The association between monthly social assistance disbursement days and emergency department visits for trauma, mental health, and substance use.

Abstract

OBJECTIVE\nSocial assistance helps fulfill the basic needs of low-income individuals. In British Columbia, social assistance is issued on the third or fourth Wednesday of every month. However, this sudden influx of resources may have negative health consequences. We investigated social assistance timing and emergency department (ED) visits related to trauma, mental health, and substance use.\n\n\nMETHODS\nWe conducted a retrospective multi-centre observational study using 12\xa0years of regional ED data from Vancouver, British Columbia (2008-2020). Each cheque week (the week following social assistance disbursement) was matched to a single control week (2\xa0weeks prior to cheque week). We compared the number of ED visits for trauma, mental health, and substance use during cheque weeks versus control weeks.\n\n\nRESULTS\nThere were 253,360 visits during all weeks of interest. Cheque week was associated with significantly more ED visits for mental health and substance-related presentations (RR 1.07, 95% CI 1.03-1.11, p\u2009=\u20090.0006). These visits increased significantly for both males and females and for adults aged 17-64\xa0years. Mental health and substance-related visits increased on the day of cheque disbursement (Wednesday) and the 4\xa0days following (Thursday-Sunday). Trauma-related ED visits were elevated on the day of cheque disbursement, but not during other days of the week.\n\n\nCONCLUSIONS\nSocial assistance disbursement is followed by an increase in mental health and substance-related ED presentations and may be associated with an increase in trauma presentations on the day of cheque disbursement. These findings support calls for clinical and policy-level changes and support to reduce cheque day-associated harm.