Involuntary Hospitalization and Suicidality: A Systemic Failure

Suicidal ideation and behaviors are one of the most common causes of involuntary detainment in a locked psychiatric setting. For example, during the 2017-2018 fiscal year, 62,406 Floridian children were detained in psychiatric facilities on involuntary status (Jones et al.). Many studies show no correlation between involuntary hospitalization and decreased suicidal ideation; in fact, many studies show the opposite. A 2017 report in JAMA Psychiatry found that the risk of suicide was 100 times greater than average directly after discharge, and a 2016 report found that “adverse experiences associated with hospitalization” were responsible for the high number of post-discharge suicide attempts (Simons). “Some patients may feel violated, disrespected, humiliated, or dehumanized by the experience of coercion,” the study authors write, potentially explaining the increased likelihood of suicide attempts after hospitalization (Chung et al.). Evidence from the MacArthur Violence Risk Assessment Study supports the abolition of involuntary hospitalization: 19% of the 905 adult psychiatric patients studied attempted suicide after their release [from psychiatric hospitals], an indication that involuntary hospitalization is ineffective at preventing suicidal behaviors (Simons).

Yet, despite research that shows involuntary hospitalization does not decrease suicidality and thousands of reports of abuse, deaths, and human rights violations in psychiatric hospital settings, hundreds of thousands of Americans are detained against their will for suicidality each year. Consequences of inpatient hospitalization in American psychiatric facilities include long-term trauma, dehumanization, and, in many cases, abuse. Every person, whether they are physically or mentally ill, should be able to decide whether the treatment is worth the pain or whether the pain is even worth continuing, given the suffering and low quality of life. If cancer patients cannot be forced to go through chemotherapy, psychiatric patients should not be forced to go through inpatient psychiatric treatment. There is no justification for imprisoning someone for exercising control over their own life, even if it is to end it.

A 2021 study, reporting on youth ages 16-27 who had experienced at least one prior hospitalization, also shows the harm caused by involuntary hospital experiences. Three-quarters of the youth reported that hospitalization had negative impacts on trust, including their willingness to disclose suicidal ideation (SI) for fear of being sent back to the hospital (Jones et al.). One youth stated in an interview, “[Afterwards] I would always think about, I don’t want to go back to [the hospital]. I don’t want to … I can’t tell anyone I’m feeling this way because they’re just going to send me back (Jones et al.).” As illustrated by this quote, youth who were involuntarily committed were found to have decreased trust in psychiatric institutions, mental health providers, and authority figures (parents, teachers) as a whole, making them less likely to seek help for future mental health challenges. Youth in the study frequently used words such as “damaging” and “traumatic” to describe their inpatient experiences (Jones et al.). These youth not only described the “damaging” treatments they experienced as “unwarranted,” but also explicitly punitive (Jones et al.). As one participant describes, “It was like a prison. You wake up at this time, they come in to wake you up, if you want to shower, they have to be [there] monitoring. We would ask, ‘When are we going to do this? When are we going to do that?’ It wasn’t like [we were] talking to them, it was like they were just standing guard and just very cold (Jones et al.).” This participant describes a prison-like environment, not therapeutic treatment. Another participant describes the oppressive situation, “After lunch, maybe, they’d take us outside [to] this little enclosure that was all fenced in. Felt like little animals on display there. After that, a few hours until dinner. All the time, you were just nothing. You’d sit there and watch the television like if you weren’t insane before, you would go insane at this place (Jones et al.).” If the “treatment” for suicidal ideation causes dehumanization and trauma, one should be able to opt to suffer from the illness rather than the supposed cure.

To further demonstrate the need for the abolition of involuntary psychiatric treatment, I surveyed eleven individuals who experience chronic suicidal ideation in combination with a mental illness or neurodevelopmental disability. Eight of the eleven participants reported they were forced into inpatient facilities against their will (Gordon). When reporting on the effects of their hospitalization, participants reported significant trauma and mistrust as a result of hospitalization (Gordon). One participant reports:

After the hospitalization, I had developed an extreme distrust of my therapists.

Immediately after, I had to lie and tell people I wasn't going to kill myself to avoid going

back there. I use a fake address and have an escape plan because I have been threatened

with being locked up four separate times. I also will never physically walk into a

therapist's office ever again, and if it ever occurs, I plan on keeping the door wide open

and having multiple witnesses during my appointments so that I won't be called a liar ever again (Gordon).

This powerful quote again demonstrates the lack of trust patients experience after hospitalization and how involuntary hospitalization can cut patients off from services for the rest of their lives, for fear of ending up back in the prison-like setting of a psychiatric hospital. Another participant reports, “I no longer go to doctors for anything because I am afraid of them. I feel paranoid expressing myself. I am terrified of healthcare professionals (Gordon).” Involuntary hospitalization is a clear barrier to receiving future care due to the mistrust of healthcare it instills in patients.

