Content warning: This story includes descriptions of suicidal thoughts and behavior.
Shyheim Banks stood on the Mon Wharf as dusk fell over the river. He was holding a gun to his head and a cell phone to his ear, pleading with the emergency dispatcher to send an ambulance before he pulled the trigger. It was the day after Thanksgiving in 2017. He was 21 years old.
Banks was heartbroken over a breakup and was struggling to adjust in a new job. He knew he needed help and sought treatment at three local hospitals, including UPMC Western Psychiatric Hospital, where he was diagnosed with acute depressive disorder and prescribed the antidepressant Zoloft. It wasn’t enough to keep him off the ledge and may even have pushed him toward it, he said, describing how hospital staff spoke to him like he was “beneath them.” And he suspects that Zoloft increased his suicidality — a known side effect of the medication.
Banks stood on an isolated part of the wharf, on the phone with the dispatcher, waiting for the ambulance he thought was coming. Instead, several police cars pulled up. They cuffed him and took him to UPMC Shadyside, he said, where one of the officers filed a petition to involuntarily hospitalize him, which was upheld. He was transferred to UPMC McKeesport — the only facility with an available bed — where his hold was extended to nearly two weeks.
What Banks experienced is known as a “302” — the section of Pennsylvania’s Mental Health Procedures Act that empowers anyone to petition for the involuntary hospitalization of a person whom they believe needs emergency psychiatric care. It’s a controversial practice that can both help and harm — and did both, in different ways, in Banks’ case.
In judgment-call cases in which some doctors would approve involuntary commitment but others wouldn’t, a 302 nearly doubles an Allegheny County resident’s risk of dying by overdose or suicide, or being charged with a violent crime, according to a recent research paper co-authored by a data scientist at the county’s Department of Human Services.
Black people like Banks bear the brunt of the system’s failures: They represent 32% of the 302 population, but just 13% of the county’s total population. They’re also less likely to access outpatient care and other services in the community, wrote a spokesperson for the Allegheny County Department of Human Services [ACDHS], noting it has reported these racial disparities for years, most recently in a 2023 analysis.
The department touted its progress on 16 interventions to narrow those disparities, including plans for a new peer respite center and a program launched in December that routes 911 calls to “behavioral health first responders” instead of police. All aim to reduce “crisis and institutionalization” and increase “community-based pathways to treatment,” the spokesperson wrote.
Shyheim Banks, of Duquesne, who goes by his artist name Treble NLS, stands for a portrait on the Mon Wharf as seen through the reflections in a piece of glass, Aug. 18, in Downtown. (Photo by Stephanie Strasburg/Pittsburgh’s Public Source)
Assisted outpatient treatment [AOT] is “aligned with these same tenets,” she added. It’s one of the most contested options the county is considering for people who refuse psychiatric treatment. It’s a legal tool for court-ordered treatment in the community and isn’t backed by a robust and conclusive scientific literature. No Pennsylvania county has been able to get a program off the ground since AOT became state law in 2018.
Some experts aren’t convinced that AOT can help achieve the county’s goals. They pointed to racial disparities in New York state’s program, which started in 1999 and offers the most comprehensive dataset. There, according to an analysis released in March by New York Lawyers for the Public Interest, 38% of current involuntary outpatient commitment orders involved Black people, who make up only about 18% of the population.
Similar disparities would likely manifest anywhere in the United States, where structural racism and anti-Black prejudice are deeply rooted in society, said Kyaein Connor, a professor in the School of Social Work at the University of Pittsburgh and director of its Center on Race and Social Problems.
An AOT program here would have “the potential to replay the same structural racism or even deepen it,” said Nev Jones, an associate professor in the School of Social Work at the University of Pittsburgh and an expert on psychosis interventions, who is studying AOT in New York. She urged the county to approach “yet another coercive intervention with so much caution” and to “consider alternatives.”
A psychiatrist in McKees Rocks said “AOT is a form of institutionalization to a degree,” noting it’s aligned with the criminal legal system in other jurisdictions. “By virtue of just who is being overrepresented in the incarcerated population, AOT is going to, by default, have a significant disparity in terms of who is being recommended,” said Daniel Salahuddin, who practices at the Sto-Rox Family Health Center.
The ACDHS spokesperson said the county is “planning for safeguards against any additional interactions with the justice system” if AOT orders are issued here, but didn’t detail them.
Experiencing a mental health crisis while Black
Banks, now 29, is a “multi-hyphenate,” Emmy-winning artist who performs under the name Treble NLS. He’s a former teaching artist for the advocacy group 1Hood, with a range that includes hip-hop recordings, screenwriting, theater and “whatever medium is at my disposal.”
