(with Natalia Emanuel, New York Federal Reserve Bank; Pim Welle, Allegheny County Department of Human Services)

The involuntary hospitalization of people experiencing a mental health crisis is a widespread practice across the US, as common as imprisonment in state and federal prisons. The intent is to prevent individuals who pose a danger to themselves or others from engaging in damaging behavior through incapacitation and treatment over a short period of time. However, the causal impacts of involuntary hospitalization are unknown. We leverage quasi-random assignment of the evaluating physician and administrative data from Allegheny County, Pennsylvania to estimate the effects of involuntary hospitalization on harm to self and others. For individuals whom some physicians would hospitalize but others would not, we find that hospitalization increases the probability of dying by suicide or overdose and of being charged with a violent crime in the six months after evaluation. Our results suggest that the system we study is hospitalizing too many individuals.