Background
In many countries, forensic physicians function as primary care providers for detainees in police custody. Their task is comparable to the tasks of general practitioners. Nevertheless, problems presented by both patient populations may differ. We therefore aimed to systematically compare presented problems and medication use in a population of police detainees to those of regular patients in general practice.
Methods
Health problems and prescription medications of 3232 detainees seen by the Amsterdam Forensic Medical Service were compared to those of general practice patients (n = 78,975) adjusted for age and gender during a 12-month period.
Results
Among those obtaining medical attention (28% of all detainees), almost 50% were diagnosed with mental health problems, with substance abuse as the leading reason for consultation. Forty-two percent received at least one prescription affecting the nervous system. In general practice, 17% (P < 0.001) of patients consulting their GP were diagnosed with mental health problems and 22% (P < 0.001) were prescribed medications affecting the nervous system.
Conclusion
The magnitude of mental health problems among police detainees has significant implications for the qualifications of police health staff and those who provide health care in the police setting especially concerning substance abuse.
Forensic physicians function as primary care providers for detainees in police custody in several countries.1 Health personnel in this setting are expected to treat acute health problems and to assess whether a stay in the police cell is safe, from a medical point of view. The health care issues of those detained by the police may differ from those seen in regular general practice for a variety of reasons. First of all, sociodemographic differences between the patient populations may exist, concerning age, level of education, socioeconomic status, access to health care prior to custody and ethnic background.2 Secondly, in police custody, acute health problems such as intoxication, withdrawal from illicit drugs and alcohol, psychiatric conditions and injury predominate the work of health staff.3, 4 and 5
From prison research, it is known that the prevalence of mental health problems and medical consumption among inmates is much higher than in the general population.6, 7, 8, 9 and 10Recent research performed among sentenced Dutch prisoners reports that 25% of all medical contact during custody included psychological aspects, while social problems and addiction were present in another 25%.11
Research performed among sentenced detainees is only partly informative for research on detainees held in police custody, however, as many of those arrested do not enter jail or prison because they are released at some stage following initial police contact. Moreover, lock-up only ranges from hours to a maximum of several days until the police investigations are finished. A look into the literature shows that, in contrast to prison populations, data concerning the mental health of police detainees are widely lacking. In police cells, only a few studies have been conducted so far.3, 12, 13, 14, 15, 16, 17, 18, 19 and 20 Information on the mental health of police detainees is necessary, however, with regard to patient safety in police custody.
Furthermore, knowledge on mental health issues of detainees helps inform those involved in the education of police health staff. A comparison of reasons for consultation in the police and general practice setting can provide valuable information concerning the different qualifications of health care providers needed. Last but not least, there is evidence for a positive relation between unresolved or untreated mental health problems in detainees and subsequent recidivism, underlining the importance of the topic to public health and society.21
Against this background, the aim of the current study is (1) to present a detailed description of the mental health problems for which primary care services were provided during police custody, (2) to shed light on differences in reasons for consultations of police detainees as compared to patients in general practice.
