Health screening in police custody

Modification of the examination of fitness for custody as a result of external factors in the period 2013–2018

Background and objectives

Previous studies have shown that the assessment of fitness for custody is influenced by external factors. In this study, we analyzed whether the changes that occurred in the period 2015–2016 (predominant involvement of forensic medicine, significant increase in the proportion of the population with a migration background) had an impact on the examination of fitness for custody in the Halle/Saale area (Germany).

Material and methods

A retrospective analysis of 1271 examinations of fitness for custody from the period 2013–2018 was carried out. Therefore, two periods (2013–2015 and 2016–2018) were considered and the various parameters were evaluated using several statistical programs.

Results

In terms of the reasons for examination, there was a significant decrease in alcohol intoxication and a significant increase in psychiatric illnesses (p = 0.016) in the period 2016–2018. Regardless of the time period there was an increase in examination time of approximately 3.5 min for examinations of people with a migration background. In comparison of the two time periods, fewer persons examined were fit for custody without restrictions and significantly more were fit for custody with restrictions only (p = <0.001).

Discussion and conclusion

The present study confirmed the influence of external factors on examination of fitness for custody. With the predominant involvement of forensic medicine, there was a significant increase in persons with limited fitness for custody. The increased proportion of persons with a migration background resulted in a broader variety of indications as well as an increase in examination time and the involvement of interpreters. For the future guarantee of the examinations, these changed circumstances must be taken into account, also including appropriate payment.

Structures, processes and outcomes of health care for people detained in short-term police custody settings: A scoping review

BACKGROUND

People detained in short-term custodial settings can require health care that may necessitate transfer to an Emergency Department (ED). What and how health care is delivered to detainees in short-term custodial settings may influence their health outcomes.

OBJECTIVE

The aim of this scoping review was to synthesise and critically appraise the evidence on health care delivered to detainees in short-term custody settings.

DESIGN

A scoping review was undertaken. Five online databases (CINAHL, PubMed, Medline, Embase and Criminal Justice Database) were searched from January 2010 to May 2020. Data extracted pertained to the structures, processes and outcomes of health care delivery. The Mixed Methods Assessment Tool was used to quality appraise the studies. Deductive analysis was used to sort the findings into structures, processes and outcomes of health care delivery and then thematic analysis was undertaken to synthesise these findings.

RESULTS

In total, 37 studies with varied designs were included in this review; 3 randomised control trials, 4 quantitative comparative studies, 21 quantitative descriptive studies, 8 qualitative studies and 1 mixed methods study. Studies were mainly from westernised countries. The quality of evidence varied across studies. Health care delivery structures had a strong focus on the identification of mental illness, with processes predominantly comprising health assessment screening on arrival to the short-term custodial setting. Outcomes (at the detainee and organisation level) included increased identification of substance misuse issues and improvement of health conditions, alongside inadequate assessment/identification of physical and mental health issues for detainees.

CONCLUSION

Gaps in evidence identified limited international perspectives as most studies originated from the US, a focus on detainee conditions/symptoms and limited long-term research within the area of health care in short-term custodial settings. Literature regarding health care delivery in short-term custodial settings focused predominantly on mental illness identification. Understanding the nature of health care delivery in short-term custodial settings further through research into specific roles such as the custody nurse is required to develop targeted interventions that address the needs of the detainee on a comprehensive level.

Identifying vulnerability in police custody: Making sense of information provided to custody officers

Vulnerable individuals frequently come into contact with the criminal justice system with those with mental health disorders over-represented in custody. Therefore, it is crucial to identify vulnerability in order to ensure the appropriate safeguards can be put in place. Research has documented that this is problematic and can be influenced by a number of factors. The current study, therefore, aimed to understand how custody officers in England and Wales made sense of different types of information presented to them, the impact that it had on their initial disposal option and whether there was a difference in police force area. Six case scenario vignettes containing different types of vulnerability were developed and disseminated. A total of 237 custody officers from 25 police forces participated. Results highlighted that custody officers were more likely to obtain a mental health assessment in all case scenarios, except if the individual displayed comprehension difficulties - custody officers would instead seek to implement the services of an Appropriate Adult. In addition, differences between police force areas were observed. Police forces in the North of England were the least likely to obtain the assistance of an Appropriate Adult when presented with a vulnerable suspect compared to other police force areas. This suggests fundamental differences in the disposal options preferred between police force areas and has implications for the treatment of vulnerable individuals in police custody.

