One in Twenty: Prevalence and Outcomes of Patients Brought to EDs Under Québec's P-38 Mental Health Act—A Retrospective Cohort Study: Un patient sur vingt : prévalence et résultats chez les patients ayant été admis au service des urgences en vertu de

Introduction In Quebec, the P-38.001 Act (P-38) allows police officers or crisis workers, under exceptional circumstances, to bring individuals at risk of harming themselves or others to the Emergency Department (ED) against their will. Data on the application of this Act remains limited. Objectives We aimed to determine the prevalence of P-38 use among ED patients with mental health presentations and to compare their characteristics, clinical course, and outcomes with those who sought care voluntarily. Methods We conducted a retrospective cohort study using a Public Health Agency of Canada–approved mental health database. Patients aged ≥14 years presenting to 5 EDs for mental health reasons in 2020–2021 were included. The main outcome, enforcement of P-38, was abstracted from medical charts. Information on care trajectory and management was also collected. Relative risks (RR) were estimated using modified Poisson regression with robust variance. Results Among 15,021 mental health–related ED visits, 860 (5.7% [95% CI: 5.4-6.1]) involved enforcement of the P-38 Act. Mean age was 41.1 ± 16.5 years, with 46.1% aged 25-44, and 54.4% being male. Most lived independently (85.4%), arrived by ambulance (80.5%), and had a documented mental health history (92.2%). A higher proportion were materially deprived ( P = 0.020). Compared with patients who voluntarily consulted in the ED, those under P-38 were more likely to be restrained (RR: 1.68 [95% CI: 1.45-1.94]), placed under preventive confinement (RR 3.41 [95% CI: 2.96-3.93]), receive multidisciplinary assessment (RR: 1.70 [95% CI: 1.59-1.80]), and be hospitalized (RR: 1.36 [95% CI: 1.24-1.48]). Conclusion Enforcement of P-38 accounted for nearly 6% of mental health–related ED visits, disproportionately affecting materially deprived individuals in early to mid-adulthood with prior mental health disorders. Our findings suggest a reliance on coercive and short-term measures, underscoring the need for targeted policy efforts to expand community-based crisis intervention alternatives for this vulnerable population.