Care and Containment: Issues in Police Custody

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Care and Containment Issues in Police Custody

• Kris Mihaly
• Custodial Medicine Unit
• Operations Support Department
• Victoria Police

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Victoria Police Mission Statement

• To provide a safe, secure and orderly society by
  serving the community and the law

Protect Life and Property Help Those in Need of
Assistance
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History of Custodial Medicine

• Traditional Police Surgeon (on-call local GP)
• 1995 Custodial Medicine Unit created with 2
  nurses to provide
• Assessment of physical health needs
• Assessment of psychiatric needs
• Risk assessment
• Support and advice to police
• Model centralised and reactive

4
Further Development

• 1998 Nursing staff increased to 3.5 EFT
• 2002 Custodial Health (Alcohol and Drug) Nurses
  Project
• Joint initiative with Drug and Alcohol Policy
  Unit
• 10 EFT nurses
• Special emphasis on AD issues
• Model decentralised and proactive

5
Prisoners in Victoria
Court
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People in Police Custody

• No access to normal health services
• Vulnerable
• Drug and alcohol problems
• Lack social skills
• Lack personal and social resources
• Burden of illness
• Physical
• Psychiatric

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Cell Environment

• No smoking
• Re heated pre prepared food
• Minimal exercise areas
• Continuous lighting
• Concrete beds
• Enforced withdrawal from illicit drugs

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Organisational change

• Nurses in police stations
• Changed police attitudes
• Sensitised police to prisoner welfare
• Change in prisoner attitudes
• Less desperation ? less self-harm
• Education
• All Sergeants and Senior Sergeants in 2002/3
• Probationary Constables after 18 months
• Policy development

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Consultations Numbers Held
CHAD
CNS
CMU
10
Custodial Nurses Networks
WHK
Medical Practitioners
Prisoner Coordination
Alcohol Drugs
Assessment Prison
Infectious diseases
?
Psych Services
Intellectual Disability
St Vincent's Hospital
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Staffing

• Metropolitan
• Senior Medical Officer
• 35 on-call GPs statewide
• Nurse Manager
• 4 Full time nurses
• 2 Part time
• Rural
• Geelong 1 Full time
• Ballarat .5 EFT
• Mildura .8 EFT

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Assessment Interventions Skills

• To provide streamlined assessment focusing on
  issues
• Up to date primary psychiatric nursing skills
• Drug and alcohol assessment and counselling
  skills
• Ability to not to be influenced by police
  management /security issues

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Clinical/Ethical Issues

• Confidentiality is challenging in a police
  environment
• RNs remain bound by professional ethics and
  codes of conduct
• Police are present during all interviews with
  detainees
• Copies of CTRS remain in files for continuity of
  care.

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Nursing Service For 12 Months

• 4086 consultations
• General medical 33
• Drug withdrawal 30
• Psychiatric 23
• Medication request 13
• Others 1
• Male 91.3 female 8.7

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Statistics
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Drug Withdrawal

• The curse of watch-house keeping
• The challenge of Custodial Medicine

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Primary Drug Use
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Standardised Withdrawal Regimes

• OPIATE REGIME
• REDUCING DIAZEPAM, BUSCOPAN, BRUFREN,
  LOMOTIL,RESTAVIT 5-7 DAYS
• ALCOHOL REGIME
• REDUCING DIAZEPM, MULTI-VITAMIN, THIAMINE
• INSOMNIA REGIME
• RESTAVIT X 1 NOCTE 3/7
• NURSE INITIATED OPIATE REGIME
• CODAPINE, LOMOTI, BUSCOPAN 3-5 DAYS

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Psychiatric Presentations 2004

• Primary diagnosis 635
• Depression 38
• Anxiety disorder / stress 20
• Schizophrenia 20
• Personality disorder 7
• Situation reaction 5
• Other 10

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Medication in Police Custody

• All Prisoners Are Entitled to
• Continue Legitimate Treatments

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CHALLENGES for CHANGE

• Provision of integrated response for prisoners
• constant movement -gt consistency of care
• communication barriers
• multiple health providers in CJS
• better health outcomes

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Thank you

• Questions Please?