Solutions Trial: Solution Focused Brief Therapy (SFBT) in 10-17-year-olds presenting at police custody: a randomised controlled trial

BACKGROUND

Within England, children and young people (CYP) who come into police custody are referred to Liaison and Diversion (L&D) teams. L&D teams have responsibility for liaising with healthcare and other support services while working to divert CYP away from the criminal justice system but have traditionally not provided targeted psychological interventions to CYP. Considering evidence that Solution Focused Brief Therapy (SFBT) leads to a reduction in internalising and externalising behaviour problems in CYP, the aim of this randomised controlled trial (RCT) was to determine whether there is a difference between services as usual (SAU) plus SFBT offered by trained therapists working within a L&D team, and SAU alone, in reducing offending behaviours in 10-17-year-olds presenting at police custody.

METHODS

Design: two-arm individually RCT with internal pilot and process evaluation.

PARTICIPANTS

N = approximately 448 CYP aged 10-17 years presenting at one of three police custody suites in the area served by Lancashire and South Cumbria NHS Foundation Trust (LSCFT) who are referred to the L&D team. Participants will be recruited and allocated to intervention:control on a 1:1 basis. Interviews will be performed with 30-40 CYP in the intervention arm, 15 CYP in the control arm, up to 20 parents/guardians across both arms, up to 15 practitioners, and up to 10 site staff responsible for screening CYP for the trial. Intervention and control: Those allocated to the intervention will be offered SAU plus SFBT, and control participants will receive SAU only.

PRIMARY OUTCOME

CYP frequency of offending behaviours assessed through the Self-Report Delinquency Measure (SRDM) at 12 months post-randomisation.

SECONDARY OUTCOMES

criminal offence data (national police database); emotional and behavioural difficulties (self-report and parent/guardian reported); gang affiliation (self-report). Process evaluation: evaluation of acceptability and experiences of the CYP, parents/guardians, site staff and practitioners; fidelity of SFBT delivery.

DISCUSSION

This two-arm individually RCT will evaluate the effectiveness of SFBT in reducing offending behaviours in CYP presenting at police custody suites within the area served by LSCFT. Our process evaluation will assess the fidelity of delivery of SFBT, the factors affecting implementation, the acceptability of SFBT in CYP aged 10-17 years and recruitment and reach. We will also examine systems and structures for future delivery, therefore assessing overall scalability.

TRIAL REGISTRATION

ClinicalTrials.gov  ISRCTN14195235 . Registered on June 16, 2023.

Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review

BACKGROUND

Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions.

METHODS

Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed.

RESULTS

We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, - 9.1%, p = 0.064 and (363 vs. 437, - 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by - 32.8% (p <  0.001). Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p <  0.001), being redirected from another hospital (p <  0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p <  0.001), depressive disorders (p = 0.021) and personality disorders (p <  0.001).

CONCLUSIONS

A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.

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.

Exploring the autistic and police perspectives of the custody process through a participative walkthrough

BACKGROUND

Research suggests that autistic individuals may be more likely to come into contact with police and have more negative experiences in police custody. However, limited information about the difficulties they experience during the custody process is available.

AIMS

This study explores the experiences of autistic individuals and officers during a walkthrough of the custody process to identify specific difficulties in these encounters and what support is needed to overcome these.

METHODS AND PROCEDURES

A participative walkthrough method was developed to provide autistic individuals and officers an interactive opportunity to identify areas where further support in the custody process was needed. Two autistic participants and three officers took part in the study.

OUTCOMES AND RESULTS

Autistic participants reported negative experiences due to: i) the emotional impact of the physical setting and custody process ii) communication barriers leading to increased anxiety and iii) exposure to sensory demands. Officers highlighted three factors which limit their ability to support autistic individuals effectively: i) the custody context ii) barriers to communication and iii) knowledge and understanding of autism.

CONCLUSIONS AND IMPLICATIONS

Adjustments are needed to the custody process and environment to support interactions between autistic individuals and officers and improve the overall wellbeing of autistic individuals.

