Investigating the association between health vulnerabilities and police enforcement during the Covid-19 pandemic: A novel study using linked administrative data in Scotland.

Public health regulations introduced in response to the Covid-19 pandemic placed unprecedented restrictions on the U.K. public. To maximise compliance with the regulations, new policing powers were introduced enabling officers to issue Fixed Penalty Notices (FPNs) to those believed to have breached them. In Scotland, where over 20,000 Covid-FPNs were issued for regulatory breaches, police officers reported particular challenges dealing with non-compliance amongst people with health vulnerabilities involving mental illness and substance use. Health studies suggest that people with such conditions were most severely impacted by the pandemic in a whole range of ways; however, there are no existing studies on whether this includes police use of enforcement. Our study addresses this gap using linked administrative data from police and health organisations in Scotland. Using a case-control design, we found that people who had accessed health services for psychiatric conditions or substance use were more likely to have received a Covid-FPN, especially during the first lockdown. The strength of this association was greatest amongst people with multiple health conditions and those accessing health services both before and during the pandemic. The findings suggest the new policing powers impacted disproportionately on people suffering from mental illness and/or addictions and point to a previously unidentified justice inequality. This novel administrative data linkage study highlights the importance of taking health vulnerabilities into greater consideration when planning for future pandemic preparedness.