The mistrust participants experience is not unjustified– all participants described extremely damaging conditions in their hospitals (Gordon). One participant describes their experience of coercive medical treatment: “At first the meds were voluntary (albeit coercive), but later they forced the meds on me every day, saying I would have a forced injection every day I refused to take the meds (Gordon).” Being forced to receive medical care against one’s will is a deterrent for seeking further medical care, as no one wants to risk being pushed into potentially risky medical interventions again. Another participant describes how the hospital did not even meet their basic needs:

Only allowed 3 days' worth of clothes. Limited access to any form of entertainment. Only about 15 minutes of phone time a day. Food was subpar, often unidentifiable. Unit was cold, and blankets very thin, nobody was allowed extras. No privacy, nobody was allowed to be in their rooms outside of lights out…… The generic body wash/shampoo/conditioner didn't work, spent a whole week with greasy hair and skin because it wasn't getting me clean. psychiatrist would spend 5 minutes a day with me and ignore any concerns I had. Anyone on low-income insurance was discharged much faster than people on better plans, regardless of emotional state….

The conditions described by these participants are further evidence of the inherent dehumanization caused by inpatient mental health treatment.

All eleven participants in the study of SI agreed that community-based care was a better option than hospitalization for suicidal patients (Gordon). Many participants advocated for peer support and support groups as alternatives to traditional clinician-led treatments. One participant, when asked if community-based treatment would be better than hospitalization, responded, “That does sound better…I feel very isolated from community (Gordon).” Respondents of this survey are looking for community and belonging to alleviate isolation and mental pain.

When asked what mental health support they’d prefer or what had helped them, participants responded with a variety of experiences that gave them feelings of connection or purpose. One participant reports, “Maybe just people validating my experience, without saying ‘oh, your parents just did the best they could’.... Video games have helped my mental health in that they are something I am capable of doing well…” Another participant reports,

My faith has done more for me than psychiatry or psychology. But a good

trauma-informed, non-pathologizing therapist is also helpful. I've found IFS [internal

family systems therapy] helpful. Living with my sister's family during the pandemic and helping care for my little nephew (as well as contributing to the household in general) gave my life a sense of meaning.” Another participant reports, “The therapist abuse awareness community has helped me tremendously when it comes to improving my mental health. Soon after the abuse, I shared my story online in multiple military forums on Reddit and met many soldiers who were just like me (Gordon).

This participant, too, found solace in community and support from peers.Another participant lists similar supports, saying, “Exercise, structured routine, community engagement and social support, having space where I am free to express my feelings without fear of judgement, stigma, or involuntary/nonconsentual treatments…” All of these responses indicate that interventions supporting connection and community are the best way to support people struggling with mental health; however, seven of the eleven participants surveyed reported being denied access to community-based care due to their suicidal ideation.

Currently, community-based programs are often reserved for low-risk patients who are not experiencing suicidal ideation, which leaves chronically suicidal patients with nowhere to turn; however, community mental health resources focused on providing connection and support to people with suicidal ideation are necessary to prevent the traumatic experiences inpatient facilities cause and address needs of people in crisis in a setting that prioritizes connection and community over control.

Worlds Cited

Chung, Daniel Thomas, Christopher James Ryan, and Matthew Michael Large. “Commentary: Adverse experiences in psychiatric hospitals might be the cause of some postdischarge suicides.” Bulletin of the Menninger Clinic, vol. 80, no. 4, Dec. 2016, pp. 371–375, https://doi.org/10.1521/bumc.2016.80.4.371.

Chung, Daniel Thomas, Christopher James Ryan, Dusan Hadzi-Pavlovic, et al. “Suicide rates after discharge from psychiatric facilities.” JAMA Psychiatry, vol. 74, no. 7, 1 July 2017, p. 694, https://doi.org/10.1001/jamapsychiatry.2017.1044.

Gordon, Lilly June. “Psychiatry Questionnaire #2.” 3 Apr. 2025.

Jones, Nev, et al. “Investigating the Impact of Involuntary Psychiatric Hospitalization on Youth and Young Adult Trust and Help-Seeking in Pathways to Care.” Social Psychiatry and Psychiatric Epidemiology, U.S. National Library of Medicine, Nov. 2021, pmc.ncbi.nlm.nih.gov/articles/PMC10105343/.

Simons, Peter. “Involuntary Hospitalization Increases Risk of Suicide, Study Finds.” Mad In America, 7 May 2022, www.madinamerica.com/2019/06/involuntary-hospitalization-increases-risk-suicide-study-finds/.