Social Determinants and Trends in Involuntary Psychiatric Detentions: A Decade of Population-Based Data

Involuntary psychiatric detentions have been increasing in Ontario, raising concerns about patient rights and health equity. Social determinants such as immigration status, indigeneity, housing instability, and socioeconomic disadvantage are known to contribute to this trend. However, population-level evidence on how these factors influence involuntary admissions remains limited.

Using data from the Ontario Mental Health Reporting System (2013-2023), the authors analyzed 53,088 adult psychiatric detentions. Sociodemographic and clinical variables from the Resident Assessment Instrument-Mental Health were assessed by logistic regression, adjusted for age, sex, psychiatric diagnosis, and previous psychiatric admissions. Joinpoint regression was used to evaluate temporal trends.

Involuntary admission and psychiatric assessment accounted for 28.2% and 25.2% of hospitalizations, respectively. Recent and long-term immigrants had significantly higher odds of involuntary admission (adjusted OR [AOR]=1.37 and 1.51, respectively). Indigenous identity was associated with increased odds of psychiatric assessment (AOR=3.06) but not involuntary admission. Postsecondary education lowered the risk for involuntary psychiatric admission (AOR=0.84). Homelessness and no income were associated with increased odds of psychiatric assessment (AORs=1.73 and 1.11, respectively) and with involuntary admission (AOR=1.87 and 1.43, respectively). Recent and long-term immigrants also had lower odds of psychiatric assessment (AOR=0.81 and 0.95, respectively). Annual involuntary admission rates increased by 3.3% over the decade.

Immigrants, homeless individuals, and those with lower education or income face disproportionate risks for involuntary psychiatric detention in Ontario. Policies that address upstream social determinants, such as housing and income support, and ensure culturally safe preventive care are needed to reduce coercion and promote equity.