Abstract for: Understanding and Mitigating Impacts of Involuntary Psychiatric Hospitalization in the Context of Recent U.S. Policy Reforms

Involuntary psychiatric hospitalization (IH) is increasingly used to manage serious mental illness and crisis in the U.S., particularly among vulnerable populations. Recent policies loosening commitment criteria cite protective benefits, yet emerging evidence suggests IH may have unintended and iatrogenic consequences that increase rates of recurring crisis and readmission. SD offers a framework for structural analysis of this tension and "revolving door" dynamic. Drawing on data from lived perspectives of crisis care quality, we facilitated three exploratory GMB sessions to test SD's applicability to our research program. Sessions generated dynamic and feedback insights, a preliminary CLD, and policy lever analysis. We then conducted a literature review to iterate and empirically validate a parsimonious CLD representing the salient mechanisms underlying IH's impacts over time. The effect of IH on distrust, follow-up care (dis)engagement, recovery, and readmission was operationalized in a simulation model. The CLD depicts the revolving-door dynamics through the "fixes that fail" archetype: IH as a short-term solution to psychiatric and social risks that generates long-term multilevel consequences. Five reinforcing mechanisms were identified: betrayal trauma, distrust and disengagement in care, internalized shame and isolation, livelihood vulnerability, and social devaluation/marginalization. The simulation model operationalizes how mistrust from perceived coercion and betrayal from forced commitment becomes a key endogenous mechanism driving recurring crises and hospitalizations. Both models offer insights into how IH has become endogenous to the system it helps perpetuate and provide the groundwork for further research and policy testing. Next steps could include conducting mixed-method and longitudinal research to examine the consequences and mechanisms of IH and policy lever analysis to reduce readmissions, minimize reliance on coercive care, and improve health and social outcomes. Cut words from abstract