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Objective: People detained in short-term police custody often have complex health conditions that may necessitate emergency care, yet little is known about their management in EDs. The present study aimed to understand ED doctors' experiences and perceptions regarding the appropriateness and management of detainee transfers from police watch-houses to the EDs., Methods: A qualitative descriptive study, using semi-structured interviews undertaken with ED doctors working in five purposively sampled EDs across Queensland, Australia. Data were analysed using inductive content analysis., Results: Fifteen ED specialists and trainees participated. Participants reported that their overarching approach was to provide equitable care for watch-house detainees, as they would for any patient. This equitable approach needed to be responsive to complicating factors common to this population, including presence of police guards; restraints; complexity (physical/mental/social) of presentation; reliance on police to transport; ED doctors' often limited understanding of the watch-house environment; justice processes and uncertain legal disposition; communication with the watch-house; and detainees misreporting symptoms. Thresholds for assessment and treatment of detainees were contextualised to the needs of the patient, ED environment, and imperatives of other relevant agencies (e.g. police). Participants often relied on existing strategies to deliver quality care despite challenges, but also identified a need for additional strategies, including education for ED staff; improved communication with watch-houses; standardised paperwork; extended models of watch-house healthcare; and integrated medical records., Conclusions: Providing equitable healthcare to patients transported from watch-houses to the EDs is challenging but essential. Numerous opportunities exist to enhance the delivery of optimal care for this underserved population., (© 2024 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Despite sustained large-scale educational campaigns, public attitudes towards mental illness have remained persistently negative. Associated with this, recent research from Victoria, Australia, reported that police commonly associated violent behaviour with mental illness. The present study examined 4267 cases of police use of force and considered what differentiated and characterised violent from non-violent behaviours reported by police in the context of a use of force incident. The specific focus was to examine the effects that historical variables such as age, gender, prior violent offending and having a prior diagnosis of mental disorder, as well as incident specific factors such as exhibiting signs of mental disorder and substance intoxication have on violent behaviour during the use of force incident. The proximal factors of apparent mental disorder and alcohol intoxication were significantly associated with violent behaviour towards police, whilst having a history of prior violence and prior mental disorder diagnoses was not associated with violence. The results challenge traditional stereotyped views about the violence risk posed by people with prior contact with mental health services and those with prior violent offending histories. A service model that allows for psychiatric triage would be able to assist with streamlining police involvement and facilitating timely access to mental health services., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Helping people in acute psychiatric crisis has become an increasingly common part of modern community policing. In certain extreme cases, police may be faced with a suicidal individual who intends to intentionally provoke police to shoot them. While fatalities are fortunately rare, anecdotal reports from frontline police suggest that these kinds of encounters are occurring on a regular basis. This paper explores 2350 psychiatric crisis incidents over an eight-month period in Victoria, Australia, and assesses the frequency and nature of potential police-provoked shootings resolved through non-fatal means. Contextual factors relating to the person's behaviour and police responses, and the person's psychiatric and criminal histories were considered to elucidate characteristics common to these incidents. Results suggest that police are potentially encountering a person who is suicidal and trying to provoke police to shoot them more than twice a week. These individuals share a number of common characteristics with those who have been fatally shot in similar circumstances and are quite different from those who attempt self-inflicted suicide. Results are discussed in relation to the impact of previous criminal contact from both the suspect and police perspectives., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Patients regularly abscond from mental health units and at times the consequences for patients and for others can be serious. The police are involved with absconding events, but are rarely considered in the mental health literature. In most jurisdictions, the police can take missing person reports for involuntary patients whose whereabouts are unknown and there are genuine concerns for their safety or welfare. Those people remain active cases for the police until located. This paper presents extracts of 25 police officers' narratives from a qualitative research project. Officers viewed absconding as a regular event, and workload burden that was exacerbated when mental health staff rarely initiated any search for the absconded patient and abdicated responsibility too quickly to the police. The officers were concerned about communication with mental health services and reported that information about the absconded patient could be inadequate or not given to police, and police often were not informed when the patient was found or discharged. Improved liaison and cooperative working that promote effective communication could strengthen police and mental health nursing collaboration and ensure better outcomes for patients., (© 2013 Australian College of Mental Health Nurses Inc.)

Background: A number of jurisdictions have instituted legislation requiring an independent person to be present during police interviews with vulnerable people. In Victoria, Australia, a group of volunteers known as independent third persons help to fulfil this role with people who present with cognitive impairment arising from their mental illness or disability. This study sought to explore the perspectives of the Independent Third Person volunteers on police identification of and responses to people with intellectual disability (ID)., Methods: All registered Independent Third Person volunteers across the State of Victoria in Australia were identified and sent a postal survey on their experiences and confidence in performing their role, their perceptions of police competency, and the challenges they faced working at this interface., Results: Of the 207 Independent Third Persons identified, 94 (45%) completed and returned the survey. Participants reported that despite being overly reliant on previous police contacts and cues relating to communication difficulties, they viewed police as generally competent in their ability to identify people with ID. They also considered themselves confident in performing their own roles at this interface, albeit more so at the perfunctory aspects of the role and less so with the emotional aspects of supporting the person being interviewed., Conclusions: Police are seen as competent at identifying those with cognitive deficits and seeking appropriate supports for the person with ID in the interview context. More specialised training for police members is recommended in communicating with people with IDs. Volunteers working at this interface require additional support and training in helping to meet the emotional needs of those being interviewed., (© 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.)

