New research calls for improved mental healthcare after police shootings

Toronto, ON, September 28, 2023 – Adults who survive a police shooting have a threefold increase in healthcare costs over five years after the event compared to those surviving non-firearm law enforcement injuries, according to new research.

The study, led by researchers at ICES and Sunnybrook Health Sciences Centre, showed that rates of disability were similar after a shooting compared to other forms of police enforcement. Long-term medical costs, in contrast, were much higher after a shooting. The main contributor to long-term costs was mental illness rather than surgical complications.

The researchers caution the study is not a commentary on police training, staffing, supervision, funding, or whether the use of force was justified.

“I practice medicine at Canada’s largest trauma centre and treating patients after a police shooting is nothing like what’s shown in movies,” says senior author Dr. Donald Redelmeier, a physician at Sunnybrook Health Sciences Centre and a scientist at ICES and Sunnybrook Research Institute. “There is none of the defiance, anger, or revenge. Instead, patients come across as deeply defeated, emotionally hopeless, and awfully depressed.”

The study analyzed health records at ICES for adults who were injured by police and required emergency care between April 2002 and March 2022 in Ontario, Canada. The cohort included 13,545 adults, of which a total of 178 were injured from a shooting (1.3%). Detailed long-term healthcare cost data were available on 8,755 individuals after five years of follow-up (accounting for reporting delays).

Study findings showed:

1. Patients surviving a shooting had three times higher average healthcare cost per year relative to those surviving other injuries by police ($16,223 versus $5,412).
2. The largest cost contributor was inpatient mental healthcare that averaged $10,573 annually after a police shooting and $1,348 annually after other control injuries.
3. About one in five individuals injured in any police intervention became permanently disabled within five years of the event.
4. The annual healthcare costs for those injured from a shooting were about tripled compared to before the shooting and averaging an extra $10,000 each year.
5. Men represented 86 per cent of those injured, 93 per cent of those shot, and nearly 100 per cent of those who died.
6. Acute costs were also much higher after a shooting including the need for surgery, critical care, blood product transfusions, and total days in hospital.

An important limitation of the study is that total costs did not account for legal fees, lost employment, possible incarceration, or other ripple effects in the community.

“In addition, the study examined correlations, cannot establish causality, and does not distinguish whether mental illness incited a police shooting or whether a police shooting worsened a mental illness,” says study author Dr. Sheharyar Raza, a University of Toronto postgraduate fellow in transfusion medicine. “Irrespective of mechanism, the disability and mental illness can last for years”.

“Police shootings receive a lot of attention, yet media reports focus on fatal cases with less attention to those injured and who do not die,” says Dr. Redelmeier. “We know from military medicine that early treatments can be effective for armed forces personnel injured in combat to reduce PTSD, anxiety, depression, or other complications. This suggests early psychiatric care might also help survivors of a police shooting.”

The study, “Costs for long-term healthcare after a police shooting in Ontario, Canada” was published in JAMA Network Open.

Authors: Raza S, Thiruchelvam D, Redelmeier DA.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on X, formerly Twitter: @ICESOntario

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