An examination of stigmatising attributions about mental illness amongst police custody staff

Individuals who enter police custody may experience mental illness, making it highly imperative for custody staff to be knowledgeable and competent in this area- however, reports suggest this is not always the case (Leese & Russell, 2017). The present study examined the differences in casual attributions and stereotypes of individuals experiencing mental illnesses, mainly, schizophrenia between police custody staff (n = 77) and members of the general population (n = 85). Using the Attribution Questionnaire (AQ-27; Corrigan, 2004), the current study found that the general population held more negative attitudes towards individuals experiencing mental illnesses than police custody staff. In particular they endorsed the attributions anger, avoidance, dangerousness and fear. Custody staff were found to help vulnerable adults more than the general population. In addition, people who knew a family member or friend experiencing a mental illness scored higher on the help and pity attributions. Furthermore, police custody staff highlighted that additional training around mental health would be beneficial to their job role. Further development of an adequate measurement of attitudes of police custody staff towards mental health needs developing in order to put in place effective training.

"A spray bottle and a lollipop stick": An examination of policy prohibiting sterile injecting equipment in prison and effects on young men with injecting drug use histories

BACKGROUND

Australian young male prisoners with histories of injecting drug use are more likely to report injecting in prison, to do so more frequently, and to be involved in more un-safe injecting-related practices than their older counterparts. Despite international evidence that prison needle and syringe programs are both feasible and effective in reducing the harms associated with injecting drug use in prison, these young men do not have access to such equipment.

METHODS

We critically analyse the interview transcripts of 28 young men with histories of injecting drug use who were recently released from adult prisons in Victoria, Australia, and prison drug policy text. We use Bacchi's 'What's the problem represented to be?' approach to examine how the 'problem' of injecting drug use in prison is represented in prison drug policy, including the assumptions that underpin these problematisations, and the subjectification and lived effects that are produced for the young men in our study.

RESULTS

Our analysis reveals how prison drug policy enables the creation and re-use of homemade injecting equipment crafted from unsterile items found in prison, and that in doing so the policy produces a range of stigmatising subjectification effects and other harmful material effects (such as hepatitis C virus transmission and injecting related injury and harms). Findings highlight, how injecting drug use is represented in policy silences other ways of understanding the 'problem' that may have less harmful effects for incarcerated young men who inject drugs.

CONCLUSION

We argue that somewhat paradoxically, the approach of prohibiting access to sterile injecting equipment in prison-which is constituted as a solution for addressing such harms-in fact helps to produce them.

Adolescent arrestees detained in police cells: an observational study in the Paris, France, area

OBJECTIVE

Custody conditions in police cells are often demeaning and considered inappropriate for human beings. The detention of young adolescents in police custody has received little attention. Our study aimed to describe the characteristics of adolescents under 18 detained in custody.

METHODS

We studied all arrestees aged 13-17 examined in 1 year (January 01-December 31, 2014) in a suburban district near Paris. We evaluated the proportion of adolescents under 18 among all arrestees detained in custody and their medical history, addictive behaviors, perceived health status, and opinion on custody.

RESULTS

Arrestees aged 13-17 accounted for 1859 individuals. They were predominantly males (94%) and accounted for 19% of all examinations in custody. Nearly half of the arrestees aged 13-15 (42%), and two thirds of those aged 16-17 (65%) had been previously detained in police cells. Somatic and psychiatric disorders were reported by 7% and 4%, respectively, of arrestees aged 13-17. Alcohol, tobacco, and cannabis consumption were reported by 5%, 24%, and 12%, respectively, of arrestees aged 13-15. These proportions were lower than the 16%, 50%, and 35%, respectively, reported by arrestees aged 16-17 (p < 0.0001). Assaults were reported by 18% of arrestees aged 13-17. They had a fair, bad, or very bad opinion on custody in 43% of cases.

CONCLUSION

The detention of adolescents in police stations is commonly associated with assaults at the time of arrest. High proportions of adolescent arrestees smoke tobacco or cannabis. We suggest that the medical examination in custody could be an opportunity for adolescents to initiate access to health care.

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.

Multiple brief interventions in police custody: The MuBIC randomized controlled study for primary prevention in police custody. Protocol and preliminary results of a feasibility study in the Paris metropolitan area, France

BACKGROUND

The 15- to 35-year-old population has little contact with the health care system and is exposed to risk factors. Several studies demonstrated the feasibility of brief interventions (BIs) in different settings, e.g., in addiction medicine during police custody, where arrestees are entitled to a medical examination. Approximately 700,000 individuals are detained in police custody in France annually, and custody is an opportunity for young people to be medically examined. The characteristics of the detainees and previous experience with BIs suggest that custody is an opportunity to contribute to primary prevention. We propose to investigate the feasibility of such a contribution.

