# Examining racial disparities in fatal overdose, self-harm, and perpetrating assaults following law enforcement-mediated involuntary commitment

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $532,767

## Abstract

Abstract
Involuntary commitment (IVC)—also known as involuntary civil commitment or civil commitment—is a legal
procedure in which a person thought to be at imminent risk of harming themselves or others is mandated by the
courts to receive treatment for serious mental illness or substance use. The process typically starts when
interested parties—often family members, medical personnel, or law enforcement (LE)—petition the court to
issue an order for treatment. If the person of concern is not already in medical care, LE will apprehend the
person in the community (which we refer to as LE-IVC) and transport to a local emergency department for
evaluation. If medical personnel deem that the person is indeed at risk for harm to self or others, mandatory
treatment is initiated. For those initiating LE-IVCs, the mechanism may be viewed as a ‘last resort’ in protecting
individual and public safety. At the same time, the extreme nature of LE-IVCs—apprehending people from the
community, depriving them of their autonomy, and forcing them to receive treatment—raises ethical and practical
questions about the government’s role in peoples’ lives; patients’ post-IVC perceptions of treatment, treatment
providers, and law enforcement; and the impact of IVC on risk of self-harm, overdose, and harming others. These
issues take on added complexity within the context of historic and ongoing racial discrimination and inequalities
in the US South, including the sometimes fraught relationships between Black persons and both the medical
community and law enforcement. Further, the high profile incidents of Black people killed by police has raised
concerns that they may be at particular risk for injury when being apprehended for a LE-IVC. Nevertheless, much
remains unknown about racial differences in the use and relative effectiveness of LE-IVCs. In response, we
propose to assess differences in the incidence, outcomes, and experiences of LE-IVCs across racial groups,
focusing primarily on Black-White differences. In North Carolina, a large southern state, we will link statewide
data (2017-2022) for emergency department visits, inpatient hospital stays, arrests and deaths, as well as gather
qualitative interview data to accomplish the following aims: 1) To describe statewide trends in LE-IVCs by race
and other socio-demographic and community characteristics; 2) To examine racial disparities in risk of overdose,
self-harm, and perpetrating assaults following a LE-IVC; 3) To explore Black and White patients’ and family
members’ perspectives on LE-IVCs. The role of LE-IVCs in perpetuating racial disparities remains largely
unaddressed. Our research will inform public health leaders, behavioral health practitioners, law enforcement,
and patient groups about the use and consequences of LE-IVCs and its possible role impacting racial disparities
in health care access and outcomes. Our study findings will also inform ongoing public discussions about
balancing public health interventi...

## Key facts

- **NIH application ID:** 10857032
- **Project number:** 5R01MD018404-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** DAVID L ROSEN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $532,767
- **Award type:** 5
- **Project period:** 2023-07-15 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10857032

## Citation

> US National Institutes of Health, RePORTER application 10857032, Examining racial disparities in fatal overdose, self-harm, and perpetrating assaults following law enforcement-mediated involuntary commitment (5R01MD018404-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10857032. Licensed CC0.

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