The Emerging Role of Police in Facilitating Psychiatric Evaluation Since the 2013 Implementation of the First Chinese Mental Health Law

In 2013, China’s first Mental Health Law (MHL) took effect, with the goal of better protecting patients’ rights. Under the law the police, with appropriate training, rather than family members, employers or medical staff sent from a hospital, are the ones who bring persons in behavioral crises to medical facilities for psychiatric assessment for possible involuntary hospitalization. We examined the proportion and distinctive characteristics of persons brought to psychiatric emergency services (PES) by the police since the implementation of MHL. We used medical records to document demographic and clinical characteristics of all persons evaluated at the PES of the Guangzhou Psychiatric Hospital, the largest psychiatric hospital in China’s fourth largest city, from April 2017 to August 2017. Bivariate and multivariate statistical analyses were performed to identify characteristics of patients brought to the PES by the police. Among 1515 PES visits, 166 (11.0%) were brought by the police as compared to virtually none in the years before the law took effect. Compared to non-police referrals, police referrals were associated with male gender, age greater than 30, more documented violent behavior, greater likelihood of having been restrained, and higher rates of hospital admission after assessment. Assessed risk of suicidality and diagnoses of substance use disorder were not significantly associated with police referral. A modest but increased and noteworthy proportion of patients evaluated at the PES after implementations of China’s MHL were brought by the police, especially those with violent behavior requiring restraint and hospitalization resulting from mental illness.