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Background Internationally, there is evidence of high rates of mental disorders amongst police custody detainees but this literature is limited, and there has been little research into the unmet needs of police detainees in the UK, or elsewhere. Such research could support better focussed interventions for improving health and recidivism outcomes. Aim To examine psychiatric and developmental morbidity amongst police detainees, and ascertain differences in need between morbidity categories. Method We used a cross‐sectional study design and interviewed a 40% sample of people entering police custody in one South London police station over a 2‐week period. A series of standardised measures was administered to screen for the presence of mental illness, general health and social care needs. Results A cohort of 134 people was generated, of whom nearly one‐third (39, 29%) had current mental illness (major depression and/or psychosis); more had a lifetime diagnosis (54, 40%). Just under a fifth met the threshold for post‐traumatic stress disorder (11, 8%). Clinically relevant alcohol or daily cannabis use affected about one quarter of the sample. Twenty‐one percent (or 28) screened positive for personality disorder, 11% (or 15) for attention deficit hyperactivity disorder and 4% (6) for intellectual disability. Nearly one‐fifth (24, 18%) were at risk for suicide. Those with psychosis, and those deemed at risk for suicide, had the highest levels of unmet need and, indeed, overall need. The most frequent unmet need was for accommodation. Conclusion Our findings not only confirm high rates of mental health problems amongst police detainees but also demonstrate their high risk of suicide and high levels of unmet need, especially as regards accommodation. This underscores the need to provide mental health services in police stations, to help identify and resolve these issues at this early stage in the criminal justice system. Extending accommodation capacity to help some arrestees may help to save lives and interrupt cycling through the criminal justice system.

Diminished Responsibility is a statutory partial defence to the charge of murder in the Homicide Act 1957 which has been amended by the Coroners and Justice Act 2009. In R v Brennan, the Court of Appeal described the new criteria as relating ‘entirely to psychiatric matters’. This article will explore to what extent such a conclusion is warranted. The statutory wording of the 2009 Act will be analysed and the role of expert psychiatric evidence will be considered. It will conclude that the new Diminished Responsibility is not a purely psychiatric matter. This is because of the moral dimensions inherent in the defence, the ambiguity in the statutory wording and the fundamental problems of psychiatry usurping the function of the jury in relation to the ultimate issue. This results in inconsistent application and role confusion in relation to the defence and asks psychiatric evidence questions it cannot answer.

SUMMARYMiscarriages of justice occur as a result of unsafe convictions and findings and inappropriate sentences. In cases involving expert psychiatric evidence it is possible that the way evidence is presented by experts or interpreted by the courts has a direct bearing on the case. Using illustrative cases from the Criminal Division of the Court of Appeal, advice is offered to expert psychiatric witnesses on ways to reduce the likelihood of contributing to such miscarriages of justice and on how they may assist in rectifying such miscarriages, should they occur.LEARNING OBJECTIVESAfter reading this article you will be able to: •understand the place of criminal appeals in the criminal justice system in England and Wales•understand what may go wrong in the provision of psychiatric evidence and how expert psychiatric evidence can assist in the administration of justice•be able to reduce the risk of unsafe convictions and inappropriate sentences when providing expert psychiatric evidence, including for cases referred to the Court of Appeal and the Criminal Cases Review Commission.DECLARATION OF INTERESTNone.