Mental health in the criminal justice system: A pathways approach to service and research design

BACKGROUND

Care pathway approaches were introduced into health care in the 1980s and have become standard international practice. They are now being introduced more specifically for health care in the criminal justice system. Care pathway delivery has the theoretical advantage of encouraging a whole-systems approach for health and social care within the criminal justice system, but how well is it supported by empirical evidence?

AIMS

The aim of this study is to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000.

METHOD

We used an exploratory narrative method to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. The available literature was reviewed using a keyword search approach with three databases: PubMed, Medline, and Google Scholar.

FINDINGS

Research in this field has covered police custody, courts, prisons, and the wider community, but there is little that follows the entire career through all these elements of offender placement. Main themes in the research to date, regardless of where the research was conducted, have been counting the disorder or the need, development and evaluation of screening tools, and evaluation of clinical intervention styles. Most evidence to date is simply observational, although the possibility of conducting randomised controlled trials of interventions within parts of the criminal justice system, especially prisons, is now well established.

CONCLUSIONS

Access to health care while passing through the criminal justice system is essential because of the disproportionately high rates of mental disorder among offenders, and the concept of structured pathways to ensure this theoretically satisfying, but as yet empirically unsupported. Further, substantial cuts in services, generally following government economies, are largely unresearched. Considerable investment in new possibilities, driven by both pressure groups and government, tend to be informed by good will and theory rather than hard evidence and are often not evaluated even after introduction. This must change.

The "appropriate adult": What they do and what they should do in police interviews with mentally disordered suspects

BACKGROUND

In almost all countries worldwide, the first point of contact with the criminal justice system is with the police. A large proportion of these individuals may have vulnerabilities, such as mental health difficulties. Given the complexities associated with vulnerable suspects, such interviews may be compromised, which could lead to a miscarriage of justice. In England and Wales, the Police and Criminal Evidence Act (PACE) 1984 and its accompanying Codes of Practice lay down requirements for interviewing vulnerable suspects and provide for attendance of "appropriate adults" to support communication between police and the vulnerable suspect. To date, however, their role has been underresearched.

AIMS/HYPOTHESES

To explore the role of appropriate adults in police interviews and test the hypotheses, first, that appropriate adults more commonly remain passive during interview than expected from guidance and, second, that any interventions are more likely than not to follow examples in current guidance.

METHODS

Transcripts of police interviews conducted with suspects with possible mental disorder and an appropriate adult present (N = 27) were analysed using a specially developed coding framework.

RESULTS

Appropriate adults were significantly more likely to remain passive than to intervene, even when current guidance would suggest intervention. When they did intervene, however, such interventions were significantly more likely than not to follow from guidance than the vulnerable suspect's needs. Police and Criminal Evidence Act (PACE) 1984.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

In our sample, appropriate adults were not fulfilling their role as outlined in the Police and Criminal Evidence Act (PACE) 1984 and accompanying Codes of Practice; specifically, they appeared to know what to do but not when to do it. There is a heightened risk of a miscarriage of justice in such circumstances without improvements.

Mental illness and the provision of mental health services in prisons

INTRODUCTION

Around 11 million people are held in prisons internationally, and criminal justice systems are overburdened with a high prevalence of multiple psychiatric disorders. In England and Wales over 200 000 people enter prisons each year, and in many cases, this facilitates their first contact with mental health services.

SOURCES OF DATA

Research, evaluations, government reports and independent reviews.

AREAS OF AGREEMENT

Screening, Triage, Assessment, Intervention and Re-integration (STAIR) are necessary components of prison mental health provision, offering an opportunity to improve the wellbeing of a complex population.

AREAS OF CONTROVERSY

There are serious problems with service provision across many parts of the world, with human rights abuses occurring in some States. Screening and service delivery models still require substantial development. In England and Wales, self-harm, self-inflicted deaths and violence are increasing.

GROWING POINTS

Introducing comprehensive mental health models throughout prisons would offer a massive public health initiative, providing new services for the socially disadvantaged. A rights-based framework would be useful in ensuring systemic improvements, especially in low and middle-income countries.

AREAS TIMELY FOR DEVELOPING RESEARCH

Mechanisms for screening and triage, specific interventions across a broad range of conditions, and practical re-integration models, should be submitted to research across international sites.

