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Mental disorder, vulnerability, substance misuse & physical health in police custody. Results from the Health Screening of People in Police Custody (HELP-PC) project – phase 3

Lookup NU author(s): Dr Iain McKinnonORCiD, Dr Samir Srivastava, Professor Donald Grubin


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Background Our previous work demonstrated deficiencies in screening for mental disorders and substance misuse among police custody detainees. Given recent developments in custody health care, concerns about deaths in custody, and statutory welfare responsibilities of police sergeants, improved first stage screening is required. Aims Develop and evaluate a novel health screening tool for custody officers within custody suites. Methods The screen was developed based upon extant screening tools and data from prior phases of our work. It was developed in conjunction with the Metropolitan Police’s custody and medical directorates along with focus groups of custody sergeants. We piloted the screen in one police station in London. Once screened by the police sergeant, consecutive detainees were approached to take part in our semi-structured clinical research interview. The screen was compared to clinical opinion. We tested the null hypothesis that there was no difference between the new screen and the standard police screen. We assessed efficacy in the following morbidity areas: Serious Mental Illness, Intellectual Disability and other mental health conditions Individuals who need to have an appropriate adult present during police interview Problematic Drug Misuse and risk of withdrawal Risk of Alcohol Withdrawal Syndrome Active suicidal ideation. Results During a three month pilot in 2012, data from 351 detainees were analysed. The new screen detected 93% of psychotic disorders, 75 % of detainees with major depression and 83% of those with suspected Intellectual Disability. These results represent improvements in sensitivity compared to the standard custody health screen. Appropriate Adults were called in almost 60% of detainees with psychosis compared to only one-third with the previous screen. 76% of those at risk of alcohol withdrawal syndrome were detected compared to 48% previously. There was a non-significant improvements in the detection of those at risk of heroin withdrawal and a small worsening in the detection of those at risk of crack cocaine withdrawal. Using enhanced detection criteria 77% of those with active suicide risk were detected compared to less than 48% with the standard screen.DiscussionIt is possible to improve the detection of mental disorders by police custody officers, using a structured screening tool. Improvements in both sensitivity and specificity compared to the previous screen resulted in no increase in workload for the HCP. Having shown its potential, we recommend implementation and a wider evaluation of the new screen, ideally a clinical trial of the intervention.

Publication metadata

Author(s): McKinnon I, Srivastava S, Kaler G, Grubin D

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Royal College of Psychiatrists Faculty of Forensic Psychiatry Annual Conference 2014

Year of Conference: 2014

Pages: 12-13

Publisher: Royal College of Psychiatrists