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.     

Fitness for detention in police custody: A practical proposal for improving the format of medical opinion

Health issues among arrestees are a worldwide concern for which only local policies have been established. Physicians attending detainees in police custody are expected to decide whether the detainee's health status is compatible with detention in a police station and make any useful observations. A high degree of heterogeneity in the information collected by the physician and transmitted to the police has been observed. We analyzed the content and limitations of available documents and developed a model that could serve as a guide for any attending physician. The document presented here has been used in France on over 50,000 occasions since June 2010. We developed a two-page template consisting of (1) a standard medical certificate to be sent to the authority who requested the doctor's attendance and (2) a confidential medical record, not sent to the requesting authority. We evaluated perceived health by the three global health indicators of the Minimum European Health Module and used DSM IV criteria for the evaluation of addictive disorders. In the case of recent traumatic injuries, the certificate has also included the collection of data on traumatic injuries and the contexts of their occurrence. The proposed certificate achieved several goals, by protecting the interests of the person examined, in case of poor conditions of arrest or detention, protecting doctors in cases of legal proceedings, and allowing epidemiological data to be collected. The certificate may also contribute to an international awareness of medical care for detainees in police custody.     

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.     

Police custody deaths in Maryland, USA: an examination of 45 cases

Previous published research suggests there are a diverse, yet relatively consistent, set of factors present in sudden, unexpected, and initially inexplicable deaths in police custody. This retrospective analysis examines police custodial deaths in Maryland, USA. Police custody death is operationalized to include deaths which occurred suddenly and unexpectedly during police/citizen encounters. Only deaths for which the cause was initially undeterminable are included. Suicidal hanging, police shootings and fatal pursuits are not included. Review of the records at Maryland’s Office of the Chief Medical Examiner indicates that 45 persons died suddenly and unexpectedly in the custody of the police, between 1990 and 2004. Commensurate with existing research, our analysis identifies multiple factors generally present in this type of police custody death. Although individual-specific, these factors include a relatively static constellation of behavioral (e.g., erratic and/or violent behavior, and physical struggle) and physical (e.g., stimulant abuse, natural disease, and obesity) dimensions. While the presence of these factors has been well-documented, their empirical significance, interactions and causal sequence have yet to be established. To increase the methodological rigor of subsequent research, we have developed a comprehensive, national custody death database by which multivariate models may be analyzed.     

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.     

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Little is understood about the incidence of sudden death, its underlying pathophysiology, or its actual relationship to subject positioning. We report data from 4828 consecutive use of force events (August 2006–March 2013) in 7 Canadian police agencies in Eastern and Western Canada. Consecutive subjects aged >18 years who were involved in a police use of force event were included regardless of outcome. Officers prospectively documented: final resting position of the subject (prone or non-prone), intoxicants and/or emotional distress, presence of features of excited delirium, and the use of all force modalities. Our outcome of interest was sudden in-custody death. Our study has 80% power to detect a difference of 0.5% in sudden death between the positions. In over 3.25 million consecutive police–-public interactions; use of force occurred in 4,828 subjects (0.1% of police public interactions; 95% CI = 0.1%, 0.1%). Subjects were usually male (87.5%); median age 32 years; 81.5% exhibited alcohol and/or drug intoxication, and/or emotional distress at the scene. Significantly more subjects remained in a non-prone vs. prone position; but over 2000 subjects remained prone. One individual died suddenly and unexpectedly in the non-prone position with all 10 features of excited delirium. No subject died in the prone position. There was no significant difference in sudden in custody death, in a worst case scenario 99.8% of subjects would be expected to survive being in either the prone or non-prone position following police use of force.     

武警部队处置突发事件因伤减员官兵救治、后送模式研究

 目的分析武警部队处置突发事件时因伤减员官兵不同情况下经过不同救治梯次的依据,确定设置不同救治梯次时各级救治机构的救治范围.方法采取回顾性调查方法,利用SAS统计分析软件对调查结果进行统计学处理.结果因伤减员官兵的2周治愈率、致残率及伤口感染率与负伤后得到第1次救治的时间和救治人员种类、处突地点距专科医院的距离、后送运力的型号及后送途中交通状况等因素有直接关系.结论应根据不同情况合理设置救治梯次,确定各级救治机构的救治范围.要靠前配置救治力量,配齐一线医务干部.     

