Research by Social Welfare Professor David Cohen was cited in a Cut article about the legal consequences for individuals deemed mentally ill in the United States. Britney Spears’ conservatorship has highlighted the way that psychiatric diagnoses can be used to strip individuals of their rights to voting, medical decision-making, financial decisions and more. Cohen’s research shows that patient privacy laws and lack of data collection pertaining to human rights violations of the mentally ill make it difficult to estimate exactly how many people have experienced involuntary commitment. Last year, a study by Cohen found that involuntary commitments over the previous decade outpaced population growth three to one, and another estimate extrapolated that over 1 million Americans a year are involuntarily committed. “This is the most controversial intervention in mental health — you’re deprived of liberty, can be traumatized and then stigmatized — yet no one could tell how often it happens in the United States,” Cohen said.
Professor of Social Welfare David Cohen was featured on the Mikhaila Peterson podcast as a guest speaker on the dangers of psychiatric medication, dependency and withdrawal. Cohen pointed out that the prescription rates for psychoactive drugs have quintupled in North America in the last 40 years. Prescriptions for children have increased even more, even though the long-term effects of psychoactive drug use not fully understood. “No one seems to be responsibly investigating these questions, despite the large number of citizens who take psychoactive drugs,” Cohen said. While psychoactive drug use is not new, the avalanche of modern synthesized psychotropics and corporate pharmaceutical promotion have served as converging factors increasing societal dependence on psychoactive drugs. “The cautions that we might feel as ordinary citizens about long-term use are short-circuited by the ideas that many of us are deficient or suffer from some pre-existing brain abnormality that requires treatment with drugs,” he said.
Professor of Social Welfare David Cohen was cited in a MedPage Today article about knowledge gaps in literature surrounding youth psychiatric admissions. A recent study in the United Kingdom found that youth with certain mental health diagnoses, including substance abuse and intellectual disability — as well as youth who were Black or of an older age group — were more likely to experience involuntary psychiatric hospitalization. However, data on youth mental health treatment and hospitalization in the United States is lacking and often not available to researchers. Laws on involuntary psychiatric holds for children and teenagers vary by state. Cohen pointed out that of the 25 states in the U.S. that have publicly available data on psychiatric commitments, only five states have released any data on youth. Collecting and sharing more data on psychiatric treatment and hospitalization of minors is recommended to better understand the impact of these detentions and the populations they affect most.
Social Welfare Professor David Cohen was featured in a Mad in America article summarizing his research findings on psychiatric detentions in the United States. According to Cohen’s research, the rate at which Americans are confined against their will under mental health laws has increased dramatically over the past decade. “This is the most controversial intervention in mental health — you’re deprived of liberty, can be traumatized and then stigmatized — yet no one could tell how often it happens in the United States,” Cohen said. “We saw the lack of data as a social justice issue, as an accountability issue.” He gathered data from court and justice systems, journal articles, state health websites and other sources to fill the gaps in literature. Cohen concluded that “state and private agencies, lay and professional groups, and independent researchers should shed more light on involuntary psychiatric detentions, their correlates and their outcomes.”
By Les Dunseith
The rate at which Americans are held against their will and forced to undergo mental health evaluations and even state-ordered confinement — lasting anywhere from a few days to years — has risen sharply over the past decade, according to a new study by researchers at the UCLA Luskin School of Public Affairs.
The analysis, published online today in the journal Psychiatric Services, shows that in the nearly half of U.S. states for which data was available, involuntary psychiatric detentions outpaced population growth by a rate of 3 to 1 on average in recent years.
The study is the most comprehensive compilation of data on involuntary detentions to date, the researchers say, an undertaking made more challenging by the lack of a national data set on the topic and longstanding inconsistencies in reporting across states and jurisdictions.
“This is the most controversial intervention in mental health — you’re deprived of liberty, can be traumatized and then stigmatized — yet no one could tell how often it happens in the United States,” said David Cohen, a professor of social welfare at the Luskin School, who led the research. “We saw the lack of data as a social justice issue, as an accountability issue.”
