Racism and Involuntary Psychiatric Commitments | Parvati Singh | TEDxOhioStateUniversity

foreign [Music] [Applause] let's start with some numbers one in five persons in the U.S currently have a diagnosable mental illness and one in 25 have a severe mental illness now let's assume that we have a loved one who's severely mentally ill one day they undergo a psychiatric crisis and run away from home what would we want for them we would want them to be safe we would want them to start treatment get access to treatment and in some cases we may need to use coercion or Force against their will to get them admitted to a psychiatric facility these types of coercive or psychiatric admissions made against the person's will are called involuntary psychiatric commitments and they occur when a person is exhibiting danger to self danger to others or grave disability now I would like to note that most psychiatric inpatient admissions in the U.S are voluntary meaning the person has autonomy over the decision to get admitted and has willingly agreed to undergo treatment involuntary psychiatric commitments often are the last resort to save a person's life and during severe crises perhaps nothing says I love you like an involuntary psychiatric commitment however the determination of a person to be involuntarily committed May rely on subjective determination of deviant or disordered Behavior and social biases that predispose certain groups to be considered dangerous threatening or untrustworthy may play a role in deciding who gets involuntarily committed and who doesn't many studies report that in the U.S black Americans appear over-represented in the persons that undergo involuntary psychiatric commitment and one study by Catalano and colleagues also finds that Latin men have a higher risk of getting involuntarily committed even when they exhibit higher levels of cognitive functioning compared to their white counterparts now those of us who work at the intersection of Criminal Justice and mental health we know that black men are up to six times more likely to be incarcerated than others similarly my research finds that that black men are also up to five times more likely to be involuntarily committed compared to all other race and sex routes combined do we really think that black populations are so Criminal that they need to be incarcerated six times more than others or that black populations are so severely mentally ill that they need to be involuntarily committed five times more than others no not based on psychiatric and other epidemiologic evidence so then why do we see these disparities Scholars have argued that these disparities indicate system level oppression of a minority group or put simply structural racism racial disparities in involuntary psychiatric commitments may arise from the mutually reinforcing feedback loop of structural racism and social perceptions also referred to as implicit bias we have policies and practices that place black Americans at a disadvantage correspond with adverse outcomes in this population that in that in turn continues priming the social perception of this group as more deserving of harsher treatment punishment and reduction in Freedom now most of the studies that I've shown you so far share a common critique and the critique is these studies do not directly say or test that racism causes racial disparities in involuntary psychiatric commitment or the common saying correlation doesn't equal causation I try to unpack the extent to which racial disparities in involuntary psychiatric commitments in the U.S arise from racism and racial bias in the society so let's do a thought experiment let's say we want to understand whether racism causes racial disparities in involuntary psychiatric commitment and let's think of race as a switch okay when the switch is turned off meaning let's say a person is white then racism would not be connected to racial disparities in involuntary psychiatric commitments and when this race which is turned on let's say a person is black then we would expect racism to be causally related to involuntary psychiatric commitments the problem is race is not a modifiable risk factor we can't change a person's race and racism comes with its own set of analytic challenges first racism is present everywhere and is deeply embedded in all our systems second it's difficult to measure or quantify racism and third it is very difficult to induce random variation in racism so here is the question that keeps me up at night what if there was a way to induce arbitrary variation from a sudden external shock a random shock that would then induce variation in racism if I had such a shock then I would circumvent the need to directly measure racism I would just measure the changes in that external shock and measure changes in involuntary psychiatric commitments to get my answer now my research has led me to believe that economic recessions might fit the bill here why economic recessions are random population level unanticipated events that are not caused by racism or by racial disparities and involuntary commitments like racism economic recessions manifest at the population level and lastly economic recessions increase social frustration with increased social frustration comes increased racial scapegoating and who we scapegoat embodies racism and racial bias in the society so what is racial scapegoating in the U.S there is an unfortunate history of society's interest over place and time and acting out against vulnerable groups Society is under stress and experiencing frustration from external shocks like