高原武警官兵情绪状态及影响因素分析

 目的 探讨入伍时间、海拔高度、焦虑、抑郁和睡眠对高原武警官兵情绪状态的影响。方法 采用多阶段随机抽样方法,于 2015年4-10月,选取西藏地区的武警官兵共1621名进行横断面调查,采用情绪状态量表(POMS)评价其情绪状态。结果 (1)入伍时间(F=3224.000,P＜0.001)、海拔高度(F=1614.000,P＜0.001)、焦虑(F=4832.000,P＜0.001)、抑郁(F=4832.000,P＜0.001)、睡眠(F=1614.000,P＜0.001)对情绪状态的紧张-焦虑(T)、忧郁-沮丧(D)、愤怒-敌意(A)、有力-好动(V)、疲惫-惰性(F)、困惑-迷茫(C)六个维度的得分均有明显影响(P＜0.001);(2)入伍时间在3~5年的官兵,T、D、F和C四个维度的得分最低,而V维度的得分最高。海拔高度越高,焦虑、抑郁越重、睡眠越差,T、D、A、F、C得分越高,V得分越低;(3)多重线性回归模型结果显示:在调整了年龄、学历、婚姻状况和官兵类别后,入伍时间与V和F得分有关;海拔高度与T、D、A、F和C得分有关,与V得分无关;焦虑程度和睡眠质量与POMS量表的6个维度得分均有关系(P＜0.05)。结论 入伍3~5年的一期士官情绪状态最好,应作为部队的中坚力量。心理和睡眠干预,是改善武警官兵情绪状态的有效途径。     

The comparison of disposal attitudes towards forensic psychiatric patients among police officers,psychiatrists and community members in China

ObjectiveTo understand disposal attitudes towards forensic psychiatric patients among police officers, psychiatrists and community members in China.Method118 community members, 121 psychiatrists and 105 police officers completed a questionnaire regarding disposal attitudes towards forensic psychiatric patients.ResultSurveyed respondents (87.4%) believed patients with mental disorders experienced discrimination, and 97.4% were in favor of providing livelihood security for them. Police officers (89.5%) agreed that patients with mental illness were more violent than the general population, which was significantly higher than 74.4% of psychiatrists (X² = 14.29, P = 0.000). Among three groups, the most preferred disposal option for those found not guilty by reason of insanity (NGRI) was to treat them in the custody of a forensic psychiatric hospital, such as an Ankang Hospital (86.9%). The respondents agreed (96.8%) that an independent review board should be established for disposing decisions for forensic psychiatric patients. The percentage who agreed that police officers, prosecutors, and judges should be included in the review board was significantly higher among police officers than among community members (x² = 6.60, P = 0.01; x² = 9.74, P = 0.002; x² = 7.38, P = 0.007). When asked, “who has the legal right to determine whether offenders with mental disorders should bear criminal responsibility”, forensic psychiatrists and judges were the top two responders (79.5% and 63.4%, respectively).ConclusionThis study suggested that the majority of those surveyed, especially police officers, held that patients with mental illness were violent and should receive violence risk assessments. Although psychiatrists paid more attention to the rights of patients, they also lacked legal knowledge, similar to community members and police officers. Therefore, it is necessary to inform the public regarding mental health, and to provide legal knowledge.     

Leading-edge forensic DNA analyses and the necessity of including crime scene investigators,police officers and technicians in a DNA elimination database

In recent years, sophisticated technology has significantly increased the sensitivity and analytical power of genetic analyses so that very little starting material may now produce viable genetic profiles. This sensitivity however, has also increased the risk of detecting unknown genetic profiles assumed to be that of the perpetrator, yet originate from extraneous sources such as from crime scene workers. These contaminants may mislead investigations, keeping criminal cases active and unresolved for long spans of time. Voluntary submission of DNA samples from crime scene workers is fairly low, therefore we have created a promotional method for our staff elimination database that has resulted in a significant increase in voluntary samples since 2011. Our database enforces privacy safeguards and allows for optional anonymity to all staff members. We also offer information sessions at various police precincts to advise crime scene workers of the importance and success of our staff elimination database. This study, a pioneer in its field, has obtained 327 voluntary submissions from crime scene workers to date, of which 46 individual profiles (14%) have been matched to 58 criminal cases. By implementing our methods and respect for individual privacy, forensic laboratories everywhere may see similar growth and success in explaining unidentified genetic profiles in stagnate criminal cases.     

