“Amanda, I’m so sorry. The cops are here.”
Panic shot through Amanda Wilson as she looked up from the hammock chair on the back deck of her Millvale home, taking in the grim expression on her mother’s face. It was the same look she wore during Wilson’s childhood when sharing that a relative had passed away.
Afraid and confused, her mind raced to understand what the police could want from her on that July afternoon — she hadn’t committed a crime. Were her friends OK? Was somebody hurt?
Wilson met the officers outside her front door. They explained they’d be taking her to an evaluation at UPMC Western Psychiatric Hospital, which would determine if she should be committed for involuntary psychiatric treatment.
She had been “302ed” — a term that comes from the section of the state Mental Health Procedures Act that governs involuntary psychiatric examinations and care.
Her confusion multiplied. From the backseat of the police car, Wilson phoned a friend who filled in a few gaps. He and another friend had submitted a petition for her evaluation. Wilson said she had been experiencing a manic episode and suicidal thoughts for two months, and although her friends knew she was seeking treatment, they didn’t think she was making progress fast enough.
“I can understand that no one wanted anything bad to happen to me,” said Wilson, 30. “They didn’t know what else to do. … But it’s still hard to get over that. It’s hard to move past the taking away of autonomy.”
From 2015 through 2021, Allegheny County recorded a 21% increase in the number of petitions filed to initiate evaluations for involuntary commitment. During that period, there was a 4% increase in the petitions that were upheld or converted, meaning the person received involuntary treatment, or the person voluntarily chose to seek treatment as a result of the petition.
Crisis response stakeholders cannot definitively pinpoint what’s causing the spurt in petitions filed, but close observers point to everything from changes in the county’s record-keeping system to an increase in the severity of mental health needs.
Police and county officials believe the rise could reflect better care for individuals experiencing mental health crises because it shows they’re being directed toward treatment more often, rather than facing alternatives like arrest. But researchers and mental health advocates are concerned with racial disparities among the people being petitioned and the potential for involuntary hospitalization to severely traumatize people.
Western Psychiatric Hospital cannot comment on any specific cases under state law, but recognizes that involuntary commitment can be a traumatic experience, wrote UPMC spokesperson Ashley Trentrock in a statement to PublicSource. She noted that “changes in the workforce” have impacted behavioral health providers and their capacity to provide care.
“We make every effort to engage all of our patients with follow-up care after their admission, regardless of their commitment status. Our top priority is ensuring the well-being of our patients, who entrust us every day with their health and safety,” Trentrock wrote.
Key Takeaways
- Allegheny County reported a 21% increase in the number of 302 petitions filed from 2015 through 2021.
- The number of 302 petitions that were upheld or converted to a voluntary psychiatric commitment rose at a much slower pace than the petitions filed, increasing by just 4% from 2015 through 2021.
- In 2021, Black adults in Allegheny County were petitioned for involuntary commitment 2.4 times more often than white adults.
When a person has posed a “clear and present danger” to themselves or others due to mental illness within the past 30 days, state law permits anyone who observed their behavior to file a petition for the county to initiate a psychiatric evaluation. If the county approves the petition, then police often escort the individual to their evaluation, where a physician determines if they should be committed at a psychiatric facility — either voluntarily or involuntarily. Involuntary commitment initially lasts up to five days, culminating in a hearing to determine whether to extend hospitalization.
Are rising 302s due to increased awareness, or increased demand?
Allegheny County’s increase in involuntary commitment petitions predates the onset of the COVID-19 pandemic, going back to at least 2015.
Local researchers find it difficult to understand the factors driving the uptick because of the scarcity of data on the reasons people were petitioned.
“It would require a lot more work beyond what is currently available to understand that in a more sophisticated way,” said Nev Jones, a professor at the University of Pittsburgh’s School of Social Work.
Jones suspects that schools’ responses to the youth mental health crisis and dementia-related aggression are among the age-related factors driving the rise in petitions.
People petitioned for 302s are most commonly in their twenties
Slide through the years to see their age range.
The uptick may also stem from increased awareness of involuntary commitment.
