Health care for persons detained by the police can reach the vulnerable population

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Curfew detainees have complex health needs in a difficult environment that nonetheless provides a unique chance to “interpret a vulnerable, complex and otherwise hard-to-reach population and identify unmet health needs,” according to the authors of a Perspective publication today from Medical Journal of Australia.

Professor Julia Creeley, Professor of Emergency Medicine at Gold Coast Hospital and Health Service and Griffith University, and colleagues reflect on a recent report which showed that 43 (9%) of 505 deaths in police custody between 1991 and 2016 .occurred in a police station, police vehicle, police cell or guardhouse. Almost half of these were deaths due to medical causes (49%).

“As a group, [police watch-house detainees] are largely excluded from health services, so that beyond their immediate, untreated health problems, relatively little is known about underlying and unresolved social determinants,” Crilly and colleagues write.

“Access to health care in short-term detention settings can be impeded by a number of underlying health care delivery contexts, structures and processes.”

Crilly and colleagues explore the key challenges for the people and systems responsible for the health and safety of detainees in short-term detention.

Challenges at the individual level:

  • detainees have significant health problems with higher rates of mental illness, substance dependence and communicable diseases; they usually present with acute exacerbations of chronic conditions such as diabetes mellitus, hypertension, asthma, substance dependence, and mental illness; they may also be acutely injured, intoxicated and/or upset;
  • detainees usually have complex social needs belonging to multiple categories of vulnerable population groups;
  • autonomous decision-making is limited for detainees and they rely on police assistance to access services; they may underreport or overreport health problems, or because they do not trust those responsible for their access to health care.

System-level challenges:

  • observation breaks are not health facilities and are not necessarily well equipped to manage the provision of health care, and health facilities are not custodial facilities — “there are inherent risks in transferring detainees from a secure setting to a health facility”;
  • observation houses are not prisons and may contain both children and adults of different sexes, all requiring segregation, which presents additional complications during a pandemic;
  • Police officers are not health professionals, but are expected to play a role in health screening of detainees and the provision of some minor care—”many detainees on guard duty have health problems that require a quick and effective response… Given the duty to care owed to police detainees, a risk reduction approach often guides transport decisions [but] there is limited evidence to guide health care management for curfew detainees.”

Interagency challenges:

  • a wide range of providers are involved in detainee health care, with “different communication preferences, organizational cultures, professional terminology, procedures, and sometimes different goals”;
  • health services must plan care around criminal justice processes and outcomes that may not yet be determined, leading to uncertainty about the provision of ongoing or follow-up care;
  • there are significant health care costs for detainees in custody, such as health personnel, drugs, general medical supplies, police escort and guard costs for transfer to and treatment in external health facilities.

“Despite myriad challenges, detention provides a unique opportunity to capture vulnerable, complex, and otherwise hard-to-reach populations and identify unmet health needs,” Crilly and colleagues wrote.

They proposed greater access to out-of-hours health care providers, out-of-hours models of health care closely linked to public health services and administered by a health agency rather than the police department, continuity of care, a shared electronic medical record, and “ a broader management framework that promotes integration between health care providers in the observatory and the community’.

“These goals will require sustained, coordinated investment in cross-sectoral collaboration. The overlap between health care and law enforcement offers important opportunities to support the provision of health care to detainees. It’s time to take advantage of these opportunities,” concluded Creeley and colleagues.

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More info:
Julia L Crylly et al, Curfew Health Care: Challenge and Opportunity, Medical Journal of Australia (2022). DOI: 10.5694/mja2.51688

Courtesy of the Medical Journal of Australia

Quote: Health care for police custody may reach vulnerable population (2022, Aug. 29), retrieved on Aug. 29, 2022, from vulnerable-population.html

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