What is the role of doctors in respect of suspects with mental health and intellectual disabilities in police custody?

Abstract

People with severe mental illness and intellectual disabilities are overrepresented in the criminal justice system worldwide and this is also the case in Ireland. Following Ireland’s ratification of the United Nations’ Convention on the Rights of People with Disabilities in 2018, there has been an increasing emphasis on ensuring access to justice for people with disabilities as in Article 13. For people with mental health and intellectual disabilities, this requires a multi-agency approach and a useful point of intervention may be at the police custody stage. Medicine has a key role to play both in advocacy and in practice. We suggest a functional approach to assessment, in practice, and list key considerations for doctors attending police custody suites. Improved training opportunities and greater resources are needed for general practitioners and psychiatrists who attend police custody suites to help fulfill this role.

The evaluation of a training course to enhance intellectual disability awareness amongst law enforcement officers: a pilot study

“…These included the need to incorporate the participation of a person with an intellectual disability in the delivery of training; additional real-life scenarios with a procedural focus and the need to facilitate greater access amongst frontline LEOs to accessible medical expertise. The latter finding has specific implications for training of medical practitioners attending police custody suites (Gulati et al 2021b).…”

“…People with intellectual disabilities are over-represented in the criminal justice system at all stages of the criminal justice pathway (Gulati et al 2018; Hellenbach et al 2017; Young et al 2013) and face barriers in accessing justice equally (Gulati et al 2021a; Gulati et al 2021b; Schatz, 2018). They report difficulties in understanding and communicating information in police custody and a paucity of appropriate supports in this setting (Gulati et al 2020b).…”

Towards inclusionary policing: a critical inquiry into the pre-trial treatment of suspects with intellectual disabilities in Ireland

“…By employing a focus group methodology – involving national and international experts in the fields of psychiatry, psychology, law and speech and language therapy, as well representatives from national disability bodies, active members of An Garda Síochána, and, most importantly, people with lived experience of intellectual disability – the review promises to yield the world's first “lived experience-informed” Easy Read Notice of Rights. Given that, less than 5% of signatories to the UNCRPD currently report progress in developing information materials accessible for people with learning disabilities (Gulati et al. , 2021b), this innovative, user-led approach may provide a best practice template to allow other international police forces to adjust their custody practices to align with their international obligations.…”

The evaluation of a training course to enhance intellectual disabilities and mental health awareness amongst General Practitioners attending police stations

“…The ability of police in identifying intellectual disabilities can be assisted by training programs, which need not be onerous or resource-intensive (2021b). Yet, doctors have a key role to play in assisting Gardai (as the Irish police service is known generally) in identifying vulnerability, providing assessments of fitness to be interviewed and in the judicious application of mental health legislation where this is strictly necessary (2021c). Clarity around the remit of mental health legislation is particularly necessary in the overlap between mental illness and intoxication, particularly in a context where 48% of those attending Garda stations suffer with substance abuse/intoxication (Garda Síochána Inspectorate, 2022) and applications by Gardai remain the most frequent form of application for detention under the Mental Health Act 2001 (Mental Health Commission, 2021).…”