心理训练对高特质焦虑新兵生理指标和考核成绩的影响

目的研究心理训练对高特质焦虑新兵考核时生理指标和成绩的影响。方法采用个人评价问卷（PEI）、状态．特质焦虑问卷（STAI）和简易应对方式问卷对参加考核的新兵实施团体测试。将被试者分为对照组、低特质焦虑组、高特质焦虑组和干预组，对干预组进行自我评价、潜能开发、团队精神强化、应对方式的心理训练。测试考核前后生理指标差值及考核成绩的变化。结果干预组新兵军事考核前后收缩压、舒张压和脉搏三项生理差值与考核成绩明显优于高特质焦虑组（P〈0．05）。结论系统的心理训练可有效改善新兵对应激情景的生理和心理反应，提高作业绩效。     

Exploring the social image of anabolic steroids users through motivation, sportspersonship orientations and aggression

The authors explored social perceptions related to the use of anabolic steroids (AS) in sports. More specifically, 78 women and 102 men read one of two scenarios depicting a male athlete facing either a drug use or non-drug use situation. Then, participants reported their perceptions of the scenario protagonist in terms of self-determined sport motivation, sportspersonship orientations, and athletic aggression. Results of a multivariate analysis of covariance indicated that, in comparison with a non-using protagonist, the AS-using athlete was regarded as less self-determined in one's motivation (i.e., sport participation based on predominant feelings of pressure to obtain external rewards or avoid punishment) and as displaying weaker sportspersonship orientations (i.e., lesser concerns for opponents, the social conventions of sport, and for one's own athletic commitment). In addition, the AS-using athlete was perceived as resorting more readily to reactive aggression than to instrumental aggression (i.e., intent to injure one's opponent vs merely hinder his performance). Finally, the analyses did not disclose significant gender or interaction effects. The findings are discussed in view of theoretical and practical implications.     

Medical,psychological and social aspects of torture: Prevention and treatment

Electrical devices for crowd control, immobilizing threatening suspects and torturing prisoners are manufactured, traded and used in many countries. This article discusses their physiological, clinical and pathological effects and considers some legal implications of their use.     

潜水员主观幸福感相关心理社会因素的路径分析

目的 了解心理社会因素对潜水员主观幸福感(subjective well-being,SWB)的影响机制和效应量方法 采用幸福感指数量表(index of well-being)、自尊量表(SES)、症状自评量表(SCL-90),生活事件量表(LES)和应对方式问卷(CSQ)对296名潜水员进行了调查.结果 SWB与SES(相关系数r=0.273)、成熟型应对方式(r=0.226)呈显著正相关,与SCL-90(r=-0.278)、LES(r=-0.121)呈显著负相关结构方程模型拟合指数(x2/df)理想为1.559,规范拟合指数(NFI)、比较拟合指数(CFI)均大于0.9,均方根误差(RMSEA)为0.077,对SWB具有直接效应的变量按照影响大小依次为SES(r =0.21)、成熟型应对方式(r=0.18)、SCL-90(r=-0.14)、LES(r =0.07)、不成熟型应对方式(r=0.03).结论 心理健康水平、应对方式、自尊是SWB的重要预测变量.     

A survey of the social, legal, historical and 'psycho-babble' factors leading to sex offenders legislation in the areas of British common law heritage

This survey covers the socio-economic and religious factors which influenced the development of the law in regard to sexual offenders in the Common Law traditions of Britain and North America. This overview shows that, in the 20th Century, ideas of psychology and psychiatry have led to perceptions (often mis-perceptions) on the part of legislators as to the implications of new knowledge and theories in regard to the formulation of legislation. This paper concludes with some recent work indicating that theories about the homogeneity and distinctiveness of different types of sexual offenders - which resulted in the evolution of legislation to its present form - might well now be considered obsolete. A brief indication of current correctional strategies and their limitations is given.     

Effects of sociodemographic characteristics, illness process, and social support on the levels of perceived quality of life in veterans

Quality of life is a broad, complex, multidimensional concept incorporating psychological, sociopsychological, economic, philosophical, social, cultural, and spiritual dimensions. As accompanying or even constituting the concept of quality life, social support (empathic, informational, instrumental, and reassurance support) has not been studied. This study sought to determine the effects of sociodemographic characteristics, illness process, and type of social support on the quality of life levels of veterans hospitalized in a rehabilitation center. Seventy-nine veterans were involved in the study. None of the sociodemographic characteristics of the veterans correlated with the quality of life of the veterans except housing conditions. The perceived quality of life scores of the veterans who needed psychological help were lower than those of their counterparts (p < 0.01). The quality of life scores of the veterans were not different from those of the average Turkish population, but veterans who had not received any type of social support had lower quality of life scores (3.74 vs. 4.70). Veterans who had empathic, informational, and reassurance social support had higher quality of life scores than did those who did not have these types of social support. Having tangible social support did not change the quality of life scores. Our findings indicate that social support has a greater impact on the perceived quality of life than sociodemographic and medical factors among the veterans.