Involuntary Psychiatric Hold Duration and Trauma-Related Re-presentation Among Kenyan Survivors: An Instrumental-Variable Analysis of Mental Health Detention Bed Availability

Kenyan survivors of trauma who are detained involuntarily under the Mental Health Act face a detention system in which the length of the hold is determined less by clinical need than by the availability of psychiatric beds. The analysis is conceptual and methodological: no primary data were collected, and the paper does not report empirical estimates. Instead, it specifies the conditions under which bed availability satisfies the exclusion restriction, formalises the complier subpopulation for whom the instrument is informative, and derives the bias that arises when bed scarcity compresses holds below the clinically indicated threshold. The framework is illustrated with reference to the Kenyan detention estate and to the DHS Program indicator on contraceptive knowledge, which is used here only to characterise the survey infrastructure on which such a study would depend. Bed availability is a defensible instrument only under a narrow set of institutional conditions, and that the resulting estimate identifies a local average treatment effect for survivors whose hold length is sensitive to bed supply. The contribution is a specification that makes the identifying assumptions explicit and testable, together with a set of falsification tests that a future empirical study would need to pass.