Evidence on Involuntary Behavioral Health Treatment

Meta-Analyses Findings on Efficacy

Evidence synthesis on coercion in mental health: An umbrella review (2024

Contradictions arise when studying coercion as a phenomenon. The physical and emotional consequences of coercive measures are well known, but the prevalence of their use remains high or unclear in all population groups. The dilemma faced by professionals in their clinical practice while trying to find a balance between the ethical principles of beneficence and maleficence is patent. Finally, a system that regulates certain coercive practices while increasing the pressure to reduce them is necessary.[i]

Compulsory community and involuntary outpatient treatment for people with severe mental disorders (2017)

Results from the trials showed overall Compulsory Community Treatment (CCT) was no more likely to result in better service use, social functioning, mental state or quality of life compared with standard 'voluntary' care. People in the trial receiving CCT were less likely to be victims of violent or non-violent crime[1][ii]

Containment strategies for people with serious mental illness (2006)

Current non-pharmacological approaches to containment of disturbed or violent behavior are not supported by evidence from controlled studies. Clinical practice is based on evidence that is not derived from trials and continued practice entirely outside of well designed, conducted and reported randomized studies is difficult to justify.[iii]

Taking an Evidence-Based Approach to Involuntary Psychiatric Hospitalization (2023)

Policy makers across the United States are seeking to expand use of involuntary hospitalization, including broadening civil commitment criteria for people with mental disorders, as well as people with substance use disorders. Accordingly, the importance of systematically monitoring, studying, and improving involuntary hospitalization practices has become even more relevant. Despite the controversies surrounding involuntary psychiatric hospitalization, many would likely agree that its use should be limited as a last resort when all other options have run out. Whether or not research-based methods can ultimately answer every question about involuntary psychiatric hospitalization, it remains clear that far too many questions remain unexplored.[iv]

  Effectiveness of Community Treatment Orders; The International Evidence (2016)

There is no evidence of patient benefits from current CTO outcome studies.  This casts doubt over the usefulness and ethics of CTOs.[v]

Involuntary Treatment for Adult Nonoffenders With Substance Use Disorders? (2023)

Evidence for the involuntary treatment of adult nonoffenders with SUD suggests limited benefits, with voluntary treatment consistently outperforming involuntary treatment. The use of involuntary treatment for SUD would likely require special legislation, the development of designated treatment sites, and extensive aftercare programming that may not justify the costs and potential ethical and legal issues. Resources likely would be better directed towards expanding voluntary treatment options.[vi]

Significant Research Findings

Pathways to Mental Health Services and Perceptions about the Effectiveness of Treatment (2018)

Persons who independently sought mental health care were more likely to rate treatment as effective compared to persons ordered into care. Among people with severe mental illnesses, the probability of rating treatment as effective is lowest among those who were ordered into care. Entry into mental health care is not sufficient for closing the treatment gap if coerced care leads to poorer quality outcomes.[vii]

Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care (2021)

Three quarters of the youth reported negative impacts of Involuntary Hospitalization on trust, including unwillingness to disclose suicidal feelings or intentions. Selective non-disclosure of suicidal feelings was reported even in instances in which the participant continued to meet with providers following discharge. Factors identified as contributing to distrust included perceptions of inpatient treatment as more punitive than therapeutic, staff as more judgmental than empathetic, and hospitalization overall failing to meet therapeutic needs.[viii] 

Racial and Ethnic Inequities in Inpatient Psychiatric Civil Commitment (2022)

Patients of color were significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization, and Black patients and patients who identified as other race or multiracial were particularly vulnerable, even after adjustment for confounding variables[ix].

  How shortcomings in the mental health system affect the use of involuntary community treatment orders (2016)

The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation.[x]

The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders (2021)

Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks.[xi]

Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms? (2022)

In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment—the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalize proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.[xii]