The medical management in police custody of alcohol dependent detained persons

The author devised a simple postal questionnaire which was sent to all of the UK members of the Association of Police Surgeons, requesting information about their management in police custody of alcohol dependent persons detained by the police. The questionnaire and the results are presented. The results are analysed. The detention by the police of alcohol dependent patients is dangerous as these patients are at risk of sudden death. Some of the relevant literature is considered and then a suggested management scheme for such a situation is proposed.     

Evaluation of problematic psychoactive substances use in people placed in police custody

Introduction and aimsIn France, the law states that any person held in custody could be examined by a doctor. The main objective of the medical examination is to give medical evidence of health compatibility with custody. This review identifies health risks such as addictive behaviour. We wanted to know which psychoactive substances are used in this particular population, and how problematic these uses are.Design and methodsA prospective, monocentric, open-ended study conducted via a structured questionnaire was carried out on detainees who reported having taken drugs or illegal substances. Practitioners investigated desired effects for each substance, and characteristics of use, by means of the dependence criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994). Problematic use was assessed when at least 3 items of the DSM IV were positive.Results604 questionnaires were examined. 90.7% of questionnaires reported tobacco use, 76.2% cannabis, 57.3% alcohol, 12.5% psychostimulants, 10.0% opiates and 0.7% benzodiazepines or Z-drugs. The frequency of problematic use was 74.6% for opiates, 44.9% for cocaine and 25.3% for cannabis. Compared to non-problematic users, problematic users were older, more likely to be jobless without financial means, more likely to have a medical history, including a greater likelihood of mental illness, and more chance of undergoing prescribed medical treatment. They included more women and more homeless people.Discussion and conclusionsThese results show characteristics of psychoactive substance use in a sample of people in custody. Psychoactive substances mentioned by respondents are not different from those observed in the general population, but for certain users, the desired effects are far from the pharmacologically expected ones. For some, taking substances seems to be part of their way of life, for others it is a means to compensate for an underlying feeling of uneasiness. Furthermore, problematic users present severity criteria which seem to be greater than in psychoactive substance users in the general population.     

Health needs of detainees in police custody in England and Wales. Literature review

The aim of this systematic is to review and analyse the literature concerned with the health needs of detainees in police custody in England and Wales.The healthcare of detainees in police custody is regulated by the England and Wales Police and Criminal Evidence Act 1984. The Faculty of Forensic and Legal Medicine of the Royal College of Physicians also sets quality standards for the provision of custodial healthcare. The provision of healthcare in custody presents a number of challenges including the patient group, the setting and the overlap between the legal and medical concerns that are addressed by the medical team. Currently, care to the detainees in custody is delivered by a mixture of private organisations, police-led forensic medical services and the NHS.A search of the PUBMED, EMBASE and PsycINFO databases undertaken using the search terms: (police custody) OR (detainees) OR (police detainees) yielded 830 publications. All of the titles were screened to identify potentially relevant publications concerned with the health needs of detainees in police custodies in England and Wales. There were no design specific criteria set for inclusion of the studies in this literature review. 77 articles were initially identified as relevant and obtained in full. After further analysis 28 publications were included in this literature review.A total sample of over 12,000 detainees was examined in this literature review. Approximately 20% of detainees seen by health care teams suffer from psychiatric conditions. On average, 50% of patients claim that they have problems with drugs and alcohol. Physical health conditions are also highly prevalent with up to 74% of detainees requiring regular medication. Forensic medical issues included the management of detainees who were restrained using handcuffs, irritant sprays and TASER. Detainees who are suspected of internal drug concealment also require intensive medical input. Injury documentation in custody is often requested for both the police officer and detainees.Current literature indicates that mental health problems including substance misuse and physical conditions are highly prevalent among the custody population and require both emergency and routine care. The current quality of the health-care services has been discussed and the need for improvement has been indicated by a number of agencies. Recent attempts have been made to incorporate the custodial services into the general structure of the NHS, aiming for more robust governance and standardization of services. Implementation of a routine health promotion service in custody has also been discussed which can be integrated into the general health care provision during detention.     

