Urban psychiatric commitments: disability and dangerous behavior of black and white recent admissions

Nationally black patients are overrepresented in public psychiatric institutions and are more likely than white patients to be committed involuntarily. This study of patients from 12 treatment units in the Chicago area, where these patterns were also true, compared the functioning of 227 acute admissions grouped by race (white or black) and admission status (voluntary or involuntary). Patients were assessed by highly trained independent observers using objective measures of dangerous behavior and disability levels, the relevant classes of functioning based on common principles underlying commitment statutes. No evidence was found that racial bias and discrimination in commitment and retention decisions would account for the overrepresentation of blacks among involuntary commitments to public institutions. Rather, the same factors that account for the overrepresentation of blacks compared with whites among all admissions may also explain their overrepresentation among the involuntarily confined. Changes in treatment programming and assessment practices are suggested.