Raised in Homewood, Banks showed no signs of serious mental illness as a child or teen, but sank into a depression as a young adult — particularly after recognizing that he had hurt people he was close to.
Shyheim Banks, of Duquesne, stands for a portrait on the Mon Wharf, Aug. 18, in Downtown. He’s an Emmy-winning artist known as Treble NLS, whose work spans multiple mediums. (Photo by Stephanie Strasburg/Pittsburgh’s Public Source)
Black people suffer from depression at a lower rate than white people, but research shows their illness is often worse and more difficult to treat. “If you’re being marginalized at every turn … that’s going to have a profound impact on your mental health,” said Salahuddin, who’s also an assistant professor of family medicine at the University of Pittsburgh.
Banks detailed what worked and what didn’t across his experiences in the county’s mental health system, which include crisis response, 302 commitment and voluntary care both before and after involuntary hospitalization.
Before his commitment, a Western Psych psychiatrist warned him about about the risk — higher among young people — of becoming suicidal on Zoloft, and told him to return immediately if he noticed that side effect. He said he didn’t because he couldn’t take more condescending treatment from providers.
Asked about physician training around anti-racism, cultural awareness and the unique needs of Black patients, a UPMC spokesperson didn’t provide details, but wrote: “Our clinicians across our system strive to better understand all experiences that shape mental health. This work is essential to building trust and delivering care that affirms the dignity of every individual we serve.”
Assisted outpatient treatment, or AOT, hasn’t caught on in Pennsylvania and county officials say they “grappled” with evidence from other states before signaling their intention to proceed.
The medical mistrust Banks and others have felt “is a legacy of historical trauma,” said Connor. She described “emotional and psychological wounding that’s been passed down through generations due to massive group trauma.”
It’s “led many people of color to avoid seeking care,” added Connor, who researches the drivers of disparities in mental health service use among racial and ethnic minorities.
That historical trauma includes the racist origins of American psychiatry, which gave scientific legitimacy to the “happy slave” myth during the Antebellum Period, then pathologized the behavior of free Black people following Reconstruction. It paved the way for mass institutionalization in segregated facilities in the 20th century. And schizophrenia — once associated with white, middle-class women — became known in the field as a Black man’s disease in an effort to discredit the Civil Rights and Black Power movements of the 1960s and ‘70s.
Experts said this history casts a long shadow over involuntary treatment in the public mental health system.
“There’s the reality that Black people tend to be treated with much greater brutality or punitive responses once in the system,” said Nev Jones, including “disproportionately high use of older-generation antipsychotics at much higher doses, with much higher rates of negative side effects.”
They’re also “more likely to be put in seclusion and restraint, much more likely to experience inpatient settings [and] involuntary medication injections” for sedation, she said.
Those petitioned for involuntary hospitalization in Allegheny County were disproportionately Black, but the rates of petitions being upheld by physicians were similar across races, the 2023 ACDHS analysis found. Men were also disproportionately likely to be subjected to an evaluation, though petitions across men and women were upheld at similar rates. White people had a higher upheld rate (79.8%) than Black people (75.2%).
That rate still leaves Black people far more likely to be involuntarily hospitalized because they are much more likely to be subjects of petitions.
When police initiate a 302
Without a provider to intervene over his increasing suicidality on Zoloft, Banks ended up at the wharf. The response to his 911 call could have been disastrous, he said, and left him “shook,” and then subject to an involuntary care order. Banks is glad alternative responses are possible now, but is wary of police involvement in that program.
Most types of involuntary treatment “have the potential to greatly increase police involvement in people’s lives,” said Jones. That could be deadly for Black people, who face higher rates of use of force and police misconduct. Being victimized by police is even a risk factor for psychosis among those with serious mental illness, she added.
Shyheim Banks, of Duquesne, known as Treble NLS, stands among the bike paths of the Mon Wharf, Aug. 18, in Downtown. (Photo by Stephanie Strasburg/Pittsburgh’s Public Source)
Police officers have significant power in the 302 process, said Miracle Jones, director of advocacy and policy at 1Hood. Unlike private citizens, an officer can make a judgment call about someone’s behavior and take them to the hospital for an evaluation without applying for a warrant.
“You’re not able to immediately advocate for yourself, because once the police officer makes that determination, the only other person who can make determinations that set you free is that medical professional, right?” she said. “And so it is a very scary process.”
As Allegheny County moves toward assisted outpatient treatment, or AOT, for people with serious mental illness, officials are grappling with a shortfall in attorneys prepared to defend those facing involuntary care petitions.
