Findings

Our findings demonstrate that Healthcare Providers (HCPs) are not embedded in all police custody suites, which is delaying healthcare assessments and treatments as HCPs need to travel in from other locations.  Not only does this delay treatments for detained persons but can also add to exhaustion and burnout for HCPs producing compassion fatigue and an inability to retain staff.  The decision to not fully embed HCPs in all suites is a strategic choice, but one that limits the availability of HCPs.

We identified a postcode lottery of medicines provision across different healthcare providers resulting in divergent forms and standards of care dependent on where arrested.  We would argue that different Patient Group Directives and medicines provision does not constitute good quality of material resources.

Stigmatising attitudes and disbelief were common across custody staff, resulting in delays or denials of treatment and care, either as a potential form of punishment or due to not trusting the medical histories of the detained persons.  Such attitudes and the associated practices do not constitute accessible or acceptable healthcare.

Stigmatising attitudes particularly came to the fore with the provision of (or lack thereof) methadone for opioid dependent detained persons.  There was no evidence of links with pharmacies or programmes to access methadone for detained persons on a treatment programme.  This resulted in detained persons leaving custody and returning to criminal networks and in some circumstances being removed from treatment programmes.  This again constitutes a breach of good quality care.

Data from our Lived Experience cohort expressed they felt confused during police interviews, having entered a state of withdrawal prior to the start of the interview but not received medication.  As medications, especially those for treating opioid and alcohol dependency can result in drowsiness, sometimes HCPs discussed with the detained person whether to medicate given the close proximity of the interview.  Medicating would mean a delay to the interview, while not medicating would mean that the person could be released sooner.  Given the understandable desire to leave as soon as possible, detained persons choose the interview, but this can result in confusion and a lack of comprehension of what is being discussed.  While we appreciate the attempt to empower detainees about their own care, given the enormous power imbalances within police custody, this responsibilisation results in detainees making decisions against their own interest and so appears to us as against acceptable healthcare.

Finally, support and referral to other services appeared to be inconsistent and we again see this as not conforming with accessible and good quality healthcare.

Recommendations

Taking these findings into consideration with the AAAQ Framework, we recommend the following changes to police custody healthcare to improve the standard of service:

Recommendation One: HCPs to be properly embedded within all custody suites. 

Recommendation Two: All healthcare providers to sign up to a standardised medication list and PGD. 

Recommendation Three: Healthcare providers to remind HCPs that there does not exist a guideline that recommends waiting for six hours of detention before medicating. 

Recommendation Four: Staff within police custody to be trained to approach detained persons with professional curiosity rather than scepticism.  Listening and trusting detained persons’ accounts with professional curiosity would promote interactions more akin to trauma-informed practice.

Recommendation Five: Methadone to be accessible in police custody to all on a rehabilitation treatment programme.  To enable this, custody teams to develop robust relationships with local pharmacy and drug services to ensure swift provision of methadone when caring for a drug dependent detainee.

Recommendation Six: Alcohol and drug dependent detained persons to be acknowledged as vulnerable and provided with an Appropriate Adult.

Recommendation Seven: Consistent referral of support services to detained persons.