OBJECTIVES

The aim of this article is to present a study protocol and some preliminary results. The primary research objective is to assess the feasibility of performing brief interventions without a specific topic in police custody settings in arrestees aged 15-35 years. The secondary research objectives include i) testing four strategies for engaging in BIs that maximize the chances of success of the BI; ii) identifying the determinants that can orient the practitioner's choice to use a specific strategy over another one; and iii) analysing the differences between individuals who engage in BIs and those who do not and, in those who do engage, the determinants of success of the intervention.

METHODS

A two-step randomized and prospective study: i) randomization of eligible patients into 4 groups of 500 patients each; analysis of the response rates for each strategy; performance of the BI; and analyses of the associated factors and ii) a real-life, full-scale phase study evaluating the effectiveness of BIs performance of the BI; and analyses of the interventions. Analyses of the determinants of a positive response to BI, of success and of the topic of intervention will be conducted.

EXPECTED RESULTS

The rates of BI performed, rates of success, and characteristics associated with response and with success are the main expected results. Additionally, the development and assessment of filter questions and an improved BI dedicated to primary prevention for police custody settings will be attained.

Contextualising health screening risk assessments in police custody suites - qualitative evaluation from the HELP-PC study in London, UK

Background

In the UK, police custody officers have a responsibility to screen for health morbidity and vulnerability among detainees. This study aimed to develop an understanding of the barriers to performing effective health screening in police custody suites, understand the impact of screening tools on practice within the custody suite, and to identify factors that could hinder or facilitate the future implementation of a new screening intervention in this environment.

Methods

A qualitative study was conducted alongside a quantitative evaluation of a novel screening tool. Qualitative methods included observation of the custody environment, semi-structured interviews with police staff, and elicitation of comments from detainees about their experiences of screening. Data were analysed inductively using thematic analysis. Normalization Process Theory (NPT) was used to inform data collection and as a framework for higher level analysis of findings.

Results

Five overall constructs were identified that develop understanding of the integration of health screening within custody: the workability of risk assessment screening tools; the effect of the custody environment and the people therein; shifts in professional roles and interrelationships amongst staff; cultural responses to risk and liability in police work; how infrastructure, knowledge and skills can impact on detainee safety.

Conclusions

Health and risk assessment screening in police custody is a complex and demanding activity which extends beyond the delivery of a screening tool. Professional roles, the demanding environment and police culture impact on the overall process. Recommendations for improved integration of health and risk assessment screening in wider police custody practice are proposed.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5271-6) contains supplementary material, which is available to authorized users.

Social vulnerabilities and health conditions of arrestees in the Greater Paris area, France, in 2013: a multicentre cross-sectional study

OBJECTIVE

The aim of this study was to describe the health and social conditions of arrestees, as compared to the general population.

METHODS

We studied a sample of 600 adult arrestees in three locations in the Greater Paris area, prospectively included (February-May 2013). A descriptive analysis has been performed, then prevalence was estimated using an indirect standardisation according to age, based on data from a population-based, representative survey in the same area.

RESULTS

Arrestees had a median age of 31 years; 92% were males. As compared to the general population, arrestees had a lower level of education (8.6 vs. 7.6%, p < 0.001), were more frequently unemployed (42.0 vs. 11.9%, p < 0.001) and in a difficult financial situation (43 vs. 11%, p < 0.001) and had less significant social support (48.1 vs. 87.9%, p < 0.001). They reported also more frequently a chronic health condition (54 vs. 36%, p < 0.001) and a limited health insurance coverage (36 vs. 15%, p < 0.001).

CONCLUSION

Comparative analysis of male arrestees and males from the general population showed that the former had worse social and health conditions. These results argue for widespread medical interventions on all arrestees. Medical examination during detention could act as a gateway to health care and social support.

