Authors: Natalia Emanuel, Pim Welle, and Valentin Bolotnyy
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Staff Reports
A Danger to Self and Others: Health and Criminal Consequences of Involuntary Hospitalization
Number 1158
July 2025
July 2025
JEL classification: I18, I12, K14
Involuntary hospitalization of people experiencing a mental health crisis is a widespread practice, 2.4 times as common as death from cancer and as common in the U.S. as incarceration in state and federal prisons. The intent of involuntary hospitalization is to prevent individuals from harming themselves or others through incapacitation, stabilization and medical treatment over a short period of time. Does involuntary hospitalization achieve its goals? We leverage quasi-random assignment of the evaluating physician and administrative data from Allegheny County, Pennsylvania, to estimate the causal effects of involuntary hospitalization on harm to self (proxied by death by suicide or overdose) and harm to others (proxied by violent crime charges). For individuals whose cases are judgment calls, where some physicians would hospitalize but others would not, we find that hospitalization nearly doubles both the probability of dying by suicide or overdose and also nearly doubles the probability of being charged with a violent crime in the three months after evaluation. We provide evidence of earnings and housing disruptions as potential mechanisms. Our results suggest that, on the margin, the system we study is not achieving the intended effects of the policy.
Author Disclosure Statement(s)
Natalia Emanuel
The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://newyorkfed.org/research/staff_reports/index.html.
Pim Welle
The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://newyorkfed.org/research/staff_reports/index.html.
Valentin Bolotnyy
The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://newyorkfed.org/research/staff_reports/index.html.
The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://newyorkfed.org/research/staff_reports/index.html.
Pim Welle
The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://newyorkfed.org/research/staff_reports/index.html.
Valentin Bolotnyy
The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://newyorkfed.org/research/staff_reports/index.html.
Suggested Citation:
Emanuel, Natalia, Pim Welle, and Valentin Bolotnyy. 2025. “A Danger to Self and Others: Health and Criminal Consequences of Involuntary Hospitalization.” Federal Reserve Bank of New York Staff Reports, no. 1158, July. https://doi.org/10.59576/sr.1158
Emanuel, Natalia, Pim Welle, and Valentin Bolotnyy. 2025. “A Danger to Self and Others: Health and Criminal Consequences of Involuntary Hospitalization.” Federal Reserve Bank of New York Staff Reports, no. 1158, July. https://doi.org/10.59576/sr.1158
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