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(September 10, 2019) Collecting and analyzing outcome data for public programs, especially those related to the treatment of severe mental illness, is vital for making evidence-based policy decisions. Having reliable information about a program’s effects allows policymakers to determine whether the program is actually helping who it is supposed to help and takes some of the guesswork out of making improvements.

In a recent report, public officials in King County, Washington outline some key outcomes of the county’s Involuntary Treatment Act (ITA) Court, the legal entity overseeing court-ordered mental health treatment for its residents. The King County ITA system involves all procedures relevant to individuals who may be civilly committed for treatment in a hospital or other treatment setting, based on whether he or she meets commitment criteria.

Among the findings, the analysis showed that a notable percentage of individuals return to the ITA system relatively quickly after a given treatment period. More than one-quarter (28%) of individuals have a new ITA case, or a new period of evaluation for involuntary treatment, within a single year of discharge. Even more (40%) have a new case within three years.

The results echo Treatment Advocacy Center research on the ‘revolving door phenomenon,’ in which individuals with serious mental illness move in and out of emergency departments, hospitals, and correctional facilities, never receiving adequate treatment to maintain stabilization after a psychiatric crisis.

Digging deeper, the authors identified a number of personal characteristics that influence a person’s likelihood of returning to the ITA system. Prior ITA cases, housing instability, and race were all associated with increased likelihood of return to the ITA court.

• More than half (52%) of individuals who were experiencing housing instability at the start of the ITA process returned within three years, compared to 36% of those not experiencing housing instability.Nearly three-quarters (73%) of individuals with three or more past cases returned to the ITA system within three years of ending a treatment period, compared to one-quarter (25%) of individuals with no case history. However, individuals with any number of prior ITA cases experienced increased rates of return to the ITA court.
• Half (50%) of individuals from most minority racial groups, including those recorded as American or Alaska Native, Black, Native Hawaiian or Pacific Islander returned to the ITA system within three years, while 36% of individuals recorded as White returned within the same time period.
• The findings could be indicative of healthcare disparities present outside the ITA system, according to the authors. For example, accessing the treatment necessary to prevent psychiatric crises and maintain stabilization after an initial treatment period may be more difficult for certain racial groups due to systemic inequalities and hurdles. Regarding the high rates of return to the system in general, the authors discuss concerns that the ITA process may not be providing some individuals with adequate care.

However, they also note the nuance involved in  drawing conclusions from this data. In this particular analysis, repeated engagements with the involuntary treatment system reflected an individual’s decompensation or declining health in the community. But in some ways, a person’s return to the ITA system signals that the process is working as intended, consistently providing additional evaluation and treatment when individuals experience subsequent psychiatric crises.

Overall, the data provide valuable information about the population involved in King County’s ITA system and represent an avenue for policymakers to better understand and improve upon public policies designed for individuals with severe mental illness. Other localities with comparable programs should consider similar data collection to allow for meaningful comparisons and further broad-scale policy development.

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