recessions terrorist attacks kobit 19 pandemic May displace on their frustration and aggress against minority groups who they feel are somehow related to the cause of that frustration we saw this happen during the covid-19 pandemic with multiple reports of serious escalated aggression against Asian Americans how do Scholars think about racial scapegoating there is a hypothesis called the frustration aggression displacement hypothesis According to which when the source of frustration cannot directly be targeted we may turn our aggression on to or we may misplace and displace our aggression onto those members of the community who have traditionally been perceived as the troublemakers or who in the society's opinion are somehow related to that source of frustration we have evidence of this after the 9 11 attacks where studies report increased involuntary psychiatric holds of Arab Americans and Muslim Americans after 9 11. and unfortunately this is not a recent phenomena black Americans have historically served as targets of this displaced aggression in the 1800s when cotton prices would fall and the economy back then would undergo a recession aggression against black Americans would increase in the form of increased lynchings in the modern context where citizens cannot overtly aggress against black Americans they made a sort to calling law enforcement to report black Americans for involuntary psychiatric commitments and this is where the role of economic recessions as a population level stressor in trying to understand whether racism causes racial disparities in involuntary psychiatric commitment comes in I turned my attention to the 2008 economic recession or the Great Recession where about 9 million people lost their jobs in the U.S and at the peak of this recession two out of five Americans reported living in poverty this was a big population level stressor and it may have increased social frustration that in turn may have led to increased involuntary psychiatric commitments among black Americans that's exactly what I studied did involuntary psychiatric admissions or commitments increase among black Americans during the 2008 recession and I wanted to examine whether monthly changes in the number of people employed corresponds with changes in involuntary psychiatric commitments among black men black women other race men other race women I looked at data on 13.1 million psychiatric inpatient admissions from 2006 to 2011. for four U.S states this graph is from the data set that I examined the line in blue shows the monthly rates of involuntary psychiatric commitments among black men and women and men and women from all other race ethnicities combined and you can see here how wide the disparities are when it comes to black men in particular so what did my analyzes show what I found was one month after monthly employment decline there's an increase of three percent of involuntary psychiatric commitments among black men which amounts to about 995 additional involuntary psychiatric commitments among black men in my study population I don't find these results for other race and sex groups and I don't find these results for voluntary psychiatric admissions among black men my results appear most consistent with the frustration aggression displacement hypothesis and I view this as a racist population level response to a sudden large macro social shock the presence of my discovered relations particularly among black men also aligns with the broader Trends in punitive harsh measures that this group faces in our society with involuntary psychiatric commitments potentially indicating another Avenue of confinement except this time medically Justified there are policies currently in place that are using involuntary psychiatric commitments on vulnerable communities one of which is shown here I leave it to you to decide who will end up being the unjust Target here now racial disparities in psychiatric outcomes did not arise in a vacuum in the 1950s as Jonathan Metzel describes in his amazing book the protest psychosis psychiatrists made up a psychiatric diagnosis called protest psychosis to declare civil rights protesters as mentally ill and potentially provide convenient grounds for involuntary psychiatric commitments of those protesters that led to a disparity in the rates of schizophrenia in the U.S that persists to this day why do I bring this up because it's possible that history repeats itself after the police killing of George Floyd in 2020 there were reports of a new word being used to justify police brutality that seems to sound very similar to protest psychosis and that new word is excited delirium in other words racism and racist excuses for targeting vulnerable communities may change their form but continue to persist now why should we care why study this why talk about this because I hope that whatever I've presented today has made you wonder if what we are seeing is acceptable or not and if we want change we have to start with measuring it because what we don't measure we can't change I would like to conclude by thanking the Giants whose shoulders I stand on my PhD advisor and Mentor Dr Tim Brookner Dr Lonnie Snowden who has dedicated his life to studying racial disparities in mental health and Dr Ray Catalano whose work on involuntary psychiatric commitments and racial disparities forms the foundation of my own thank you [Applause]

Channel: TEDx Talks

Views: 4,876

Keywords: English, Health, Public Issues, Public health, Racism, TEDxTalks, [TEDxEID:51863]

Id: vtjB0y8gnXs

Length: 14min 15sec (855 seconds)

Published: Mon Jun 26 2023