In 2014, the county installed a new electronic filing system, which improved the ability of crisis intervention stakeholders to input records about involuntary commitment petitions. The county’s Department of Human Services [DHS] has trained stakeholders to use the new system over the years, which has improved understanding of involuntary commitment and increased the number of petitions.
“We’ve been in the community, with the police in the [crisis intervention trainings], explaining the law to them so they know it a little better now,” said Mike Rocco, the manager of the Information, Referral and Emergency Services unit within the DHS Office of Behavioral Health.
In addition to receiving training from DHS, police have hosted refresher courses on de-escalation and responding to mental health crises, which may have led to an increase in police-initiated petitions, said Logan Hanley, a lieutenant for the Pittsburgh Bureau of Police. He serves as the administrator for the Tactical Negotiations Team that frequently responds to incidents involving people in crisis.
Hanley added that he’s personally observed a rise in incidents involving mental health crises and views the increase in involuntary commitment petitions as a corollary of this trend. While the pandemic has served as a “pressure cooker” exacerbating people’s mental health, he said issues like the opioid addiction pushed people to a state of crisis long before the virus’ arrival.
“We see a lot more overdoses, and from those overdoses we see a lot more grief, a lot more embattled families, things like that,” Hanley said. “It’s causing a lot of stress in the community, too, when it becomes constant.”
Involuntary commitment as a path to healing
DHS Director Erin Dalton said the countywide uptick in involuntary commitment petitions has the potential to be a positive force.
“To be clear, it depends on whether people then got the help that they need and went on to have more well-being and connection,” she said.
The department has not yet analyzed whether involuntary commitment improved individuals’ abilities to connect with services to support their long-term mental health needs. Dalton said there’s interest in eventually conducting this analysis.
Hanley said that for people experiencing mental health crises, involuntary commitment can be a preferable outcome to alternatives like arrest. He added that “people who are experiencing mental health issues can display symptoms that might look like purposeful non-compliance, but really, they’re just symptoms of mental health.”
Mental health advocates point out that involuntary commitment can be a necessary tool for treating people experiencing anosognosia, a symptom of severe mental illness that can hinder people’s abilities to understand their illness or seek treatment on their own.
“It’s very different than denial or just lack of acceptance,” said Elizabeth Sinclair Hancq, the director of research for the Treatment Advocacy Center. “It really is an anatomical change in the brain that impacts these individuals, especially when they’re symptomatic in psychosis.”
At least half of people with schizophrenia and 40% of people with bipolar disorder experience symptoms of anosognosia, which can wax and wane in severity over time.
How a 302 disrupted the treatment plan
When the police came to Wilson’s parents’ home in July, she already had a treatment plan in motion.
She suffered from severe depression and was diagnosed with bipolar disorder earlier this year. May marked the beginning of her first manic episode, and it prompted her long-time therapist and psychiatrist — who only saw Wilson virtually — to request that she begin seeing a different care team, who could monitor her symptoms more closely. She was struggling to find local help, but reserved a bed at the Steps to Recovery treatment program in Philadelphia. Her parents were set to drive her.
Instead, her involuntary commitment derailed her plans and fractured her support network.
Although involuntary commitment can be a necessary step in connecting individuals with mental health services, experts agree that it poses a risk of severely traumatizing individuals.
Wilson’s stay at Western Psychiatric Hospital lasted from July 1 through July 8. It took her until the end of August to find a new therapist, and late October to find a new psychiatrist. She’s lost touch with three of the four friends involved in filing the petition for her involuntary commitment. Two of them she hasn’t seen since the fifth day of her hospitalization, when they appeared via Zoom at her hearing.
“I know this isn’t exactly accurate, but it feels like people threw me in the hospital and then bailed because they had no plan or concept for, ‘Well, what next?’” Wilson said.
Wilson said the only positive aspects of her involuntary commitment were receiving a prescription for mood stabilizers — which she could have received without being hospitalized — and connecting with other people experiencing similar mental health issues.
“The camaraderie of that — of going through the hospitalization experience together — that got me through for sure,” Wilson said.