The management of opiate addicts in police custody.

Many suspects detained at police stations for questioning are under the influence of illicit drugs. This presents a problem, as the reliability of confessions made under the influence of drugs or whilst experiencing withdrawal symptoms may be adversely affected. This paper reviews the current management of opiate addicts in police custody and relevant legislation in the UK to highlight some of the difficulties that arise. It concentrates in particular on the specific problem of defining and assessing fitness for interview in this group and reviews the current evidence of the effect of opiates and opiate withdrawal symptoms on the reliability of testimony. It concludes that any framework for the assessment of fitness for interview must address the question of reliability. More needs to be known about the effects of opiates and opiate withdrawal symptoms on the reliability of testimony in the police interview situation.     

The functional health needs of older persons in custody: A rapid review

IntroductionThe number of older persons in custody is increasing and older incarcerated individuals have higher functional healthcare needs and higher healthcare costs. Consideration of available measures and interventions to address functional decline, are therefore imperative given the importance of disability to healthcare spending.PurposeTo identify the existing literature describing the functional health needs of older incarcerated individuals.MethodsThis rapid review synthesized existing literature on the functional health of older incarcerated individuals. Three electronic databases and two correctional service health-related journals were searched. Bibliographic searches of seminal articles and key authors were conducted for thoroughness.ResultsFifteen articles were retained in the final analysis. The methods of the included studies were heterogenous. Consideration of basic self-care (activities of daily living) and functional mobility were the primary ways of capturing functional health. The concept of ‘Prison ADLs’ emerged and measured the unique aspects of correction-specific functional activities.ConclusionsThis review identified the existing literature on how the functional health of older incarcerated persons is operationalized and measured, and how it is considered within this unique context. The concept of ‘Prison ADLs’ provides insight into the functional experiences of this population. Additionally, performance across PADLs typically declines before abilities across traditional ADLs.     

The identification and treatment of opiate users in police custody

All detainees admitted to seven London police stations were observed over a six-month period (n=2,947). Four per cent were identified as opiate users, although the actual percentage is likely to be much higher. Compared to the general population of detainees there were significantly more women among known opiate users and this group also contained a higher percentage of white detainees and people born in the British Isles. People born in continental European countries were also over-represented. A little more than half of known users did not reveal their use on arrival at the police station. At least 60% of known opiate users remained well throughout their detention, 30% were intoxicated through drugs at the time of their arrest, but only 13% displayed signs or symptoms of withdrawal during their detention. Overall, 65% of the known opiate users were seen by a police surgeon and of these 52% were given medication. All of those withdrawing were given drug treatment, but most of those who were intoxicated by opiates, or who remained well throughout their detention, received no medication. Of those given medication 86% received an opiate, dihydrocodeine being the commonest preparation, usually in association with a benzodiazepine. Despite the adoption of differing management paradigms among police surgeons, the actual medical treatment of opiate-using detainees was pragmatic and determined by individual need.     

Deaths in police custody during 1994: a retrospective analysis

This paper presents the results of a retrospective analysis of deaths in police custody from 1 January to 31 December 1994. During that year, there were 32 such deaths in the UK. For purposes of analysis, the deaths were grouped into three principal categories based on the frequency of their occurrence: deaths by hanging (12); deaths among those arrested for drunkenness (11) and other deaths (9). By considering the results of this study together with a comprehensive literature review, several strategies for reducing the frequency of deaths in police custody are proposed.     

The clinical management of substance misusers in police custody -- a survey of current practice

Large numbers of substance misusers are seen in police custody. Their management remains a significant part of a forensic physician's workload. Substance misuse, including alcohol, is a factor in a substantial number of deaths in custody. Guidelines have been produced on the acceptable minimum standards for assessment and treatment. The aims of this study were to determine the current attitudes and practice of forensic physicians to see whether there had been any change in practice since their publication. The results suggest that the majority of respondents had read the guidelines. However, there were still considerable variations in practice and circumstances where the minimum standards were not being achieved. Whilst 90% of respondents felt confident in dealing with substance misusers, many commented that further information on specific drugs and further training on management of substance misusers would be beneficial.     