A record linkage study on former police detainees who died in Amsterdam between 2013 and 2015

BACKGROUND

Police detainees are known to have inferior health. This study identifies the number of former police detainees who received medical care among deaths examined by forensic physicians and presents their death characteristics.

METHODS

We included all deaths that were examined by forensic physicians of the Public Health Service Amsterdam from 2013 to 2015. Patient files of subjects were scanned for the presence of a prior medical consultation in the police cell and death characteristics were collected from post-mortem examination reports. We performed statistical analyses to discover what characteristics at post-mortem examination were associated with a prior consultation in the police cell.

RESULTS

We identified n = 2618 subjects that met the inclusion criteria. Eight percent of subjects had one or more medical consultation(s) in the police cell in a mean follow up time of 4.8 (±3.0) years. No difference was found in the share of unnatural deaths between subjects with and without a prior consultation (68%), but distribution of death causes differed significantly. Male gender OR 2.3 (p < 0.001), age OR 0.98 (p < 0.001), unspecified unnatural dead OR 1.8 (p = 0.002), crime related dead OR 2.2 (p = 0.012) and accidental drowning and submerging death OR 4.6 (p < 0.001) were independently associated with the presence of an earlier consultation in the police cell.

CONCLUSION

Our data suggest that a small percentage of police detainees seen by forensic physicians for provision of medical care are also examined after death by these physicians, typically young males who seem to display risk-taking and criminal behavior resulting in unnatural dead.

The health of female arrestees in police cells: A descriptive study

INTRODUCTION

Little information is available regarding the medical status and health care needs of female arrestees. Our objective was to evaluate the perceived health and somatic or psychiatric disorders reported by female arrestees in police cells.

MATERIAL AND METHODS

We conducted an observational study in a regional reference department of forensic medicine in France. We studied female arrestees examined in police cells (01/01/2013-06/30/2013). Data were collected regarding individuals' medical characteristics, addictive behaviours, and perceived health status, as well as reported assaults or recent traumatic injuries. We recorded medical decisions regarding fitness for detention in police cells.

RESULTS

A total of 438 women (median age, 29; range, 13-67) accounted for 5% of the 7408 examined arrestees. Females considered their overall health as good or very good in 314/395 cases (70%). Women reported chronic somatic or psychiatric disorders more frequently than men (89/379, 23% vs. 757/6,135, 12%, p < 0.001 and 59/379, 15% vs. 392/6319, 6%, p < 0.001, respectively). Daily tobacco consumption and cannabis use were reported by 255/403 (63%) and 98/438 female arrestees (22%), respectively. Physical assaults were reported in 113/415 cases (27%). Female arrestees were considered fit for detention in 92% of cases. Among 24 pregnant arrestees, 6 (25%) were unfit for detention, 2 (8%) were fit for custody during daytime only and 16 (67%) were fit for detention if certain conditions were met.

CONCLUSIONS

Detention in police custody involves a minority of females. Females are older and report somatic or psychiatric disorders more frequently than males.

Screening for psychiatric morbidity in police custody: results from the HELP-PC project

Aims and method

To ascertain the efficacy of custody health screening for mental disorders. We assessed a sample of detainees for the presence of mental disorders and the need for an appropriate adult. The assessments were carried out using pragmatic interviews and examinations supported by structured tools. Where possible, we attributed a probable clinical diagnosis based on the information available to us. The need for an appropriate adult was judged based on this information and capacity assessments.

Results

Existing screening procedures missed a quarter of cases of severe mental illness and moderate depression; they also failed to detect about a half of those at risk of alcohol withdrawal and 70% of those at risk of withdrawal from crack cocaine. The need for an appropriate adult was not recognised in more than half of cases.

Clinical implications

Consideration should be given to modifying police screening procedures for mental and associated disorders so that detainees receive the appropriate attention.

Pathways through the criminal justice system for prisoners with acute and serious mental illness

PURPOSE

To evaluate pathways through the criminal justice system for 63 prisoners under the care of prison mental health services.

