Healthcare services in police custody in England and WalesBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1994 (Published 14 April 2016) Cite this as: BMJ 2016;353:i1994
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Aude Lepresle, MD,1,2 Camille Vidal, MD,1 Patrick Chariot, MD, 1,3
1 Department of Forensic Medicine, hôpital Jean-Verdier (AP-HP), 93140 Bondy, France
2 Department of Psychiatry, CHU d'Amiens, 80000 Amiens, France
3 Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, UFR SMBH, Sorbonne Paris Cité, université Paris 13, France
Forrester et al. deplore a decision from the UK government not to pursue the transfer of custody healthcare commissioning to NHS England . They consider this decision as a missed opportunity to improve the quality of healthcare provided to arrestees detained in police cells. The authors confine their statements to the UK. We suggest that the situation of healthcare in police custody abroad could also be usefully considered. Health issues related to short-term detention in police cells have been recognized as an important unsolved question in many countries [2-4]. A lack of consistency and harmonisation in standards and practice across the European countries has been reported . In France, the need for a national network of reference forensic medical units has been identified and its creation was recommended by a national conference about doctors’ attendance on detainees in police custody in 2004 [2,6]. In 2010, a regulation implemented by the French Ministries of Justice and Health has set up the suggested network . Since then, the organization of forensic medicine in France includes a funding by global budgets instead of fee-for-service and an increased involvement of forensic medical units in the care of arrestees, but some local variations persist in 2016 .
Forrester et al. point out the importance of healthcare screening and the high morbidity of individuals taken into police custody, which is in accordance with published data from other countries. In Amsterdam, arrestees were 1.6 times more likely to report a chronic health condition than the general population . In France, the identification of unmet health needs among arrestees and high proportions of arrestees with addictive disorders has prompted the development of brief interventions in custody .
If performed in close connection with the national health system, the medical examination of arrestees is an opportunity to enable vulnerable individuals to access healthcare. Furthermore, it can facilitate continuity of care, which may offer short- and long-term individual and collective benefit.
1. Forrester A, Valmaggia L, Taylor PJ. Healthcare services in police custody in England and Wales. BMJ 2016; 353:i1994
2. Chariot P, Martel P, Penneau M, Debout M. Guidelines for doctors attending detainees in police custody: a consensus conference in France. Int J Legal Med 2008;122:73‑6.
3. Ceelen M, Dorn T, Buster M, Stirbu I, Donker G, Das K. Health-care issues and health-care use among detainees in police custody. J Forensic Legal Med 2012; 19: 324-31.
4. Heide S, Stiller D, Lessig R, Lautenschläger C, Birkholz M, Früchtnicht W. Medical examination of fitness for police custody in two large German towns. Int J Legal Med 2012;126:27‑35.
5. Heide S, Chariot P, Green P, Fabian J, Payne-James JJ. Healthcare and forensic medical aspects of police detainees, suspects and complainants in Europe. J Forensic Legal Med 2016, in press. doi.org/10.1016/j.jflm.2016.01.022
6. Agence nationale d’accréditation et d’évaluation en santé. Consensus conference. Doctors’ attendance on detainees in police custody, 2004. Available at: http://www.has-sante.fr/portail/jcms/c_272395/fr/intervention-du-medecin...
7. Circulaire CRIM-2010-27/E6-21-12-2010, relative à la mise en œuvre de la réforme de la médecine légale. 27 December 2010. Available at: http://www.textes.justice.gouv.fr/art_pix/JUSD1033099C.pdf
8. Chariot P. Organisation nationale de la médecine légale en France. [National organization of forensic medicine in France]. Rev Prat 2012 ; 62 : 796-8.
9. Chariot P, Lepresle A, Lefèvre T, Boraud C, Barthès A, Tedlaouti M. Alcohol and substance screening and brief intervention for detainees kept in police custody. A feasibility study. Drug Alcohol Depend 2014;134:235-41.
Competing interests: No competing interests
Here in the state of Victoria, competitive tendering with correctional services holding the purse strings has become the norm. Prisons are built with public funds and then handed over to a private, usually large overseas, provider of prison services. This company is then tasked with provision of health services and does so by a further competitive tender process. Physical health and mental health prison services are given over to separate organisations that may have no prior history of co-working.
Health services are thus even further removed from the locus of system control and decision making. With no overarching clinical governance framework or shared vision co-ordination of care and communication difficulties are endemic and give rise to problematic risk-laden clinical scenarios.
Fortunately, judging by reports of conditions in UK prisons, the milieu is generally much less noxious and as a result mitigates for the structural deficiencies in delivery of healthcare.
Competing interests: No competing interests