Understanding Risks: Practitioner’s Perceptions of the Lottery of Mental Healthcare Available for Detainees in Custody

Abstract

The range and growing number of healthcare requirements being presented within custody environments has been widely debated (Rekrut-Lapa, T. and Lapa, A. (2014). ‘Health Needs of Detainees in Police Custody in England and Wales: Literature Review’. Journal of Forensic and Legal Medicine 69–75). Despite a number of reforms following the recommendations of the Bradley Review (Bradley (2009). Lord Bradley’s Review of People with Mental Health Problems or Learning Disabilities in the Criminal Justice System. Department of Health and Ministry of Justice) and the amendments made to the ACPO guidance on safe detention in 2012, research continues to highlight a lack of consistency to services available to effectively identify the needs of individuals in these arenas. This article is based on part of a wider research project conducted in the Metropolitan Police Service and portrays the voice of the police practitioners working in custody suites. The research found that various notions of risk are central within this setting and that current practices are not sufficient for ensuring the safety of both detainees and officers. The research concludes by offering a proposal for capturing good practice and learning in order to create a more reflective and learning environment in custody suites.

‘I Feel Trapped’: The Role of the Cell in the Embodied and Everyday Practices of Police Custody

“…Hence it is likely staff are required to managed complex healthcare risks of detainees. (see Rekrut-Lapa and Lapa 2014;Skinns 2011;Williams et al 2017) As this chapter will demonstrate, the custody cell is a site where many of these risks, such as those of self-harm and violence, can be amplified. The cell, then, is a site of increased risk of harm where the 'corrosive effects of the custody environment' (Cummins 2008:41) can be observable.…”

“…Frequently the cell is used to de-escalate situations, where detainees who are arrested and are too violent, uncooperative or incoherent through drink or drugs to be dealt with immediately, are taken straight to the cell. This makes the time a detainee is in a police cell an inherently risky period, where risk of suicide and self-harm is heightened (Williams et al 2017). As a result, the cell can be a place where the detainee exercises their power in the context of custody, resisting, being violent and, importantly, a place where emotions are actively managed by staff.…”

“…Managing risk and 'risky' populations is a core part of role of working in custody. As Williams et al (2017) note, a lack of bespoke training on mental health and a 'one-size fits all' approach to risk assessment leads to custody staff feeling under pressure and ill-equipped to deal with the multitude of risks related to health. Those detainees coming into custody frequently have complex healthcare needs that pose a risk to the detainee and also to the staff managing them.…”

Violence against women

“…The very complex relationship between decision-making and vulnerability is discussed later on but ensuring vulnerability is assessed correctly is essential for an effective investigation. Training for police officers involved in identifying vulnerability and mental health issues is poor and therefore officers can refer to their experiential knowledge to make decisions about categories of vulnerability (Williams et al, 2017). Having access to information, advice from and working with relevant expert partners, such as other health agencies and psychologists would be hugely beneficial.…”

Variation in detainee risk assessment within police custody across England and Wales

“…It should be stressed that this study does not examine the effectiveness of the risk assessment to identify all risks or vulnerabilities, clinical or otherwise. Recent studies investigating this issue have found that generally, the current risk assessments fail to identify a significant proportion of risks (Carter and Mayhew 2010, McKinnon and Grubin 2013, Noga et al 2015, Williams et al 2017 or identify vulnerable adults (Dehaghani 2016a(Dehaghani , 2016b.…”