Substance Misuse Detainees in Police Custody: Guidelines for Clinical Management (3rd edn)

Council Report CR132, May 2006, Royal College of Psychiatrists and Association of Forensic Physicians, £12.50, 64 pp

There has been a major increase in the size and scale of substance misuse problems over the past decades and a corresponding increase in the numbers detained in police custody. Most of these detainees are vulnerable individuals. Recognition of substance misuse problems in these detainees is important and is now receiving local and national attention. The prevalence of such problems makes guidelines necessary for forensic physicians (police surgeons, forensic medical examiners and forensic medical officers) on the acceptable minimum standards for the assessment of those with drug and alcohol dependence and for treatment intervention.

These guidelines, now in their third edition, have been updated by a working group under the chairmanship of Professor Hamid Ghodse, including representation from the Association of Forensic Physicians, the Royal College of Psychiatrists, the Royal College of General Practitioners, the Faculty of Accident and Emergency Medicine, the Association of Chief Police Officers (ACPO), the Home Office and the Department of Health. Since the last edition there have been a number of initiative developments in services for those who misuse substances and in the clinical justice system in support of treatment and prevention. Although the outcome of some of these initiatives is not yet clear, there is now a greater emphasis on diverting those in conflict with the law from custodial sentences towards treatment. This edition has taken account of those who are sentenced to prison and those with mental disability whose substance misuse brings them into conflict with the law.

The assessment and treatment of those who misuse substances present forensic physicians with particular challenges which require skills and experience to ensure appropriate management. Good communication, working closely with custody officers, and shared responsibility for the safety and care of detainees with substance misuse problems are all important factors. In particular, the guidelines stress the importance of:

1. • forensic physicians' full participation in all aspects and at all stages of the healthcare of detainees with substance misuse/dependence problems

2. • providing advice to custody officers and others involved with detainees with substance misuse/dependence problems

3. • comprehensive contemporaneous records

4. • appropriate sharing of information in accordance with the law and the General Medical Council's advice on professional confidentiality

5. • all interventions being made with an awareness that the interests of the detainee as a patient are paramount.

The guidelines will be of immense value to all practitioners in helping and supporting detainees, and to the staff of law enforcement agencies who are involved in the care of detainees with substance misuse problems. They will also be useful for teaching purposes for medical and nursing staff and arrest referral officers.