatric patients with multiple involuntary hospitalizations in public facilities. Whether this overrepresentation under court-ordered outpatient treatment is unfair depends on one's view: is it access to treatment and a less restrictive alternative to hospitalization, or a coercive deprivation of personal liberty?

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Available from: John Monahan, Aug 27, 2014
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    • "Moreover, some research suggests that pathways into treatment may differ for African Americans compared to Whites regardless of severity of use. Interactions with the criminal justice system (Swanson et al., 2009; LeCook and Alegria, 2011) and other public services such as Medicaid are possible mechanisms by which African Americans are more likely to obtain treatment than other groups. One study found African Americans were more likely to be referred to treatment when reporting alcohol use to social services systems, regardless of the individual's alcohol consumption (Dobscha et al., 2009). "
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    ABSTRACT: Background: Life course theory emphasizes the need to examine a wide variety of distal factors along with proximal factors, longitudinally. Yet research on who obtains substance use treatment is generally cross-sectional and limited to examining developmentally proximal factors (e.g., substance use severity) and demographic factors. Methods: To investigate treatment within a life-course framework, we studied 522 drug and/or alcohol users from a community cohort of African Americans followed prospectively from age 6. Developmentally distal factors of childhood and adolescent social behavior, family environment, academic achievement, mental health, and substance use along with the key proximal factors of substance use severity and socioeconomic status were examined using regression analyses to assess their impact on obtaining adult substance use treatment. Results: One-fifth of the study population obtained treatment for substance use by age 32 (20.5%). Although adult socioeconomic status was not associated with substance use treatment in adulthood in the multivariable model, the proximal factor of substance use severity was a strong predictor of obtaining substance use treatment, as expected. After including several developmentally distal factors in the model, childhood aggression also had an independent effect on adult substance use treatment, above and beyond substance use severity. Conclusions: These findings emphasize the importance of using a life course framework when exploring predictors of treatment; early life characteristics are important influences beyond the more proximal factors in adulthood. Research should continue to take a life course approach to better understand pathways to substance use treatment.
    Full-text · Article · Sep 2014 · Drug and Alcohol Dependence
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    • "For over two decades there has been concern about the large number of people from Black and ethnic minority (BME) groups being compulsorily detained for psychiatric treatment in UK, Europe and America (Claassen et al. 2005; Compton et al. 2006; Lay et al. 2007; Singh et al. 2007; Swanson et al. 2009; Vinkers et al. 2010). This excess has been observed for both civil (Bebbington et al. 1994; Davies et al. 1996; Singh et al. 1998; Burnett et al. 1999; Morgan et al. 2005; Lawlor et al. 2012) and forensic detentions (Dunn & Fahy, 1990; Banerjee et al. 1995; Maden et al. 1999) and has been confirmed in several reviews, which have also found inter-and intra-ethnic variations in detention rates between different BME groups and between first-episode and chronic disorders (Churchill et al. 1999; Bhui et al. 2003; Morgan et al. 2004; Singh et al. 2007). "

    Full-text · Article · Mar 2014 · Psychological Medicine
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    • "For over two decades there has been concern about the large number of people from Black and ethnic minority (BME) groups being compulsorily detained for psychiatric treatment in UK, Europe and America (Claassen et al. 2005; Compton et al. 2006; Lay et al. 2007; Singh et al. 2007; Swanson et al. 2009; Vinkers et al. 2010). This excess has been observed for both civil (Bebbington et al. 1994; Davies et al. 1996; Singh et al. 1998; Burnett et al. 1999; Morgan et al. 2005; Lawlor et al. 2012) and forensic detentions (Dunn & Fahy, 1990; Banerjee et al. 1995; Maden et al. 1999) and has been confirmed in several reviews, which have also found inter-and intra-ethnic variations in detention rates between different BME groups and between first-episode and chronic disorders (Churchill et al. 1999; Bhui et al. 2003; Morgan et al. 2004; Singh et al. 2007). "
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    ABSTRACT: There has been major concern about the 'over-representation' of Black and ethnic minority groups amongst people detained under the Mental Health Act (MHA). We explored the effect of patient ethnicity on detention following an MHA assessment, once confounding variables were controlled for. Method Prospective data were collected for all MHA assessments over 4-month periods in the years 2008, 2009, 2010 and 2011 each in three regions in England: Birmingham, West London and Oxfordshire. Logistic regression modelling was conducted to predict the outcome of MHA assessments - either resulting in 'detention' or 'no detention'. Of the 4423 MHA assessments, 2841 (66%) resulted in a detention. A diagnosis of psychosis, the presence of risk, female gender, level of social support and London as the site of assessment predicted detention under the MHA. Ethnicity was not an independent predictor of detention. There is no evidence for that amongst those assessed under the MHA, ethnicity has an independent effect on the odds of being detained.
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