RESEARCH WEEKLY: No Accountability Without Data 

By  Elizabeth Sinclair Hancq

Accountability means being responsible for one’s actions. This could mean an obligation to justify a decision or the ability to explain an action.  

We hold politicians accountable for their decisions at the ballot box. Because they are elected officials, we can vote them out of office.  

In a democratic society, government bodies should likewise be accountable to the public for its decisions and actions.  

Accountability and trust in government go hand-in-hand. Trust is vital between citizens and their government, especially when policies depend on responses by the public. Lack of trust compromises public relations and makes government problem solving societal issues almost impossible.  

The Office of Research and Public Affairs has long been calling for accountability in data availability for severe mental illness. In December of 2016, we met with leaders at the Substance Abuse and Mental Health Services Administration about the significant  gaps in data  and research on severe mental illness.  

Data is essential for this trust and accountability. Without it, there is no way to know if policies are successful or that achievement metrics are being met. Data is also vital for reforms because it can highlight inequities or problem areas that otherwise would be unknown.  

Data for civil commitment  

Dr. Nathaniel P. Morris, a psychiatrist at Stanford University, writes in a recently published article in  Psychiatric Services  about the need for public tracking of civil commitment in the United States. Public tracking of this data in the United States is essential for accountability and reform, he argues.  

There are a host of reasons as to why there currently exists no publicly available, national data on civil commitment in the United States. Chief among those reasons is the fragmented system of care for people with mental illness in the United States; the decentralization and variation between systems makes national data collection difficult. Also, civil commitment laws vary by state and can vary in practice from one locality to the next. Further, patient privacy laws limit access to patient records.   

Morris offers several arguments for  improving public tracking of civil commitment. He suggests that public tracking of civil commitment will help to increase the public’s understanding of civil commitment and the associated laws. This understanding is important not only because of a public citizen’s role in influencing policy making through voting in elections but also because they or their family members may be subjected to the laws when in need of psychiatric treatment.  

“Improved public tracking of civil commitment might help individuals navigate these laws,” Dr. Morris writes. “In many places, patients and their families might ask simple, important questions about civil commitment (e.g., ‘How long does involuntary hospitalization typically last?’ or ‘How frequently are civil commitments overturned during hearings?’), to which first responders, clinicians, judges, and other authorities may not have accurate answers.”  

The Treatment Advocacy Center began working 22 years ago to improve laws and procedures of civil commitment. Publicly available data of civil commitment from state and federal mental health systems are needed to ensure government entities and their contractors are providing appropriate psychiatric treatment. Without data on trends and inequities of how mental health providers and judicial systems use or do not use civil commitment, policy makers or practitioners cannot make evidence-based decisions. States should establish systems for collecting and publishing data on civil commitment to ensure accountability and inform decision making.  

Elizabeth Sinclair Hancq is the director of research at the Treatment Advocacy Center.