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Care of Detainees

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Healthcare professionals may be asked by the police to assess the fitness for detention in police custody of adults and juveniles arrested in connection with an offense; those detained by immigration; individuals requiring a place of safety (children and the mentally ill); remanded or sentenced (convicted) prisoners; or those detained under terrorism legislation. Detainees may have to be interviewed regarding their involvement in an offense and possibly further detained overnight for court; guidance may therefore have to be given to the custodians regarding their care.


  • Asthma
  • Attention deficit hyperactivity disorder
  • Autistic spectrum disorder
  • Diabetes
  • Epilepsy
  • Heart disease
  • Intellectual disability
  • Mental health
  • Self-harm
  • Drug searches

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Fig. 9.1
Fig. 9.2


  1. Police and Criminal Evidence Act 1984 Codes of Practice A-H 2018 for England and Wales. TSO, London. Accessed 29 May 2019. Accessed 10 Apr 2019

  2. British Medical Association Medical Ethics Department and Faculty of Forensic and Legal Medicine (2009) Health care of detainees in police stations. British Medical Association, London

    Google Scholar 

  3. Stark MM, Rogers DJ, Norfolk GA (2009) Good practice guidelines for forensic medical examiners. Royal Military Police, GPG Editors, Oxford

    Google Scholar 

  4. Council of Europe (2006) European Committee for the prevention of torture and inhuman or degrading treatment or punishment (CPT). The CPT standards. Accessed 10 Apr 2019

  5. College of Policing. Authorised professional practice. Detention in custody. Risk assessment. Accessed 10 Apr 2019

  6. McKinnon I, Grubin D (2010) Health screening in police custody. J Forensic Legal Med 17:209–212

    CrossRef  Google Scholar 

  7. Sturgiss EA, Parekh V (2011) The work of forensic physicians with police detainees in the Canberra city watch house. J Forensic Legal Med 18:57–61

    CrossRef  Google Scholar 

  8. Ceelen M, Dorn T, Buster M et al (2012) Healthcare issues and healthcare among detainees in police custody. J Forensic Legal Med 19:324–331

    CrossRef  Google Scholar 

  9. Rekrut-Lapa T, Lapa A (2014) Health needs of detainees in police custody in England and Wales. Literature review. J Forensic Legal Med 27:69–75

    CrossRef  Google Scholar 

  10. Payne-James JJ, Green PG, McLachlan GMC, Moore TCB (2010) Health issues of detainees in police custody in London, UK. J Forensic Legal Med 17:11–17

    CrossRef  CAS  Google Scholar 

  11. Sondhi A, Williams E (2018) Health needs and co-morbidity among detainees in contact with healthcare professionals within police custody across the London metropolitan police service area. J Forensic Legal Med 57:96–100

    CrossRef  Google Scholar 

  12. Dorn T, Ceelen M, Buster M, Stirbu I, Donker G, Das K (2014) Mental health and healthcare use of detainees in police custody. J Forensic Legal Med 26:24–28

    CrossRef  Google Scholar 

  13. Heide D, Stiller D, Lessig R et al (2012) Medical examination of fitness for police custody in two large German towns. Int J Legal Med 126:27–35

    CrossRef  PubMed  Google Scholar 

  14. McKinnon I, Grubin D (2014) Evidence-based risk assessment screening in police custody: the HELP-PC study in London UK. Policing 8:172–182

    CrossRef  Google Scholar 

  15. McKinnon I, Thomas SDM, Noga HL, Senior J (2016) Police custody healthcare: a review of health morbidity, models of care and innovations within police custody in the UK, with international comparisons. Risk Manag Healthcare Policy 9:213–226

    CrossRef  Google Scholar 

  16. Police and Criminal Evidence Act 1984 Code C Revised July 2018. TSO, London. Accessed 27 Apr 2019

  17. McMillan R, Stark MM (2010) HCP examination of detainees in custody. Guidance for custody staff. Metropolitan Police Service, London

    Google Scholar 

  18. Home Office Circular (02/2003) Healthcare professionals in custody suites—guidance to supplement revisions to the codes of practice under the Police and Criminal Evidence Act 1984. Accessed 27 Apr 2019

  19. Wall I, Stark MM (2019) Quality standards in forensic medicine: GFM & SOM FFLM.

  20. Cladingboel J, Smith J, Stark MM, Wall I (2019) Quality standards for nurses & paramedics: GFM. FFLM.

  21. Functional Map for HCP Working in Police Custody Settings. Skills for Health, 2007.

  22. Chariot P, Martel P, Penneau M, Debout M (2008) Guidelines for doctors attending detainees in police custody. Int J Legal Med 122:73–76

