Psychiatric emergency room decision-making, social control and the 'undeserving sick'

The influence of social factors on involuntary hospitalisation has been an important and controversial area of sociological focus for many years. Traditionally, social control theory has been used to understand disproportionate rates of involuntary hospitalisation among marginalised and powerless groups. However, dramatic changes in the social context of mental healthcare have necessitated a re-examination of the role of social factors in involuntary hospitalisation. In this study 287 psychiatric emergency room visits were examined in order to test hypotheses for understanding social influences on disposition. Little support for the traditional social control hypothesis was found. People from marginalised groups were not disproportionately involuntarily hospitalised, but instead were disproportionately treated and released from the hospital as people's social resources were used to access care rather than to prevent hospitalisation. This study highlights the importance of the historical relevance of our theoretical understanding of the relationship between social factors and involuntary commitment.