Psychiatry Boot Camp Involuntary Psychiatric Treatment in Modern Psychiatry with Dr. Dinah Miller
Jan 26, 2026
Dinah Miller, psychiatrist and author of Committed, blends clinical experience with policy analysis. She discusses civil versus forensic commitment, how emergency holds and outpatient orders work, and why evidence on safety effects is limited. The conversation covers system failures like ED boarding, advocacy battles over coercion, and ways to humanize involuntary care while wrestling with ethical tensions.
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Deinstitutionalization's Unfinished Promise
- Deinstitutionalization cut psychiatric beds from ~550,000 to ~44,000 while population rose, but promised community supports often never materialized.
- The result dispersed needs into jails, homelessness, and underfunded community systems rather than a simple transfer of the same patients.
Childcare In Old State Hospitals
- Dinah Miller recalled a state hospital superintendent's family story where patients once babysat children, illustrating past normalization of institutional care.
- She used the anecdote to show how earlier hospitals differed drastically from modern expectations and ethics.
Limited Evidence On Public Safety Effects
- There is limited evidence that easier involuntary treatment reduces public violence or suicide because trials would be unethical and data are confounded.
- Social factors like gun laws, housing, and systemic variables complicate causal claims linking mental illness and mass violence.
