What is 'Equivalence' in Police Custody Healthcare?
Lead Research Organisation:
Newcastle University
Department Name: Sch of Geog, Politics and Sociology
Abstract
Context
At present, there is no clear standard for healthcare provision in police station custody suites governing the level of care expected by those detained. Healthcare providers are expected to work within the standards outlined by their own professional bodies; however, these are vague, and no clear standard exists for detention staff, who perform most custody healthcare. This is troubling due to the high rate of persons in police custody with mental health and substance abuse concerns and the rate of deaths in custody; both these rates are unequally distributed along ethnicity lines. It also stands in contrast to other parts of the criminal justice system (for instance prisons), where an equivalence standard, i.e. an expectation that persons detained in prison will receive healthcare equivalent to those at liberty, is the norm.
There are two common explanations the absence of such a standard: police custody is a law enforcement space; and persons are only detained for a few hours, meaning that they can access traditional healthcare upon release. Traditionally, healthcare in police custody is understood as resolving emergencies (including sending those that cannot be treated in custody to hospital) and ensuring that detainees are fit to be interviewed. However, the high rate of persons who are detained during a mental health crisis, as well as the 'chaotic lifestyles' of those detained, means that the healthcare needs of detainees in police custody spaces are increasingly important.
Aims and Objectives
As a result of these changes, this project aims to develop knowledge about the healthcare practices of police custody staff (police officers, detention officers, and healthcare providers) in order to inform an equivalence standard and provide guidance for its implementation into custody work. The project will ask four key questions:
1) How do custody staff (police and healthcare) interact with detainees, and how do these interactions impact detainees' experiences of health and wellbeing in police custody? How do detainees' observable characteristics (age, body size, skin colour, gender) influence these interactions?
2) How do police and healthcare staff in custody interact with each other, and what is needed to achieve optimal multiagency working and deliver equivalence in healthcare?
3) What role does the age and space of police custody environments play in the delivery of healthcare?
4) What health information about detainees is accessed, recorded, managed, and shared within police custody; how is this done, and how is the information secured?
To answer these questions, we will carry out the following social science research methods:
- Up to 500 hours of observations in four police custody suites
- Semi-structured interviews with 60 custody staff and 40 detainees
- Audits of 1,600 police custody risk assessment files and interviews with 20 police custody desk sergeants about their risk assessment procedures
Potential Benefits
The chief outcome of the research will be a policy brief outlining what an equivalence standard in police custody would include and how it could be implemented. We expect that this will include advice on the interactions between detainees and staff (police, civilian, and healthcare), the forms of information that detainees receive and the ways in which they receive it. In addition, we also expect to comment on the interactions between staff in custody, especially as they discuss detainees across professional boundaries. For instance, the transfer of personal information about a detainee between staff should be highly confidential, and so we would introduce guidance on the handling of such information in order to maintain patient confidentiality. It is expected that the production of an equivalence standard that works with current custody suite practice will improve healthcare outcomes for those who attend police custody, while also reducing the potential for deaths in custody.
At present, there is no clear standard for healthcare provision in police station custody suites governing the level of care expected by those detained. Healthcare providers are expected to work within the standards outlined by their own professional bodies; however, these are vague, and no clear standard exists for detention staff, who perform most custody healthcare. This is troubling due to the high rate of persons in police custody with mental health and substance abuse concerns and the rate of deaths in custody; both these rates are unequally distributed along ethnicity lines. It also stands in contrast to other parts of the criminal justice system (for instance prisons), where an equivalence standard, i.e. an expectation that persons detained in prison will receive healthcare equivalent to those at liberty, is the norm.
There are two common explanations the absence of such a standard: police custody is a law enforcement space; and persons are only detained for a few hours, meaning that they can access traditional healthcare upon release. Traditionally, healthcare in police custody is understood as resolving emergencies (including sending those that cannot be treated in custody to hospital) and ensuring that detainees are fit to be interviewed. However, the high rate of persons who are detained during a mental health crisis, as well as the 'chaotic lifestyles' of those detained, means that the healthcare needs of detainees in police custody spaces are increasingly important.
Aims and Objectives
As a result of these changes, this project aims to develop knowledge about the healthcare practices of police custody staff (police officers, detention officers, and healthcare providers) in order to inform an equivalence standard and provide guidance for its implementation into custody work. The project will ask four key questions:
1) How do custody staff (police and healthcare) interact with detainees, and how do these interactions impact detainees' experiences of health and wellbeing in police custody? How do detainees' observable characteristics (age, body size, skin colour, gender) influence these interactions?
