Session: Scrutinizing Involuntary Hospitalizations and Coercion in Mental Healthcare
Ethical Considerations Surrounding Involuntary Hospitalization: Dissecting New York City's Involuntary Commitment Plan for Mental Health
Saturday, October 14, 2023
9:00 AM – 10:15 AM ET
Location: Iron (Fourth Floor)
The practice of involuntary hospitalization among individuals with severe mental illness (SMI) is longstanding, raising ongoing debates. Despite history’s unethical treatment of individuals with SMI by way of involuntary hospitalization, many still consider the practice the best means to balance beneficence and nonmaleficence and fulfill moral and ethical obligations to individuals with SMI. However, concerns surrounding this practice include respect for persons, creating more harm than good, equity, short- and long-term clinical care and public health implications. Further, there is little consensus or agreed-upon practice regarding involuntary hospitalization standards, which often falls on law enforcement, many of whom are not trained to make such determinations and have demonstrated significant operational bias (e.g., racial). Providing no care can also be ethically problematic. This paper examines ways in which individuals with SMI can be afforded ethical, cost-effective, efficient care.
In response to increased crime by houseless individuals with SMI, New York City announced an Involuntary Commitment Plan, which argues that the city has a moral obligation to treat residents with SMI. Despite US court rulings deeming involuntary hospitalization legal, is this practice ethical, and if so, under what circumstances? This paper will build on the work of Aashna Lal’s essay, “New York City’s Involuntary Commitment Plan: Fulfilling a Moral Obligation?” (The Hastings Center, Bioethics Forum Essay, 01/10/2023) to address this issue. This paper’s analysis will include implications for vulnerable patients, the health system, and the US and global community. Further, it will discuss how current interventions for the SMI population fall short.
Gina RadiceVella, PsyD – Clinical Psychologist & Psychology Internship Training Director, Department of Psychiatry, Hackensack Meridian Health - Jersey Shore University Medical Center; Adriana Fitzsimmons, MD – Psyciatrist, Director of Consultation Liaison Psychistary, Clinical Vice Chair & Assistant Professor, Department of Psychiatry, Hackensack Meridian Health - Jersey Shore University Medical Center