It’s unclear if law enforcement will play a role if AOT is implemented here. State law bars courts from holding a person in contempt if they refuse to adhere to treatment under an AOT order. But courts can order an evaluation for a 302, which may involve law enforcement taking the person to a hospital.
New York courts, also unable to impose civil penalties, have made the possibility of involuntary inpatient commitment a core part of AOT enforcement. It’s called a “pick-up order,” said Sunny Aslam, a psychiatrist who’s worked in a state hospital there and provides street medicine and other low-barrier care, mostly to people of color, in Syracuse and its surrounding areas. Onondaga County asked him to issue one, but he refused, comparing the practice to jailing “a person against their will.”
A hospitalization that both helped and harmed
Banks said his stay at UPMC McKeesport was one of the few times he was treated with kindness by hospital workers.
“The nurses talked to me like I was a human and helped me see that I have redeemable qualities,” he said. They encouraged him to go to group therapy sessions with other patients — a resource he found “life-changing” and wished he could have accessed sooner.
But he didn’t have a good experience with the psychiatrist. He wasn’t eager to try more medication after his experience with Zoloft, but she insisted. “She was like, ‘I don’t think you realize how serious your situation is,’” he said. “‘You were 302’d by police, so you can either take the medication, or we’ll have to hospitalize you for longer.’”
He didn’t want a prolonged hospitalization, so he felt coerced into taking the medication, he said.
The psychiatrist worked with him to create “a safety plan” to facilitate his recovery. It included regular therapy sessions, identifying people he can reach out to in a crisis and restricting access to guns and other objects he might use to hurt himself.
“I’m not gonna lie, this was the first time hospitalization actually ended up being helpful for me,” he said, though he would describe his overall experience as “mixed.”
But problems were waiting for him outside the hospital walls. Before the crisis, he worked 5 a.m. barista shifts. He asked to be put back on the schedule, then reconsidered. As a night owl, he felt the early starts had contributed to his destabilization.
The county and allied researchers zoomed in on some 40% of involuntary hospitalizations over a decade and found a trail of violence, overdose and suicide where stabilization and healing had been the goal.
Without a steady income, he had to move back in with his mother. They were evicted when she missed rent a few months later and had to couch surf until they could get on their feet.
The disruptive effects of an involuntary commitment can be even more dire, as researchers documented in the July analysis of Allegheny County 302s. It hypothesized that “earnings and housing disruptions” may be to blame for the high rates of suicide, overdose and incarceration found in patients hospitalized in “judgment-call” 302s.
Water splashes along the edge of the Monongahela River as Shyheim Banks, known as Treble NLS, stands for a portrait along the Mon Wharf, Downtown, on Aug. 18. Art “gave me hope,” he said. “I was like, ‘Oh, things are possible that I didn’t even know.’” (Photo by Stephanie Strasburg/Pittsburgh’s Public Source)
The hospital didn’t set him up for success in therapy, he said.
UPMC McKeesport referred Banks to a white therapist who “ain’t know nothing about the Black experience,” he said. “I would tell him about my life and he would act all appalled. And then I would have to take the time to explain certain circumstances I had to endure as a Black person in America. Sometimes he still wouldn’t understand after I explained it to him.”
What Banks went through is yet another system failure that could have deterred him from seeking therapy, experts said. “The number of mental health care providers who are also people of color is incredibly small,” said Connor, the Pitt social work professor. “So, Black folks and Asian Americans in particular have an incredibly difficult time identifying a clinician who they feel understands them and … their cultural context.”
Banks wouldn’t find the right therapist until starting his 1Hood job in 2018, which connected him with resources like Vision Towards Peace, a counseling practice almost entirely staffed by Black women, and Steel Smiling, a nonprofit that connects Black people with community-based mental health supports. The group paid for his initial therapy sessions.
After years of therapy, Banks feels he’s fully recovered. He made a decision with his therapist this year to discontinue treatment. He no longer had major issues to unpack in his sessions because he was equipped with the tools to remain stable.
He’s thriving as the multi-talented artist Treble NLS: He’s recorded studio albums and put on a digital performance for City Theatre called “Treble Minded,” which is a “therapy-style” conversation with himself. And he won a regional Emmy in 2021 for a visual poem titled “Don’t Clip our Tails,” which is an act of resistance against forced assimilation. He wrote the poem at the height of the George Floyd protests in 2020 and collaborated with Public Source to visualize it.
Art “gave me hope,” he said. “I was like, ‘Oh, things are possible that I didn’t even know.’”
Venuri Siriwardane is the health and mental health reporter at Pittsburgh’s Public Source. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
The Jewish Healthcare Foundation has contributed funding to Public Source’s health care reporting.
This story was fact-checked by Ayla Saeed.
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