Does Involuntary Hospitalization Help the Mentally Ill?

As concern about violence committed by the mentally ill has grown, so has the number of Americans who are involuntairly committed for mental care. Does that help? Abstract of a new paper:

The involuntary hospitalization of people experiencing a mental health crisis is a widespread practice, as common in the US as incarceration in state and federal prisons and 2.4 times as common as death from cancer. The intent of involuntary hospitalization is to prevent individuals from harming themselves or others through incapacitation, stabilization and medical treatment over a short period of time. Does involuntary hospitalization achieve its goals? We leverage quasi-random assignment of the evaluating physician and administrative data from Allegheny County, Pennsylvania to estimate the causal effects of involuntary hospitalization on harm to self (proxied by death by suicide or overdose) and harm to others (proxied by violent crime charges). For individuals whom some physicians would hospitalize but others would not, we find that hospitalization nearly doubles the probability of being charged with a violent crime and more than doubles the probability of dying by suicide or overdose in the three months after evaluation. We provide evidence of housing and earnings disruptions as potential mechanisms. Our results suggest that on the margin, the system we study is not achieving the intended effects of the policy.

I know nothing about the authors, and obviously this is a topic that many people approach with strong prior views. But I think a lot of data shows that stabilizing mentally ill people and then releasing them is often unhelpful. Here's a good line:

Resource constraints, such as under-resourced and porous follow-up services, can make for detrimental experiences.

Many of these folks are leading rough lives; in this study, 60% of those being tracked used an emergency room at some point in the following year. These mentally ill, often homeless people make up about 1.5% of those covered by Medicaid but use 25% of the budget. This is why programs that just give people housing often save money; if we are spending $50,000 a year on someone's health care, then getting them off the streets can be a money-saving strategy. But, of course, those programs work best when they focus on people most likely to benefit, that is, the least messed-up. For the far gone, there isn't much we can do, and after repeated overdoses, head injuries, frostbite, and so on they will mostly likely be dead in a few years.