Purpose: To examine the estimated rates of mental disorders and associated situational characteristics in people involved in nonfatal use of force incidents with police in VIC, Australia., Methods: A random sample of 4,267 cases between 1995 and 2008 from a dedicated police Use of Force Register were linked with the state-wide public mental health database and a police contacts database. Rates of ICD 9 and ICD 10 mental disorders recorded on the public mental health database were examined, as well as rates of criminal offending and the characteristics of force used by both parties., Results: More than a third of people on whom the police resorted to using force (n = 1,621, 38%) had a history of mental disorder. Significant overrepresentations of the estimated prevalence of psychosis [12.5%, OR = 9.03, 95% CI (7.41, 11.01), p < 0.001] and schizophrenia [9.1%, OR = 9.73, 95% CI (7.59, 12.47) p < 0.001] were found. Those diagnosed with mental disorders were 1.52 times more likely to use or threaten to use weapons on police, even after taking into account age, sex, substances intoxication and violent behaviour [95% CI (1.23, 1.91), p < 0.001]; however, they were no more likely to injure or be injured by police than those without a recorded history of mental disorder. There was a noted trend for police to use, or threaten to use, weapons on people with a history of psychosis (other than schizophrenia) [OR = 1.40, 95% CI (1.11, 1.78), p = 0.005]., Conclusions: Psychoses and schizophrenia are dramatically overrepresented in cases where police resort to using force. Situational characteristics evident in the encounters are suggestive of a sub-group of people with mental disorders presenting with aggressive and otherwise problematic behaviours coupled with histories of criminal offending; this presents significant ongoing challenges for the police.

Objective: To examine the relationship between committing homicide, the presence of schizophrenia, substance misuse and past criminality., Method: The study employed a data linkage design, using contacts recorded on two statewide databases, one of which recorded public mental health services contacts and the second of which recorded contacts with the police. The estimated rates of schizophrenia disorders, substance abuse and criminal convictions found among a population of 435 homicide offenders were contrasted with estimated rates in two composite comparison samples., Results: Of the 435 offenders, 38 (8.7%) had been diagnosed with a schizophrenia disorder, which was RR 13.11 (95% CI 9.14-18.80) times more likely than a comparison sample. Rates of known substance abuse between homicide offenders with and without schizophrenia and community-dwelling residents with schizophrenia did not differ significantly. However, these rates were higher than those found in the general community. A similar pattern emerged for comparisons regarding offending histories between these same groups., Conclusion: The association between homicidal violence and having a schizophrenia disorder cannot be explained away simply on the basis of either comorbid substance abuse or prior criminal offending., (© 2011 John Wiley & Sons A/S.)

Objective: The aim of the present study was to explore the mental health and offending histories for all cases that resulted in fatal use of force by Victoria Police between November 1982 and February 2007., Methods: Forty-eight fatalities were extracted from the Use of Force (UoF) Register, and then linked with the mental health and police contacts databases. These data were supplemented, where necessary, with relevant information from Coronial Reports and an Office of Police Integrity Report., Results: All but six cases had involved recorded histories with mental health and criminal justice systems before the fatal incident occurred. Rates of all Axis I disorders were significantly overrepresented, with estimated rates of psychosis and schizophrenia 11.3- and 17.3-fold higher than estimated rates in the general population (95% confidence intervals = 6.3-20.2 and 9.2-32.4, respectively). Although the number of fatalities has halved since inception of Project Beacon (32 before vs 16 after 1995), there has been no reduction in representation of mental illness among those fatally shot., Conclusions: The significant over-representation of Axis I disorders, including severe mental disorders of psychosis and schizophrenia, is of considerable concern for both the police and the mental health providers. Functional interagency partnerships and police training on how to interact with people in distress are recommended to address the overrepresentation of mentally ill persons in these encounters.

Iain G McKinnon,1,2 Stuart DM Thomas,3–5 Heather L Noga,6 Jane Senior7 1Institute of Health and Society, Newcastle University, Academic Psychiatry, Campus for Ageing and Vitality, 2Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; 3School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, 4Legal Intersections Research Centre, University of Wollongong, Wollongong, NSW, 5Southern Clinical School, Monash University, Clayton, VIC, Australia; 6School of Criminology, Simon Fraser University, Burnaby, BC, Canada; 7Offender Health Research Network, University of Manchester, Manchester, UK Abstract: This paper is a scoping review of the available evidence regarding health care issues in police custody. It describes the types and prevalence of health disorders encountered in custody and provides an overview of current practice and recent innovations in police custody health care. In contrast to the health of prisoners, the health of police custody detainees has, until recently, received little academic or clinical attention. Studies on health care in police custody identified for this review are limited to a few geographical jurisdictions, including the UK, continental Europe, North America, and Australia. There are significant health concerns among police detainees including acute injury, chronic physical health problems, mental and cognitive disorders, and the risks associated with drug and alcohol intoxication or withdrawal. There is some evidence that deaths in police custody have reduced where attention has been paid to the latter issue. Police personnel continue to experience difficulties identifying detainees with health issues relevant to their safe detention, but research shows that the use of evidence-based screening tools improves detection of such morbidities. Innovations in police custody health care mainly relate to detainees with mental disorders, including improved identification of illness, timely access to mental health services, the protection of the rights of mentally disordered detainees, and the diversion of mentally disordered persons from the criminal justice system into appropriate health and social care interventions. There is a lack of rigorous research relating to interventions for physical health problems, protecting those at risk of substance withdrawal, and detainees with preexisting or peri-arrest injures. Research to improve the health of police custody detainees requires greater priority, focusing on case identification and service redesign to address high levels of morbidity and to facilitate health promotion and prevention activities. Keywords: police, vulnerable detainees, criminal justice system, deaths in custody, mentally disordered offenders, police health care innovations