RESULTS

A small number (3%) were acutely mentally ill at prison reception, which may reflect the successful operation of liaison and diversion services at earlier stages in the pathway. However, a third (33%) went onto display acute symptoms at later stages. Cases displaying suicide risk at arrest, with a history of in-patient care, were at increased risk of acute deterioration in the first weeks of imprisonment, with a general absence of health assessments for these cases prior to their imprisonment. Inconsistencies in the transfer of mental health information to health files may result in at-risk cases being overlooked, and a lack of standardisation at the court stage results in difficulties determining onward service provision and outcomes.

CONCLUSIONS

Greater consistency in access to pre-prison health services in the criminal justice system is needed, especially for those with preexisting vulnerabilities, and it may have a role in preventing subsequent deterioration. A single system for health information flow across the whole pathway would be beneficial.

Eight years of psychiatric examination of detainees by forensic physicians in the Netherlands

BACKGROUND

Forensic physicians are responsible for first-line medical care of detainees (individuals held in custody) in the police station. The Dutch police law contains a 'duty of care', which gives the police responsibility for the apparent mentally ill and/or confused people they encounter during their work. The police can ask a forensic physician to do a primary psychiatric assessment of any apparent mentally ill detainee. The forensic physician determines if the apparent mentally ill behavior of the detainee is due to a somatic illness, or has a psychiatric cause for which the detainee needs admission to a psychiatric hospital. The forensic physician consults the second-line Public Mental Health Care (PMHC).

OBJECTIVE

This study aims to give an overview of the outcomes of psychiatric assessments of apparent mentally ill detainees in police stations. These assessments were done by forensic physicians over a period of eight years (2005-2013). A distinction is made between mental disorders, social problems, and alcohol/drugs abuse.

METHODS

All psychiatric assessments were registered in a medical database. When a secondary public mental health care assessment was performed, the conclusions and/or written feedback were received and included in the medical database. This information was used for this retrospective observational study.

RESULTS

Of all the apparent mentally ill individuals brought by the police into the police station, the forensic physician sent home or referred 51.8% to their own respective caretakers or the individuals were voluntarily admitted to addiction care or other care facilities. When the forensic physician referred a detainee to PMHC, a compulsory admission to a psychiatric hospital was indicated by PMHC in 62.8% of the cases. Ultimately, of the total apparent mentally ill individuals brought in by the police 30.0% was admitted to a psychiatric hospital.

DISCUSSION

Many apparent mentally ill individuals brought to the police station are sent home by the forensic physician. Before the psychiatric assessment, medical causes of psychiatric illnesses, for example excited delirium syndrome and hypoglycemia, drug use (GHB, cocaine, heroin), and cerebral pathology are excluded. The police perform as one of the channels through which the mentally ill get entrance to mental health care. Our data show no changes in the number of psychiatric assessments during 2005-2013.

Can deaths in police cells be prevented? Experience from Norway and death rates in other countries

PURPOSE

To describe the changes in death rates and causes of deaths in Norwegian police cells during the last 2 decades. To review reports on death rates in police cells that have been published in medical journals and elsewhere, and discuss the difficulties of comparing death rates between countries.

METHODS

Data on deaths in Norwegian police cells were collected retrospectively in 2002 and 2012 for two time periods: 1993-2001 (period 1) and 2003-2012 (period 2). Several databases were searched to find reports on deaths in police cells from as many countries as possible.

RESULTS

The death rates in Norwegian police cells reduced significantly from 0.83 deaths per year per million inhabitants (DYM) in period 1 to 0.22 DYM in period 2 (p < 0.05). The most common cause of death in period 1 was alcohol intoxication including intracranial bleeding in persons with high blood alcohol levels, and the number declined from 16 persons in period 1 to 1 person in period 2 (p = 0.032). The median death rate in the surveyed Western countries was 0.44 DYM (range: 0.14-1.46 DYM).

CONCLUSION

The number of deaths in Norwegian police cells reduced by about 75% over a period of approximately 10 years. This is probably mainly due to individuals with severe alcohol intoxication no longer being placed in police cells. However, there remain large methodology difficulties in comparing deaths rates between countries.