Predictors of disability discharge disposition for Navy personnel with a mental health problem

This study examined the extent to which severity of mental health diagnosis and length of military service predict medical discharge disposition for Navy personnel (N = 1,450). Results corroborated the findings of a similar study related to back problems in which both severity and length of service were significant predictors. Examination of consistency of mental health diagnoses from time of hospitalization to last Physical Evaluation (PE) Board determination revealed that nonpsychotic primary diagnoses were likely to shift to psychotic diagnoses by the time of last PE Board determination. Last, the contribution of entitlement costs to the total costs of medical care are discussed.     

Healthcare issues of detainees in police custody in London,UK

Little is known about the general healthcare needs of detainees in police custody. The aims of this study were to: determine the level of general health issues, diseases and/or pathology for detainees in police custody, and to determine how well those general health issues, diseases and/or pathology are being managed. This was done by a detailed analysis of healthcare issues of a cohort of detainees and reviewing intended and prescribed medication needs with current medication availability. In August 2007, a prospective detailed, anonymised, structured questionnaire survey was undertaken of 201 detainees in police custody in London, UK. Of these 83.6% consented to participate in the study. 85.1% of subjects were male; mean age was 33.9 years; 70.8% had English as a first language; 13.7% were of no fixed abode; 70.2% were registered with a general practitioner (primary care physician); 25% were already in contact with other healthcare teams; 7.1% had previously been sectioned under the Mental Health Act 1983; 16.7% had previously intentionally self-injured; 33.9% were dependent on heroin, 33.9% on crack cocaine; 25% on alcohol, 16.6% on benzodiazepines and 63.1% on cigarettes. 56% of subjects had active medical conditions; of those with active medical conditions 74% were prescribed medication for those medical conditions; only 3/70 had their medication available. 28/70 were not taking medication regularly, and many were not taking it at all. Three subjects who had deep vein thromboses were not taking their prescribed anticoagulants and six subjects with severe mental health issues were not taking their anti-psychotic medication. Mental health issues and depression predominated, but there was a very large range of mixed diseases and pathology. Asthma, epilepsy, diabetes, deep vein thrombosis, pulmonary embolism, hepatitis, and hypertension were all represented. The study has achieved its aims and has also shown that – in part because of the chaotic lifestyle of many detainees – appropriate care was not being rendered, thereby, putting both detainee, and potentially others coming into contact with them, at risk.     

Guidelines for doctors attending detainees in police custody: a consensus conference in France

Medical practice in police custody needs to be harmonized. A consensus conference was held on 2–3 December 2004 in Paris, France. The health, integrity, and dignity of detainees must be safeguarded. The examination should take place in the police station so that the doctor can assess the conditions in which the detainee is being held. If the minimum conditions needed for a medical examination are not available, the doctor may refuse to express an opinion as to whether the detainee is fit to be held in custody or may ask for the detainee to be examined in a hospital. Doctors are subject to a duty of care and prevention. They should prescribe any ongoing treatment that needs to be continued, as well as any emergency treatment required. Custody officers may monitor the detainee and administer medication. However, their role should not be expected to exceed that required of the detainee’s family under normal circumstances and must be specified in writing on the medical certificate. Doctor’s opinion should be given in a national standard document. If the doctors consider that the custody conditions are disgraceful, they may refuse to express an opinion as to whether the detainee is fit for custody.     