While each state has its own laws governing these detentions, nearly all specify that people who have not been accused of a crime but who may pose a danger to themselves or others or can’t take care of themselves — because of mental illness or substance abuse — can be detained in an authorized facility, usually a hospital, Cohen said. An initial evaluation can last several days, but detention can be extended at the discretion of mental health professionals.
Cohen and his co-lead author, Gi Lee, a social welfare doctoral student at the Luskin School, scoured health and court websites for all U.S. states and were able to cull usable counts on emergency and longer-term involuntary detentions from just 25 of them for the period from 2011 to 2018. In those 25 states, they found, annual detentions varied from a low of 29 per 100,000 people in Connecticut in 2015 to a high of 966 in Florida in 2018.
Twenty-two of those states had continuous data from 2012 to 2016, and the authors found that during this five-year span, the average yearly detention rate in these states increased by 13%, while their average population grew by just 4%, the authors say. Further, using data from 24 states that make up 52% of the country’s population, the researchers calculated a rate of 357 emergency involuntary detentions per 100,000 people in 2014 — a total of 591,000 detentions.
“If you think that coercion is necessary in mental health, then a rise in detention rates may be welcome news, a sign that society is doing whatever it takes to help people in crisis and keep order,” Cohen said. “But if you think that coercion is punishment, that we need services to prevent or defuse crises in families and society before they get out of control, then a rise is a bad sign.”
One of the most common triggers for a detention is a threat of suicide, said Cohen, who noted that the detentions often involve law enforcement personnel.
“The process can involve being strip-searched, restrained, secluded, having drugs forced on you, losing your credibility,” Cohen said. “For people already scarred by traumatic events, an involuntary detention can be another trauma.”
The rate of suicide is high for people recently released from psychiatric hospitalization, but how many of these hospitalizations are involuntary is not known, nor is it clear whether such detentions may play a protective or risk-increasing role in suicide. Likewise, while former involuntary detainees interviewed in previous studies have expressed both gratitude and resentment, data on the lasting effects of being coerced into a facility for psychiatric treatment is scarce, the authors say.
“These studies have mostly focused on subjective experiences of psychiatric detention, which are important to understand,” Lee said. “However, not much is known about more objective outcomes of psychiatric detention — on employment, education, contact with the criminal and juvenile justice systems, and others.”
Still, the authors stress that their study is not about whether involuntary psychiatric detention helps or hurts but about determining precisely how often it occurs in the U.S. in the hopes of spurring a national discussion on these issues. That, say Cohen and Lee, will come with more data.
Despite the current limitations, the researchers gleaned several other important findings from the available data:
- Among the eight states that provided data on longer-term detentions, average annual rates over time ranged from lows of 25 (Oklahoma) and 27 (Missouri) per 100,000 people to highs of 158 (Virginia) and 159 (California). These longer-term detentions were, on average, 42.2% of the eight states’ rate of all emergency detentions.
- 24 of the states studied comprised 52% of the U.S. population in 2014. Five of them — Florida, California, Massachusetts, Texas and Colorado — accounted for 59% of the population of those 24 states but were responsible for 80% of the total detentions that year.
- While only six states provided information on the detention of minors, the researchers believe even this partial data is the most complete glimpse yet of the involuntary detention of minors in the U.S.
“Greater transparency in data would not only lead to a better understanding of the epidemiology of psychiatric detentions in the U.S.,” Lee said, “but could help determine to what extent commitment is a last resort.”
Professor of Social Welfare David Cohen was featured in a Mad in America article discussing the mental health industry’s response to growing concerns about climate change. As the impacts of a warming planet have become more prominent, a new refrain has emerged that climate change causes mental health problems requiring treatment, including fear, sadness, eco-anxiety and PTSD. According to Cohen, the pathologizing and medicalizing of feelings about climate change derails social activism. He explained that the terms “mental health” and “mental illness” frame negative feelings in response to climate change as pathologies or illnesses inside individual brains that require psychiatric or psychological treatments rather than social-political solutions. Instead of encouraging social activism and environmental advocacy, this medicalization “enfeebles us, making us feel dependent on ‘expert’ health professionals to help manage these feelings,” Cohen said. He concluded that these medicalized diagnostic labels undermine the citizen empowerment necessary to effect change.