2) How do police and healthcare staff in custody interact with each other, and what is needed to achieve optimal multiagency working and deliver equivalence in healthcare?
3) What role does the age and space of police custody environments play in the delivery of healthcare?
4) What health information about detainees is accessed, recorded, managed, and shared within police custody; how is this done, and how is the information secured?
To answer these questions, we will carry out the following social science research methods:
- Up to 500 hours of observations in four police custody suites
- Semi-structured interviews with 60 custody staff and 40 detainees
- Audits of 1,600 police custody risk assessment files and interviews with 20 police custody desk sergeants about their risk assessment procedures
Potential Benefits
The chief outcome of the research will be a policy brief outlining what an equivalence standard in police custody would include and how it could be implemented. We expect that this will include advice on the interactions between detainees and staff (police, civilian, and healthcare), the forms of information that detainees receive and the ways in which they receive it. In addition, we also expect to comment on the interactions between staff in custody, especially as they discuss detainees across professional boundaries. For instance, the transfer of personal information about a detainee between staff should be highly confidential, and so we would introduce guidance on the handling of such information in order to maintain patient confidentiality. It is expected that the production of an equivalence standard that works with current custody suite practice will improve healthcare outcomes for those who attend police custody, while also reducing the potential for deaths in custody.
Organisations
| Description | Data was collected from two police forces in England via three work packages. Work Package One was an ethnography of four custody suites (two in each constabulary), spending a total of 500 hours across the four sites, including 130 hours of in-custody observations. Work Package Two involved retrospective interviews with persons detained in police custody, as well as semi-structured interviews with Police Custody Officers, Detention Officers and Healthcare Professionals. 76 interviews were conducted in total. Work Package Three performed quantitative analysis on 3,200 police custody risk assessments (1,600 from each constabulary) and qualitative analysis on 60 custody logs, the documentary record of a person's period of detention. Data was analysed across all three work packages and the following headline findings have been identified: • Healthcare Professionals (HCPs) are not embedded within all police custody suites, a result of cost-cutting measures by police forces and private providers. This impacts the ability of custody teams to respond to healthcare needs. • A postcode lottery of medication provision exists based on the private provider. Medications and the directions for provision of medication, should be standardised across providers. • We observed Testimonial Injustice based on disbelief of detained persons' medical histories. We recommend more professional curiosity on the parts of custody staff (police and healthcare) in order to ascertain whether a person's account of their medical history is legitimate, and if not, to try and understand why that account is inaccurate. • We found that detained persons were often responsibilised about their medications before a formal police interview, weighing up a desire to leave custody early with their medical needs (for instance medical withdrawal). Doing so, resulted in detained persons being confused during the interview which could result in false confessions. • While custody teams did provide referrals to detained persons, these were not done in a way likely to be remembered by detainees on release. We recommend more enthusiastic referrals to support services, more likely to result in people contacting service, which might significantly reduce recidivism. Based on these findings we are currently working with various stakeholders from both the governance of police and healthcare in order to make our recommendations a reality. We have not developed an "Equivalence Standard" for police custody as originally stated, as it was obvious from the early work in each work package that healthcare in police custody is very far from being close to an equivalence standard. Additionally, colleagues, for instance Prof Andrew Forrester on our Advisory Panel advised us that the prisons Equivalence Standard, which we were originally aiming to emulate, is too vague a standard by itself. Prof Forrester instead recommended to us the "Availability, Accessibility, Acceptability and Good Quality" (AAAQ) standards developed from Human Rights legislation, and it is working with this standard that we have developed our own recommendations. As a result, we changed our aim from an Equivalency Standard to an AAAQ Standard, and these are present in our recommendations. At time of writing, we are in crucial talks with leading actors in the governance of police custody healthcare and within the next year we aim to have significantly impacted the provision of healthcare in police custody, based on our AAAQ recommendations. |
| Exploitation Route | At the present time we are in communication with various organisations (for instance the College of Policing, the Care Quality Commission, the Faculty of Forensic and Legal Medicine, amongst others) in order to try and change the criteria upon which healthcare delivery is inspected, as we expect that this is the only way that reform will actually take place in custody. Changing the ways that the police and healthcare providers are inspected, in line with our AAAQ recommendations, will improve the quality of care delivered in police custody. |
| Sectors | Communities and Social Services/Policy Healthcare Government Democracy and Justice Other |