Detainees arrested for the first time in French police stations

The psychological impact of incarceration vary from individual to individual and most people first entering prison experience severe stress. Our objective was to describe the characteristics of detainees arrested for the first time and who had medical examination during custody. The study sample included 200 detainees arrested for the first time in 2012 and examined for the second time before May 31, 2013, 200 detainees arrested for the first time in 2012 and who had not a second examination by May 31, 2013, and a control group of 200 individuals who had been arrested before. Collected data related to persons' characteristics, the course of detention, alleged assaults and traumatic injuries. In our sample, victimization was the most frequent motivation for requesting a medical examination and affected 31-46% of patients who requested the examination. The medical examination was less frequently requested by the detainee at the first detention than at subsequent detentions (35% and 31% vs. 51%, P < 0.001). Unremarkable psychic states were found in most cases in all groups. Detainees expressed a good or very good opinion on custody in 40-51% of cases. In 75-89% of cases, detainees were considered to be unconditionally fit for detention. The present findings suggest only minor differences between clinical features of individuals arrested for the first time and their clinical status when they were arrested for the second time. The systematic collection of more detailed description of the detainees' psychic state could be relevant at the time of medical examinations in police cells.

The Alcohol-Intoxicated Person in Custody: Diagnosis, Differential Diagnosis and Management

Individuals who are intoxicated with alcohol (most commonly ethanol) will commonly be detained by police for a wide range of offenses. It is essential that custody staff are trained to recognize individuals with alcohol use disorders and comorbid health conditions and request medical assistance as required. Forensic physicians and other health care professionals should perform a comprehensive assessment to diagnose alcohol intoxication and ensure that the detainee is fit to be detained and interviewed by police. Forensic pathologists should be aware of the appropriate clinical management of alcohol-intoxicated persons in custody when involved in death in custody investigations.

Detainees in police custody in the Paris, France area: medical data and high-risk situations (a prospective study over 1 year)

BACKGROUND AND OBJECTIVE

The annual number of detainees held in police custody in France is approximately 700,000. Medical data regarding arrestees are scarce across countries. We present the medical characteristics of detainees kept in police custody, including addictive behaviours and high-risk medical situations.

METHODS

We conducted a prospective study over 1 year in a suburban area near Paris.

RESULTS

A total of 19,098 medical examinations were performed on 13,317 individuals. The examinations mainly concerned male subjects (18,116 of 19,098, 95 %). Median age was 24 years (range 13-83). Medical examination was requested by the detainee in 6,638 of 16,801 cases (40 %). Assaults were reported in 4,052 of 17,312 cases (23 %) and occurred at the time of arrest in most cases (2,243, 13 %). A total of 2,394 of 13,317 detainees (18 %) had at least one chronic somatic disorder including asthma (603, 5 %), diabetes (263, 2 %) and arterial hypertension (205, 2 %). A history of psychiatric disorder was reported by 6 % of individuals (674 of 11,787). Regular alcohol drinking was reported by 58 % of detainees. Illicit drug use mainly involved cannabis (4,021 cases, 30 %). In 14,661 of 19,098 cases (77 %), detainees were considered to be unconditionally fit for detention in custody, and 274 detainees (1 %) were declared unfit to be detained.

CONCLUSION

The present study showed a high frequency of alcohol or substance use and reported assaults or traumatic lesions in arrestees. Attending physicians should pay particular attention to addictive behaviours and traumatic injuries in arrestees, both for immediate care and for prevention.

Medical, social, and law characteristics of intoxicant's users medically examined in police custody

INTRODUCTION

There are no studies on medically examined persons in custody which specifically focus on identifying dependence profiles among users of intoxicants. Nonetheless, the characterisation of dependence profiles for intoxicants such as alcohol, cannabis, cocaine, heroin, amphetamines and their by-products is a medical necessity in this setting.

MATERIALS AND METHODS

A prospective, monocentric, open-ended study conducted by structured questionnaire was carried out on detainees who admitted to having taken an intoxicant/s (tobacco, alcohol, drugs or illegal substances). Social, legal and medical data were collected. The aim of the study was to explore characteristics of these persons in police custody.

RESULTS

817 questionnaires were examined. More than one-third have a dependence on at least one substance. 37.7% were dependant of tobacco, 86.5% of drinkers, 24.7% of cannabis users. Of these, 90.1% were from men with a mean age of 29.4 years, 40% from individuals living alone, 25.7% from persons with no financial means and 19.6% from homeless persons. 10% were believed to be suffering from mental illness, 7.2% were thought to be asthmatic, 3% to have a chronic infection, and 2.9% to have epilepsy. 36.2% reportedly received treatment, 37.5% of which included benzodiazepine and 20.3% opiate substitution therapy. Incidence of psychological and psychiatric disorders is close to 10% of intoxicant detainees.