Building on mental health training for law enforcement: strengthening community partnerships

Purpose The purpose of this paper is to describe the current state of law enforcement training related to the high number of interactions with persons with mental illness, and to recommend next steps in preparing law enforcement to effectively meet this challenge. Design/methodology/approach The authors reviewed the current literature on relevant law enforcement training programs, focusing primarily on crisis intervention team (CIT) training, and used the case example of California to identify opportunities to improve and enhance law enforcement preparedness for the challenge of responding to persons with mental illness. Findings Broad-based community partnerships working together to develop programs that meet the local needs of both those with mental illness and law enforcement, the availability of mental health treatment centers with no-refusal policies, and a coordinating person or agency to effectively liaise among stakeholders are critical enhancements to CIT training. Originality/value As increasing attention is paid to adverse interactions between police and vulnerable populations, this paper identifies policies that would build on existing training programs to improve police responses to persons with mental illness.

Confidentiality & consent in police custody: General principles

The care of detainees (prisoners) in police custody has had much focus in recent years. The nature of the role of the doctor or other healthcare professionals within the police custodial setting may often be subject to conflicts, but their respective duties as healthcare professionals should generally overide any police or forensic issue that may be relevant. The laws or rules or statute that govern doctor, nurse or paramedic practice may vary from country to country, but the broad principles of healthcare ethics are universal and have been formulated not only by national healthcare regulatory bodies but by international organizations such as the World Medical Association. This article discusses in particular the duties of consent and confidentiality within the police custodial setting, giving examples of where conflicts may arise, and how they should be dealt with.

Deaths in police custody

Deaths in police custody often attract a huge amount of public interest and are frequently associated with controversy related to causation. While systematic investigations of deaths in police custody are currently available for countries in Europe, North America and Australia, the different inclusion and exclusion criteria and the lack of a uniform definition limits their comparability. Rates of death vary by age and gender with some similarities across different countries and continents. The male dominance is essentially due to the fact that around the world women are much less frequently taken into police custody than men. Similarly, in the U.S., the most common cause of custody death was natural illness and disease progression such as heart disease and cancer; along with high rates of suicide deaths. In most European countries there is a considerable dominance of non-natural deaths. The causes of death are dominated by alcohol, drugs and medications, but suicide, injury and trauma are also common. Deaths in custody require careful investigation to determine causality as well as culpability when appropriate. While many deaths may not be preventable, some are. Further systematic research of this issue, including detailed analyses and investigations of such cases, is necessary to develop general and specific preventative measures to reduce the risk of death in the custody population.

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.

A pilot feasibility trial of alcohol screening and brief intervention in the police custody setting (ACCEPT): study protocol for a cluster randomised controlled trial

Background

There is evidence of an association between alcohol use and offending behaviour and around a quarter of police time is spent on alcohol-related incidents. Police custody, therefore, provides an important opportunity to intervene. This pilot trial aims to investigate whether a definitive evaluation of screening and brief interventions aimed at reducing risky drinking in arrestees is acceptable and feasible in the custody suite setting.

Methods

Screening will be carried out by trained detention officers or drug and alcohol workers in four police forces across two geographical areas (North East and South West England). Detention officers (or drug and alcohol workers) will be cluster randomised to one of three conditions: screening only (control group), screening followed immediately by 10 min of manualised brief structured advice delivered by the individual responsible for screening (intervention 1) or screening followed by 10 min of manualised brief structured advice delivered by the individual responsible for screening plus the offer of a subsequent 20-min session of behaviour change counselling delivered by a trained alcohol health worker (intervention 2). Participants will be arrestees aged 18+ who screen positive on the Alcohol Use Disorders Identification Test. Participants will be followed up at 6 and 12 months post-intervention. An embedded qualitative process evaluation will explore acceptability of alcohol screening and brief intervention to staff and arrestees as well as facilitators and barriers to the delivery of such approaches in this setting.

Results

Recruitment is currently underway and due to end May 2015.

Conclusion

Results from this pilot trial will determine if a definitive evaluation is possible in the future and will provide stakeholder input to its design.

Trial registration

Reference number: ISRCTN89291046.

Mental health at the intersections: the impact of complex needs on police contact and custody for Indigenous Australian men

Indigenous Australians experience significant social risk, vulnerability and disadvantage. Nowhere is this more starkly demonstrated than in the levels of contact that Indigenous Australians have with the criminal justice system, particularly the police. Utilizing a linked dataset of extant criminal justice, human and health service administrative data in New South Wales (NSW) Australia, this paper explores patterns of police contact and custody for a cohort of Indigenous males with complex needs. Four significant factors are identified that alone or in combination appear to impact on the frequency with which these men experience police contact and custody, including young age at first police contact, experiencing out of home care as a child, alcohol misuse, and limited locational mobility. Whilst it might be expected that the presence of mental ill-health and/or cognitive disability would be a key predictor of the frequency and intensity of police contact and custody, the findings suggest rather that the presence of multiple disadvantages beginning in the early years and compounding throughout individuals' lives, in which mental illness may or may not be a factor, is more significant than the presence of any one diagnosis in precipitating police contact and custody for this group.

