Understanding and Mitigating Impacts of Involuntary Psychiatric Hospitalization in the Context of Recent U.S. Policy Reforms

Monday, July 20, 2026, 11:00 AM

Session: SOC Poster Session (Overflow) (In-person)

Involuntary psychiatric hospitalization (IH) is increasingly used to manage serious mental illness and crisis in the U.S., particularly among vulnerable populations. Recent policies loosening commitment criteria cite protective benefits, yet emerging evidence suggests IH may worsen mental health, social risk, and readmission over time. A fundamental debate persists: eliminate IH entirely, or reduce its use and mitigate harm? System dynamics offers a framework for deeper structural analysis of this tension. Drawing on data from lived perspectives of crisis care quality, we facilitated three exploratory group model building sessions to test system dynamics' applicability to our research program. Sessions generated dynamic and feedback insights, a preliminary causal loop diagram (CLD), and policy lever analysis. We then conducted a literature review to iterate and validate a more parsimonious, empirically grounded CLD representing the salient mechanisms underlying IH's positive and negative impacts over time. The CLD depicts the revolving door dynamics of IH through the "fixes that fail" archetype — IH as a short-term solution to psychiatric and social risk that generates unintended consequences, exacerbating the original problem. Four salient reinforcing mechanisms were identified: institutional harm eroding trust and help-seeking; erosion of therapeutic alliance and non-compliance; exacerbated social vulnerability; and self-stigma intensifying social isolation. The CLD illustrates how IH has become endogenous to the system it helps perpetuate and lays the groundwork for measuring multi-level unintended consequences and identifying policy levers supporting long-term recovery and reduced reliance on coercive care. Next steps include transforming the CLD into a simulation model to test care pathways and policy strategies, and developing additional CLDs addressing community-based alternatives, peer support, and political will.