Social Welfare Professor David Cohen spoke to the Hill about the temporary relaxation of laws on alcohol purchases during the coronavirus outbreak. Some states are now permitting takeout and delivery of alcoholic beverages to provide relief for restaurants and small businesses. Cohen said it was common to rethink regulations during emergencies but also cited the influence of the beer, wine and spirits lobby. “Regulations result from balancing many interests, but the weight of manufacturers, wholesalers and distributors of alcoholic beverages in influencing policy through lobbying is notable,” he said. Alcohol laws exist for a reason and relaxing them could be dangerous, he added. “Alcohol used excessively can lead to serious problems in people and in communities in the short and the longer term. If changes in access to alcohol occur, consequences must be monitored so we can understand more clearly the impact — desirable, undesirable and unanticipated — of our regulations,” he said.
“Medicating Normal,” a new documentary about the widespread use and resulting harms of anti-depressants, anti-anxiety medications, ADHD drugs and mood stabilizers, highlights research by Social Welfare Professor David Cohen, an authority on the benefits and risks of psychoactive drugs. The film notes that one in five Americans take these psychiatric medications daily but many are unaware of their potentially debilitating side effects. In the documentary and in online resources published by the filmmakers, Cohen weighs in on misconceptions about mental illness as brain damage; the challenges psychiatric patients face in providing fully informed consent; and the severe symptoms associated with withdrawal from benzodiazepines such as Xanax. He also spoke about the intense pressure on parents to medicalize their children’s problems, a break from previous generations. “You didn’t go to the doctor before if your kid misbehaved. You went to your sister-in-law or you went to your clergyman or you went to the Reader’s Digest,” Cohen said. “It’s hard right now in the contemporary world, in the 21st century, it’s hard for a parent to know, what should I do with my kid? … You get 20 different views on the internet, you are surrounded by opinions, and you’re supposed to do the right thing, the perfect thing.” Swayed by peer pressure, drug marketing and fear of making the wrong choice, many parents conclude that their children have a disorder and turn to medication, he said. “Medicating Normal,” which argues that profit-driven drug companies are concealing the harms caused by their products, was recently screened at the Santa Barbara International Film Festival.
A Los Angeles Times column about the difficulty of coming off antidepressants quoted Social Welfare Professor David Cohen, whose research focuses on psychoactive drugs. The column noted that the number of Americans age 12 and over who use antidepressants has tripled over the last two decades. For some patients, ongoing treatment is the best option for a functional life. Others may opt to wean themselves from the drugs, which must be done with care to prevent severe withdrawal symptoms. “Users themselves must decide about meds’ helpfulness in their own lives,” said Cohen, who is associate dean for research and faculty development at UCLA Luskin. Two recent studies by Cohen looked at clinical trials funded by the pharmaceutical industry that appeared to misinterpret withdrawal symptoms as relapse, bolstering the case for staying on the medications and raising questions about the reliability of the trials.
Social Welfare Professor David Cohen provided context and history in a CNN report assessing the veracity of President Trump’s comments linking gun violence to the closure of mental health facilities. “They closed so many — like 92% — of the mental institutions around this country over the years, for budgetary reasons,” Trump said. Cohen clarified that, since the mid-1950s, about half of the nation’s psychiatric facilities have closed and the number of residents in state mental hospitals has fallen from about 550,000 to about 100,000 today. The facilities closed in an effort to “deinstitutionalize” the mentally ill by placing them in less restrictive environments — not because of budget cutbacks, he added. But many patients were left with nowhere to go. “Society after World War II discovered a new passion to solve social problems and include the excluded, and all sorts of institutions — including orphanages, institutions for mentally retarded persons, homes for unwed mothers, youth detention centers, etc. — were phased out, with their residents often in effect kicked out from where they had lived for years,” Cohen said.