Psychiatric disorder in criminal populations Police detainees

The police service is likely to be the first agency to which a mentally disordered offender presents. Indeed, an American study refers to the police as the 'streetcorner psychiatrist' with a 'pivotal' role as a mental health resource.(33) Outcome in essentially similar cases will be determined by many factors. For example, whether the offender is dealt with in the criminal justice or psychiatric service, or by a combination of both, will depend on the following:

• the nature of the offence

• local policy for diverting offenders from prosecution

• the organization of emergency psychiatric services

• the nature of local psychiatric resources, particularly inpatient beds

• the quality of liaison between criminal justice and health services.

These are all non-clinical variables of crucial importance. Poor cooperation between health and police services has been identified as a recurrent failing in a series of inquires in England into psychiatric homicides.(34) An observational study by Robertson et al.(35) of procedure at seven police stations in London over 18 weeks found that 37 of 2721 detainees (less than 2 per cent) had definite or probable acute psychiatric illness and nearly all were speedily diverted to treatment agencies. Failure to divert was significantly associated with black ethnicity. Alcohol and drug problems are prevalent in cohorts of police detainees. In a Dutch study of 309 police detainees, Blaauw et al(36) found nearly half had attended an alcohol- or drug-treatment facility. A report of 277 deaths in police custody in England between 1990 and 1996, attributed 172 (62 per cent) to the deceased's own actions (self-inflicted injury or self-poisoning) of which 69 were associated with alcohol or drugs. (37)

In England, the government has funded initiatives to encourage the early removal of mentally disordered offenders from the criminal justice system, with an emphasis on avoiding inappropriate remands in custody (to prison) for obtaining a psychiatric report. (38.) Court diversion schemes are widely developed, some involving the use of a ourt-based psychiatrist, while others utilize a community psychiatric nurse to sift cases held in custody. In central London, and probably elsewhere, these schemes cannot function properly without access to appropriate inpatient beds.(39)

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