DISCUSSION

In this study, some of the stated pathologies occur in ratios similar to those in other published results. But, there is a high, and probably underestimated, prevalence of psychological and psychiatric disorders in this population of detainees reporting exposure to intoxicant or illegal substances.

Police custody following driving under the influence of cannabis: a prospective study

Traffic offences are a common cause of detention in police custody. We hypothesized that drug intoxication while driving could correspond to specific medical conditions of the detainees. Our objective was to evaluate medical features and addictive behaviours of suspected drug drivers and to collect data regarding assaults or injuries in these individuals. We conducted a prospective study (April 2010-December 2011) of suspected drug driving arrestees, who were compared to drink drivers or persons aged over 18 detained for other reasons. Data collected concerned persons' characteristics, reported assaults, and observed injuries. A total of 205 drivers were tested positive for drugs in blood, 116 were either positive for drugs in urine or saliva and negative in blood, or negative in urine. Cannabis-only users accounted for 201 of 205 drug drivers (98%). Suspected drug driving arrestees had good overall health rating. Drug drivers were younger than controls and requested more rarely medical examination (12% vs. 44%, P<0.0001). They were rarely involved in addiction treatment (3%) and reported assaults or presented traumatic injuries less often than drink drivers and controls (8% vs. 38% and 25%, P<0.0001). Drug drivers were less often alcohol abusers than controls. Their opinion on custody was better than that of controls and they were considered unconditionally fit for detention more frequently (99% vs. 77%, P<0.0001). We conclude that arrested drug drivers were young, healthy, and infrequently reported assaults or presented traumatic injuries, which does not put them in a high risk medical condition. Medical care could include brief interventions on addictive behaviours.

[Detainees in police custody in Seine-Saint-Denis (France): Medical data and high-risk situations, a descriptive study]

OBJECTIVES

The number of detainees held in police custody in France increased up to 792,000 yearly in 2009. Medical examination is a right for every detainee. Our objective was to assess medical characteristics and addictive behaviours of arrestees.

METHODS

In this study, we systematically evaluated arrestees detained in police custody in Seine-Saint-Denis, a suburban area near Paris over one year (June 1, 2010-May 31, 2011).

RESULTS

A total of 22,379 medical examinations were performed. Males accounted for 94% of detainees. Median age was 23 (range: 13-78). In 2968 of 18,466 cases (16%), the detainee had at least one chronic somatic disease. Asthma, diabetes, and arterial hypertension were the most commonly encountered. A history of psychiatric disorder was reported in 819 of 16,697 cases (5%). Daily alcohol consumption was reported by 14% of detainees and 77% smoked tobacco. Drug use was reported by 40% of detainees, cannabis in most cases (38%), infrequently cocaine or crack (4%) or heroine (1%). Assaults were reported by 20% of detainees, at the time of arrest in most cases (11%).

PERSPECTIVES

The present study showed the high frequency of addictive behaviours and reported assaults or traumatic injuries in arrestees. Attending physicians should pay particular attention to addictive disorders and recent traumatic lesions in arrestees, both for immediate care and for prevention.

Police custody following drink-driving: a prospective study

BACKGROUND

Drink-driving is a crime and traffic offences are a common cause of detention in police custody. Legal assessment of alcohol intoxication is based on breath or blood testing. We hypothesize that refusal of breath alcohol testing or inability to perform it can correspond to singular medical characteristics of the detainee, possibly assaulted or injured during the arrest. Our objective was to determine medical characteristics of detainees held in custody for drink-driving.

METHODS

Prospective monocentric study (April-October, 2010) of drink-drive arrestees. Controls were persons aged over 18 detained for other reasons than drink-driving. Data collected concerned persons' characteristics and reported assaults or observed injuries.

RESULTS

223 drivers were tested positive for breath alcohol level and 55 suspected drink-drivers refused or were not able to complete breath test. 2212 consecutively examined persons served as controls. Drink-drive arrestees requested medical examination more rarely (18% and 7%, vs. 43%, P<0.0001) and drivers tested positive for breath alcohol were more frequently alcohol abusers (25% vs. 14%, P<0.0001) than controls. Drivers who did not complete breath test more often reported assaults than those tested positive for breath alcohol (22% vs. 8%, P=0.007). They had more frequent traumatic injuries than those tested positive and than controls (29% vs. 11% and 17%, P=0.003 and 0.02). Only 1% of drink drivers were unfit for detention after medical examination.

