Introduction

While certain conditions may be over represented in those in police custody the range of conditions is no different from those present in the general population. Clinical assessment of the detainee should, therefore, be of the same standard and afford the same respect and dignity to that detainee as if it had been carried out elsewhere in a typical clinical setting. The range of options thereafter and the recommendations which can be made differ from practice in the community. Criminal justice and public safety considerations need to be taken into account, although patient care remains of primary importance.

As in other areas of clinical forensic medicine, it cannot be overemphasized how important it is to keep clear, comprehensive, legible contemporaneous notes.

Clinical assessment includes a consultation and an examination of the mental state, supported by gathering background information. The circumstances of the arrest may include details of clinical relevance, and previous convictions may also be helpful in showing a pattern of deteriorating social functioning or a previous psychiatric disposal. The family, friends or local community services may be useful informants. Physical examination is required if there is any suspicion of an organic cause of an abnormal mental state.

A police station is not an easy place in which to make a clear diagnosis. When assessing a detainee, the task is not to make a definitive diagnosis, but rather to determine those cases where expert assessment is indicated, particularly if the use of mental health legislation may be required.