Black adults more likely to face involuntary commitment
In Allegheny County, Black adults were petitioned for involuntary commitment 2.4 times more often than white adults in 2021, according to data from DHS.
Jones said these disparities are not surprising. She noted that nationwide, Black people are most commonly the targets of “the most pronounced excess use of force, excess use of coercive mechanisms, excess involuntary hospitalization, excess use of seclusion and restraints, and on and on.”
The racial disparities in who’s petitioned may stem from neighborhood-level factors, like poverty levels and racial segregation, said Leah Jacobs, a professor at the University of Pittsburgh’s School of Social Work. These factors create stressful living conditions — like living from paycheck to paycheck — that weigh heavily on people’s mental health and deter them from accessing care services.
“If you are not regularly connected to an existing provider, then whatever mental health problems you’re experiencing are likely to get worse to the point where they’re going to become a crisis,” she said. “Potentially, what did not necessarily need to turn into an involuntary hospitalization then becomes a need for an involuntary hospitalization.”
The racial disparities in involuntary commitment petitions are emblematic of the inequities of the county’s broader mental healthcare system. A 2021 county report found that Black residents are less likely to access preventative care, but more likely to use crisis services, than white residents.
“Without that preventive care it is, therefore, more likely people end up seeking crisis services,” Dalton said.
Dalton, who was part of the stakeholder group that penned the report, said the inequities within the mental health system raise a host of questions. “Are our services culturally competent? Are they located in places where people live? Are they what people want? Is the formal system something that people are actually seeking assistance from?”
DHS is analyzing data to understand which geographic areas it should target for more crisis response services, mobile teams and informal mental health supports, said Jenn Batterton, the department’s manager of special initiatives.
Which ZIP codes report the highest 302 petitions rates?
Hover over each ZIP code to learn about the rate at which residents were petitioned for involuntary commitment. Map includes ZIP codes that are entirely, or almost entirely, within Allegheny County.
Dalton said the department is emphasizing improved access to peer supports within communities. This approach is not a “cure-all,” but an example of how the department is working to improve its engagement and competency.
After the 302, struggling with trust
In the months since Wilson left Western Psychiatric Hospital, she’s experienced increased anxiety, panic attacks and nightmares. She’s been living with her parents because she’s afraid to be alone.
Research shows that suicide rates drastically increase in the months after people are discharged from psychiatric hospitals.
Even if Wilson did experience suicidal thoughts in the months since she was discharged, she wouldn’t tell a soul.
“I feel way less safe to be honest with people about where my mental health is,” Wilson said. “I definitely would straight up lie before I would do anything that would lead me to be hospitalized again.”
She’s also stuck footing a $400 hospital bill for the services she did not want — a common outcome among involuntary commitment patients.
As Wilson continues navigating the aftermath of her involuntary hospitalization, she’s certain of one thing: The experience has destroyed her trust in Allegheny County’s mental healthcare system.
Hancq said involuntary commitment’s potential to diminish people’s confidence in their support systems — whether that includes family, friends or mental health professionals — is one of its most dangerous consequences.
“It can have long-standing negative consequences on that individual’s perspective and trust in the medical system and the psychiatric treatment system in terms of ability to trust and develop a good rapport with their treatment providers.”
When Wilson was discharged from Western Psychiatric Hospital, she was given suggestions for a physician and basic psychiatric services to connect with. She said she’s heard from them once since — a phone call in response to her filling out a survey saying she had a terrible experience.
Because of Wilson’s faltering confidence in local treatment options, she’s considering moving — either to Los Angeles, where she has extended family, or other areas of Pennsylvania, like Lancaster or Philadelphia.
“You didn’t fundamentally change anything about someone’s life,” Wilson said. “All the same problems are there, but it’s worse because my autonomy has been taken away, and now I have all of this trauma from the stay there, and I have a lack of support system, too.”
Amelia Winger is PublicSource’s health reporter with a focus on mental health. She can be reached at amelia@publicsource.org or on Twitter @ameliawinger.
This story was fact-checked by Ladimir Garcia.
This reporting has been made possible through the Staunton Farm Mental Health Reporting Fellowship and the Jewish Healthcare Foundation.
