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

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. 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. 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. 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.