Association between mental health apprehensions by police and monthly income assistance (welfare) payments

Abstract

Objective: Social misconduct, increased police activity, and increased emergency department (ED) use are associated with monthly income assistance (welfare) payments. The relation, if any, between welfare payments and mental health and addictions presentations to the ED requiring police involvement remains unknown. Our purpose was to determine if a relation exists between mental health apprehensions (MHAs) by police and monthly welfare cheque distribution, and the association between monthly payments and mental health and substance-related ED presentations. Method: The Vancouver Police administrative database was analyzed during an 81-week period (June 8, 2011, to December 25, 2012). Comparisons were made between the numbers of MHAs by police during the week following welfare payment to those during nonpayment weeks. The weekly number of mental health and substance-related ED presentations were also analyzed during the study period. MHAs were analyzed continuously, and compared using the 2-tailed t test. Results: During the study period, 4009 MHAs occurred (range 1 to 18 MHAs/day). The mean weekly MHAs during welfare week was 54.6 (95% CI 51.75 to 57.45), compared with 48.6 (95% CI 46.35 to 50.85) during nonpayment weeks (P = 0.004). This translates to 85 MHAs annually related to welfare payments. Total mental health and addictions-related presentations to the ED were also significantly increased in the week following welfare payments (P < 0.001), and could not be solely attributed to increased MHAs by police. Conclusion: A statistically significant increase in the number of MHAs by police follows welfare payments. This is superimposed on a significant increase in overall mental health and substance-related ED presentations seen during the same period.