Elderly arrestees in police custody cells: implementation of detention and medical decision on fitness to be detained

INTRODUCTION

Most individuals detained in police custody are male adolescents or young adults. Demeaning custody conditions, which are common in French police cells, bring to light legitimate questions about the detention of elderly people. We aimed to determine the proportion of detainees over age 60, their health characteristics and conditions of detention, and the factors included in medical decisions on fitness to be detained.

METHODS

We studied all arrestees over age 60 examined in one year (January 1st-December 31st, 2009) by forensic physicians from our department. We collected data concerning their medical histories, their experiences in police custody, and their reported assaults.

RESULTS

Individuals over 60 accounted for 180 of 15,481 detainees (1%) and were predominantly male (92%). Some arrestees were examined several times during one or more detentions such that a total of 265 medical examinations were performed. Most individuals (133 of 172, 77%) reported one or more chronic somatic disorders and 115 of 160 (72%) were currently receiving treatment for a condition. Less half of two detainees (78 of 170, 46%) expressed some complaints during examination, commonly including pain (54 of 170, 32%), and 115 of 160 arrestees (72%) received medication while in custody. Detainees were considered to be completely fit for police custody in 119 of 259 cases (46%), and 25 of 259 cases (10%) were considered to be unfit to be detained.

DISCUSSION

The harsh conditions of police custody are particularly inappropriate for elderly individuals. Guidelines for custody officers and attending physicians that take the specific health needs of older detainees into account should be implemented.

Detainees in Amsterdam, a target population of the Public Mental Health System?

The Forensic Medical Service of the Public Health Service offers health care to detainees in police cells in Amsterdam. This study describes the registered mental health, addiction and social problems and compares them to the self-reported problems among a sample of detainees. Registers of the Forensic Medical Service are related to information from registers of police detention episodes. A general assessment of substance use, mental health and social problems is obtained by interviewing a sample of 264 detainees. The Forensic Medical Service was contacted in 24% of the 17,321 detention episodes. In 14% of the episodes mental or substance related disorders were observed. Within the sample 59% scored positively on indicators of substance abuse or mental health problems, 35% had additional social problems (debts, unemployment, housing). This proportion increased with age. It is concluded that substance abuse and mental health problems combined with social problems are highly prevalent among detainees, especially among the older ones. This urges for a close cooperation between Public Mental Health Care and Forensic Medical Services.

Alcohol and substance screening and brief intervention for detainees kept in police custody. A feasibility study

BACKGROUND

Screening and brief intervention programs related to addictive disorders have proven effective in a variety of environments. Both the feasibility and outcome of brief interventions performed in police custody by forensic physicians are unknown. Our objectives were to characterize addictive behaviors in detainees and to evaluate the feasibility of a brief intervention at the time of the medical examination in police custody.

METHODS

This prospective study included 1000 detainees in police custody who were examined by a physician for the assessment of fitness for detention. We used a standardized questionnaire and collected data concerning individual characteristics, addictive disorders, and reported assaults or observed injuries.

RESULTS

944 men and 56 women (94-6%) were studied. We found an addictive disorder in 708 of 1000 cases (71%), with the use of tobacco (62%), alcohol (36%), cannabis (35%), opiates (5%), and cocaine (4%) being the most common. A brief intervention was performed in 544 of these 708 cases (77%). A total of 139 of the 708 individuals (20%) expressed a willingness to change and 14 of 708 (2%) requested some information on treatment options. The main reasons why brief interventions were not performed were aggressive behaviors, drowsiness, or fanciful statements by the detainee.

CONCLUSION

Brief interventions and screening for addictive behaviors in police custody are feasible in the majority of cases. The frequent link between addictive behaviors and the suspected crimes highlights the value of such interventions, which could be incorporated into the public health mission of the physician in police custody.

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.

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.

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.