Rates of civil commitment vary widely across the country, with nine states and the District of Columbia (D.C.) reporting significant increases from 2010 to 2022, according to a survey study published today in Psychiatric Services. No states showed a significant decrease.
Civil commitment, a legal process whereby individuals experiencing mental or substance use disorders are involuntarily detained in a psychiatric hospital for treatment, is governed by state laws, with substantial variation in how states collect and report civil commitment data. “This lack of standardization limits the ability to draw firm conclusions about national trends or about cross-state comparisons,” wrote Mustafa Karakus, Ph.D., of Westat, and colleagues.
Using systematic website searches and direct outreach to state mental health authorities (SMHAs) and court systems, the researchers obtained data on civil commitment rates between 2010 and 2022 for 32 states and D.C. Of the 18 states where no data was available, staff from seven SMHAs or state courts reported that no state office was currently tracking the number of civil commitments in their state. For the remaining 11 states, the online search yielded no data and the study team received no responses to outreach attempts.
Across the 32 states and D.C., there were an average of 213.84 involuntary civil commitments per 100,000 population. Rates ranged from 13.50 per 100,000 population in Tennessee to 875.98 per 100,000 in Florida. Rates reported by SMHAs were significantly higher than rates obtained from state court data.
“Such stark differences likely did not reflect true underlying differences in need or use of civil commitment but rather appeared to be largely driven by variation in how states collect, define, and manage their data on civil commitments,” Karakus and colleagues wrote.
The overall rate of civil commitment increased by an average of 3.78 per 100,000 population each year between 2010 and 2022; nine states plus D.C. were statistically above this average, led by Colorado with an annual increase of 16.01 civil commitments per 100,000 population.
The researchers said that the findings underscore the need for consistent and transparent reporting standards. “Improved data collection would also create opportunities to better understand contributing and explanatory factors and to identify best practices,” they wrote. “These practices include determining when and for whom civil commitment is most appropriate and designing care plans aimed at safely reducing lengths of stay and preventing involuntary inpatient readmission.”
For related information, see the Psychiatric News article “States Paint Complex Picture of Civil Commitment for Dementia.”
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