Electronic Health Record–Integrated Legal Documentation to Measure Involuntary Mental Health Detention of Children

Abstract

Objective

To examine the prevalence and correlates of child involuntary mental health detentions through evaluation of legal documentation embedded in medical records and children’s electronic health information.

Method

Medical records were analyzed from 3,440 children ages 10 to 17 years with MH-related emergency department visits in a large academic health system over 2 years (2017-2019). Bivariate analyses and random forests were deployed to identify child-, neighborhood-, and systems-level correlates of involuntary MH detentions.

Results

Nearly 1 in 4 (n = 769, 22.4%) visits involved an involuntary detention. Half of detained children (n = 357, 46.4%) arrived on a detainment that was discontinued after MH provider evaluation. Odds of detention were greater among Black (odds ratio 1.33 [95% CI 1.02-1.73]) and publicly insured (odds ratio 1.63 [95% CI 1.37-1.94]) children. Children detained in prehospital settings resided in census tracts with greater social vulnerability scores (χ² 13.42, p < .001). Machine learning classifiers (area under the curve 0.83, [95% CI 0.81-0.84]) revealed that strongest indicators of detainment included psychiatric chief concern, prior year psychiatric hospitalization, Social Vulnerability Index, and ICD-10-CM code for suicide or self-harm.

Conclusion

Medical record–embedded legal documentation supports transparency in the use of detentions, which are common and jointly predicted by children’s clinical need and social vulnerability.

Plain language summary

Study finds that clinical need and social vulnerability jointly predict child involuntary mental health detention. Linking electronic-format detainment orders to emergency department (ED) health records within a large urban health system in Los Angeles, the team discovered factors associated with detainment including suicide-related diagnoses, use of antipsychotic medications, history of psychiatric hospitalizations, child’s age, location of the ED visit, and neighborhood social vulnerability. Findings highlight the growing role of informatics in understanding critical emergency care processes in child psychiatry.