Psychiatric problems and substance abuse common among detainees in police custody

Twenty-eight per cent of detainees in police custody receive medical care. Of this group, half have psychological or addiction problems; substance abuse is the main reason for consulting a physician. Researchers from the Public Health Service of Amsterdam (GGD Amsterdam) and the Netherlands Institute for Health Services Research (NIVEL) have found that this kind of medical care requires forensic experience. They have published their findings in an article in the Journal of Forensic and Legal Medicine.

 
Medical care inside the walls of a jail is different from care on the outside. In jails, care is provided mainly by forensic physicians, who usually work for a public health service. Compared with general practitioners (GPs), forensic physicians working in jails see three times as many patients with psychological or addiction problems, and prescribe psychiatric medications (such as drugs used to treat addiction, antipsychotic drugs, and antidepressants) nearly twice as often. From time to time the debate on medical care for detainees and prisoners resurfaces, for example, because their ability to choose their own doctor is limited and because some forensic physicians are not trained GPs.
 
Addicts and psychiatric patients
“For somatic conditions, such as acute stomach complaints, the care has to be comparable to what a GP would provide,” says Tina Dorn, researcher at the Public Health Service of Amsterdam (GGD Amsterdam). “But considering the large proportion of addicts and psychiatric patients, the average GP lack sufficient experience to handle this. These patients are really very different from the ones GPs generally see in their practices. Because of their training, forensic physicians are usually well equipped to provide this kind of care.”
 
Aggressive patients or cases of poisoning
“This is about more than just medical knowledge,” she explains. “It’s also about how you deal with these patients. Many of these people are aggressive, severely intoxicated, or have drug or alcohol poisoning. A forensic physician then decides whether such a person can remain in jail or if they have to be sent to a hospital. They have a lot of experience with this. In addition, forensic physicians are very knowledgeable about the legal side of things.” According to Dorn, the training for forensic physicians has improved greatly over the past few years, and the work they do is increasingly valued.
 
Prison doctor
“There are major differences not only between the patients seen by GPs and the detainees seen by forensic physicians, but also between detainees in police custody and those in prison – they can’t really be compared,” according to Dorn. “For those in prison there’s the prison doctor, who’s been specially trained for this. But in prisons there are also fewer acute, extreme situations than in jails. Alcohol or drug poisoning is less of an issue, and there are fewer people who can’t be approached or who are unresponsive.”
 
NIVEL Primary Care Database
For the comparison with general practice patients, information from 3,232 detainees was compared with data from general practices in the NIVEL Primary Care Database. The NIVEL Primary Care Database makes use of data from the electronic patient files of participating GPs, and gathers information about conditions, numbers of contacts, procedures, drugs prescribed, and referrals on an ongoing basis.

Cooperating partner
GGD-Amsterdam Contact: dr. Manon Ceelen (mceelen@ggd.amsterdam.nl)