بازداشت شدگان در آمستردام، جمعیت هدف سیستم بهداشت روانی عمومی؟

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.

People that are detained in prisons, jails or police cells of Western countries show more psychiatric illnesses e.g. psychotic disorders, severe depression and personality disorders, than the general population.1, 2 and 3 Contrarily, clients known at the Public Mental Health Care System run a higher risk for police arrests compared to the general population.4 Moreover detainees who are homeless, and who suffer from substance use disorders and schizophrenia run the highest risk for re-incarceration.5 The Public Health Service (PHS) in Amsterdam is responsible for both forensic medical services (FMS) and the coordination of Public Mental Health Care (PMHC). The FMS ensures the health and safety of people detained in police cells. Care is provided at police stations and at the Police Service cell blocks. The PMHC provides care and support to individuals or families with severe and complex psychosocial problems who are characterized either by not actively seeking help for their psychiatric or psychosocial problems, or by not having their health needs met by regular health care services.6 The majority of the patients of the PMHC is signalled by the police or (via hotlines) by citizens who worry about, or experience nuisance from their neighbours.7 Psychiatric and addiction treatment after detainment can reduce the risk of re-incarceration.5 Likewise, frequency of police contact may even be considered as a performance indicator of the Public Mental Health System.8 The ability to reduce criminality is one of the reasons that the benefits of treatment modalities such as heroin co-prescription exceed the costs of it.9 This study describes registration and interview data among detainees. Previously published articles based on these data focus on the physical health issues and general lifestyle characteristics of the sample and mental health.10 and 3 This study aims to identify the PMHC population among detainees, defined as those with a combination of mental disorders, social problems and unmet care. The prevalence of detainees with mental health and addiction problems is expected to be higher among the older arrestees. Therefore special attention is given to the age association. Furthermore, by comparing the interview data, registrations of the Forensic Medical Service and information of the total population of arrestees of the police services we will discuss the coverage of these problems in the daily practice of forensic nurses and physicians.

The assessment of the characteristics of the detainees provides valuable information (other than data of health services or population surveys) about the risk groups eligible for PMHC. The data indicate that detainees show high levels of drug abuse, homelessness and psychopathology and have limited contact with health services. We conclude that the target population of the FMS and PMHC shows a considerable overlap. In the first place, forensic physicians or nurses are responsible for the health care and safety of the detainees during their period of detainment. However, considering the population they serve, they are also a potential liaison for those patients that are not reached by the PMHC.