武警某部新兵一般自我效能与心理健康的相关研究

 目的 分析武警某部新兵一般自我效能与心理健康的相关关系.方法 应用自我效能感量表(General Self-Efficacy Scale,GSES)、症状自评量表 (SCL-90),对1941名新兵进行测查.结果 男性新兵SCL-90各因子分及总分均低于2000年王家华的新兵常模、1999年王焕林的军男组常模、1986年上海协作组的地方常模(P＜0.05);自我效能与SCL-90各因子分和总分均有统计学负相关,且双尾检验(P＜0.01);高自我效能组和低自我效能组之间SCL-90各因子分和总分的差异性显著(P＜0.05),高自我效能组的SCL-90各因子分及总分的得分均低于低自我效能组.结论 通过提高自我效能有可能促进新兵心理健康.     

Near miss incidents in police custody suites in London in 2003: a feasibility study

INTRODUCTION: Potentially preventable deaths in police custody include those which involve illicit drugs, alcohol and deliberate self-harm. Near miss incidents (NMI) that did not result in death have a crucial role in understanding risk factors in custody. Such research has not previously been undertaken. A program of research has been developed to study NMI, in order to better identify those at risk in police custody. For the purposes of this research, NMI have been defined as 'an unplanned and unforeseeable or unforeseen event that could have resulted, but did not result, in human death or may have resulted in injury or other adverse outcomes'. It was intended that the definition although broad, would not include simple accidents (e.g. slipping on urine in a cell) or trivial injury. AIMS AND METHODS: The two aims of the study are (a) to determine whether it is realistic to attempt to assess NMI with the intention of identifying information of use in enhancing detainee care and (b) to assess how frequently NMIs occur and whether there are specific patterns. Pilot interviews were conducted with three forensic physicians practising in London, UK to create a structured questionnaire for all forensic physicians working in London. The questionnaire provided the basis of a retrospective recall survey of all forensic physicians working in London as Forensic Medical Examiners. The questionnaire was designed to assess the numbers of NMI, patterns in occurrence and relevant learning points within the previous 6 months. A covering letter, background questionnaire (exploring the background of the medical practitioner), copies of the survey, and reply paid envelopes were sent to each Forensic Medical Examiner (n=134) in London, contracted to provide forensic medical services for the Metropolitan Police Service. Data about all incidents were anonymized. RESULTS: Ninety six (73%) Forensic Medical Examiners responded. Of these 18% were Principal grade, the remainder were Senior (24%), Standard (35%) and Assistant (23%). Thirty eight NMI were reported by 27 Forensic Medical Examiners (of all levels). The initial reason for police contact was recorded as alcohol (n=8), theft and robbery (n=7), warrants (n=4), violence (n=3), traffic violations (n=2) and single cases of drugs, murder and immigration offences. Of the main perceived cause of each NMI, illicit drugs were involved in 12/38, alcohol in 17/38, deliberate self-harm in 11/38, issues concerning searches, checks or rousing in 8/38, failure of inter-agency communications in 5/38, and possible resource issues in 4/38. In a number of cases more than one factor was involved. CONCLUSIONS: The information established about NMI is broadly consistent with documented patterns of deaths in police custody in England and Wales which supports the validity of the data. The next stage of this research will be a prospective six month study in which NMI will be analysed in order to learn lessons which may be utilised to attempt to prevent potentially avoidable deaths in police custody.     

Assessment in police custody of individuals under the influence of alcohol with co-morbid psychiatric disorders

Individuals with a diagnosis of excessive alcohol intake are commonly encountered in police custody. These individuals have a high incidence of co-morbid psychiatric disorders. The Epidemiological Catchment Area (ECA) Study reported that 37% of alcoholics have a co-morbid mental disorder.(1)It is, therefore, important that individuals in custody who have a history of excessive alcohol intake are adequately assessed, in order to identify such co-morbid disorders so that appropriate management is implemented. Assessment of all individuals in police custody should include: To date, little has been written on how such assessments should be carried out in police custody. This paper discusses the presentation of psychiatric disorders in individuals with a history of excessive alcohol intake and suggests how they should be assessed in custody. A subsequent issue of the journal will include an article discussing the management of such individuals.