CONCLUSION

Physicians need to give attentive care to detained drink-drivers. Special attention should be paid to drink-drivers who refused or were not able to complete breath alcohol measurement.

Reported assaults and observed injuries in detainees held in police custody

The deprivation of liberty in police custody can be associated with violent situations and traumatic injuries. The rare available data did not mention whether alleged assaults occurred at the time of the arrest or during custody. Our objectives were to describe the frequency of recent traumatic injuries observed in detainees at the time of medical examination and to record detainees' self-reports of received physical violence, either before being arrested, at the time of the arrest, or during custody. In 2694 consecutive detainees examined in a suburban area near Paris, we compared persons' characteristics in four groups, according to the existence of alleged assaults or the presence of recent traumatic injuries, or both. Detainees reported to be victims of physical assaults in 25% of cases (686 of 2694): 374 assaults of 686 (55%) occurred at the time of arrest and 87 of 686 (13%) during custody. The opinion of assaulted detainees on custody was worse than non-assaulted detainees. Detainees alleging assaults by the police, whatever the time of the assault, accounted for 396 cases (15%). Three quarters of detainees (547 of 686, 79%) alleging assaults had recent traumatic injuries. When we considered all detainees, medical examination showed recent traumatic injuries in 724 of 2694 (27%). Injured detainees were declared unfit for detention more frequently than non-injured non-assaulted detainees (P<0.05). These results strengthen the need and usefulness that the attending physician systematically takes note of detainees' self reports of assaults and investigates recent traumatic injuries at the time of custody.

Health screening of people in police custody--evaluation of current police screening procedures in London, UK

BACKGROUND

Previous research has highlighted excess health morbidity in offender populations. A small number of studies have described health problems within police custody settings. The efficacy of police screening procedures has not been evaluated.

METHODS

Prospective clinical interviews with custody detainees in London were conducted. Clinical findings were compared with those recorded in police health screening documentation.

RESULTS

High levels of health morbidity were observed. The sensitivity and specificity of the current screen with respect to its ability to trigger a call for a health-care professional (HCP), regardless of the reason, was 70 and 66%, respectively. Fifty-one percent of the detainees with asthma, 36% with diabetes mellitus and 40% with epilepsy were not picked up by the screen. Fewer than one-half of the detainees at risk of alcohol withdrawal syndrome had 'alcohol' documented on their screen, although 81% saw the HCP. The police screen missed heroin use in 28% and crack cocaine use in 68% of users. A HCP was called in 84 and 64% of the cases, respectively, for any reason. Two of the 12 detainees (17%) who described a head injury with serious-associated symptoms were detected; 9 had a HCP called for any reason. Whereas mental disturbance was detected in 79% of the detainees with serious mental illness, one-third of the detainees with a risk history of suicide and one-half of the detainees with suicidal ideation were not documented as such on the police screen.

CONCLUSION

Given the amounts of morbidity and the need for reliable triage, improvement in the health screening procedures used by the police is needed.

Medical examination of fitness for police custody in two large German towns

Worldwide, there is a high risk of medical complications or death in police custody. This risk is often increased by unclear legislation, a lack of clearly defined responsibility and medical examination standards. Any solution to these problems requires as a very basis the systematic analysis of the medical examinations that determine whether a person is fit to be detained in custody. We analysed a total of 3,674 medical records on fitness for custody, taken from two large German towns (Halle/S and Bremen). The examined individuals were predominantly males or of a younger age. The indication in the majority of cases was acute alcoholic intoxication or drug withdrawal syndromes. Traumata and internal or mental diseases were also quite frequent. For approximately 50% of all cases, fitness for custody was declared on certain conditions. Only 39.8% were found to be unconditionally fit for detention in custody. In just under 10% of the cases, the person was found unfit for custody. These cases concerned mainly persons with psychological symptoms and advanced alcohol or drug withdrawal syndromes. We were able to show that the recent introduction of new police custody regulations in Halle/S had a significant influence on the medical decision on fitness for custody. Our detailed assessment has provided us with the basis to develop solutions for the improvement of medical care in police custody. The focus lies here on the organisation and legal regulation of the medical aspects of custody but also on policing and medical work.