2022/08/28 by Julia Crilly, Julia L Crilly, Caitlin Brandenburg +13 · 2 citations
Medicine · Health Professions · #Emergency and Acute Care Studies #Healthcare Systems and Challenges #Health Services Management and Policy
paper · pdf · doi:10.5694/mja2.51688
Police watch-house detainees have complex health needs that involve multiple agencies and require coordinated, interagency solutions Police watch-houses (Queensland term) are buildings designed “for the temporary holding of prisoners before prisoners are released or transferred to a corrective services facility or detention centre”.1 They may also be used to hold people who are intoxicated, appear mentally ill, or are awaiting trial.2 Watch-houses are also referred to as police cells, station cells, lock-ups, holding cells, jails, and custody suites in other Australian jurisdictions and countries. “Temporary” means “overnight or for 24 hours or longer”,1 and can be as long as 4 weeks.2, 3 In Queensland, watch-houses are staffed primarily by police officers, in some cases assisted by civilian watch-house officers. Common problems faced in prison health care include vulnerability, physical and mental stress, and associated social determinants of poor health.4 These are reflected among watch-house detainees.5, 6 A review of 505 coroners’ reports pertaining to deaths in police custody in Australia between 1991 and 2016 revealed that 43 (9%) occurred in a police station, police vehicle, police cell, or watch-house;7 of these, 15 occurred in Queensland, and 17 were Aboriginal or Torres Strait Islander people. The primary cause of those 43 deaths was medical (49%), followed by suicide (33%), accident (2%), intentionally killed (2%), and other (14%).7 As a group, detainees are largely disconnected from health services, so beyond their immediate, untreated health problems, comparatively little is known about underlying and unaddressed social determinants (eg, homelessness, unemployment, poor education, low incomes). United Nations Mandela Rule 24.1 stipulates that prisoners are entitled to medical care that is equivalent to that which they could access in the community.8 While complying with the Mandela Rule has challenged Australian prisons,9 the extent to which this includes the watch-house setting is unclear. A study of detainee experiences in Victoria indicates significant challenges, with reports of deprivation of material comfort, dignity and respect, and exposure to harsh, hostile, overcrowded and degrading environments.2 Access to health care in short term custody settings can be hampered by a range of underlying contexts, structures and processes of health care delivery.10 Evidence predominates from the United States and United Kingdom.10 To further advance reform in this neglected area, our group has been investigating strategies used at several geographically diverse police watch-houses across Queensland. This follows on from single-site research reporting that situating an emergency trained nurse within a watch-house yielded multiple positive impacts,11 including reducing unnecessary detainee transfers to the emergency department (ED) and associated costs. This article highlights key challenges for the people and systems responsible for the health and safety of detainees in Queensland, and identifies potential opportunities to reduce the burden on these systems and improve access to appropriate health care. Overseas, the health needs of detainees in police custody represent challenges at individual, system, and inter-agency levels.12 It is important to understand these challenges in the Queensland context to inform opportunities to drive equitable, cost-effective strategies for this population. Despite the myriad challenges, watch-house detention provides a unique opportunity to intercept a vulnerable, complex and otherwise hard-to-reach population, and identify unmet health needs.23 As has been suggested for prisons, health training for all staff working in watch-houses should include social determinants of health.4 Given the high rates of Indigenous Australians in custody,16 further investment in resourcing for culturally capable care, especially mental health services, is also needed.18 The short term nature of watch-house detention limits the potential to achieve sustained health improvements for detainees, although brief interventions for some health needs24 (eg, substance use, sexual health screening, vaccination) may be effective. Increased access to health care providers in watch-houses would improve assessment, triage and management of some health problems. This could help minimise adverse outcomes, and potentially reduce unnecessary and resource-intensive transfers to EDs. Consistent with World Health Organization recommendations for prisons,21 models of health care in watch-houses should be closely linked with public health services and, ideally, administered by a health care agency rather than the police service. Consistent with this, understanding the expected roles of the health team and those of the police watch-house would be imperative. Further investment in interagency strategies is needed to reduce the burden on police and EDs, and ensure appropriate care for detainees. Potential strategies should balance the risk of unnecessary transport to hospital with the imperative to address the entrenched social, security and health challenges25 at play in this especially vulnerable population. Continuity of care should be a key consideration in this context,9 capitalising on the opportunity to link this population to ongoing services to support sustained improvements in health. A shared electronic medical record would be optimal; however, a broader governance framework that promotes integration between watch-house and community health care providers is needed to facilitate effective information sharing and continuity of care. These goals will require a sustained, coordinated investment in intersectoral collaboration. The overlap of health and law enforcement offers important opportunities to support health care delivery to detainees. It is time to capitalise on these opportunities. This work was supported by funding from the Emergency Medicine Foundation. Open access publishing facilitated by Griffith University, as part of the Wiley - Griffith University agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.