    CrossRef  PubMed  Google Scholar 

  23. Stark MM (2000) The medical care of detainees and the prevention of tragedy—the role of the forensic medical examiner. Clin Risk 7:15–19

    CrossRef  Google Scholar 

  24. Payne-James JJ (2010) Clinical risk and detainees in police custody. Clin Risk 16:56–60

    CrossRef  Google Scholar 

  25. Payne-James J (2018) Confidentiality & consent in police custody: general principles. J Forens Legal Med 57:66–72

    CrossRef  Google Scholar 

  26. Fewkes S, Smith J, Stark M (2019) The role of the health care professional. FFLM. Accessed 27 Apr 2019

  27. Hocking G, Kalyanaraman R, deMello WF (1998) Better drug history taking: an assessment of the DRUGS mnemonic. J R Soc Med 91:305–306

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  28. Phillips C, Brown D (1998) Entry into the criminal justice system: a survey of police arrests and their outcomes. Home Off Res Study 185:109. Accessed 24 June 2019

    Google Scholar 

  29. HMIC (2015) The welfare of vulnerable people in police custody. p 83. Accessed 27 Apr 2019

  30. Chariot P, Heide S (2018) Custody medicine. J Forensic Legal Med 57:55–57

    CrossRef  Google Scholar 

  31. Cooke C, Payne-James JJ (2016) Safe and secure administration of medication in police custody. Recommendations. FFLM. Accessed 27 Apr 2019

  32. National Prescribing Centre (2009) Patient Group Directions. A practical guide and framework of competencies for all professionals using patient group directions.

  33. Fablet D, Chariot P (2018) Children detained in French police cells. J Pediatr Child Health 54:788–792

    CrossRef  Google Scholar 

  34. Coudert C, Vidal C, Lefèvre T, Chariot P (2019) Adolescent arrestees detained in police cells: an observational study in the Paris, France area. Int J Legal Med 133(4):1251–1258.

    CrossRef  PubMed  Google Scholar 

  35. Howitt J (1995) Poor conditions of detention compromise ethical standards. J R Soc Med 88:40P–41P

    PubMed  PubMed Central  Google Scholar 

  36. Epilepsy Foundation 2017 Revised Classification or seizures. Accessed 11 Apr 2019

  37. Galizia E, Faulkner HJ (2018) Seizures and Epilepsy in the acute medical setting: presentation and management. Clin Med 18(5):409–413. Accessed 11 Apr 2019

    CrossRef  Google Scholar 

  38. NICE 2018. Epilepsies: diagnosis and management, CG 137. Accessed 11 Apr 2019

  39. Mathur R, Bell D (1996) Asthma management in police study. J Clin Forensic Med 3:133–140

    CrossRef  CAS  PubMed  Google Scholar 

  40. British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) (2016) British guideline on the management of asthma, quick reference guide. Accessed 27 Apr 2019

  41. FFLM (2017) Management of diabetes mellitus in custody. Accessed 11 Apr 2019

  42. Hypoglycaemia—treatment in diabetic patients. Accessed 11 Apr 2019

  43. Heller MB, Vukmir RB (1992) Glucagon for metabolic/endocrinologic emergencies: hypoglycaemia. In: Picazo J (ed) Glucagon in acute medicine. Pharmacological, clinical and therapeutic implications. Kluwer Academic, London

    Google Scholar 

  44. The National Institute for Clinical Excellence (NICE) (2010 updated 2016) Chest pain of recent onset. CG 95 Quick reference guide. Accessed 27 Apr 2019

  45. Nolan J, Soar J et al (2015) The ABCDE approach. Accessed 28 Apr 2019

  46. The National institute for Clinical Excellence (NICE) (2011) Hypertension in adults: diagnosis and management. CG 127. Accessed 28 Apr 2019

  47. Payne-James JJ (1993) The role of cyanoacrylate tissue adhesive (Histoacryl blue) in forensic medical practice. Police Surg 43:30–31

    Google Scholar 

  48. Marks PV (1994) Acute head injury: assessment and practical management. J Clin Forensic Med 1:43–46

    CrossRef  CAS  PubMed  Google Scholar 

  49. Jennett B, Teasdale G (1977) Aspects of coma after severe head injury. Lancet:878–881

    Google Scholar 

  50. The National Institute for Clinical Excellence (NICE) (2014) Head injury: assessment and early management. CG 176 Quick reference guide. Accessed 28 Apr 2019

  51. Leigh A, Johnson G, Ingram A (1998) Deaths in police custody: learning the lessons, police research series paper 26. Police Research Group Publications, Home Office, London

    Google Scholar 

  52. Lindon G, Roe S (2017) Deaths in police custody: a review of the international evidence. Home Office Research Report 95, Home Office, London

    Google Scholar 

  53. Payne-James JJ, Marks P (2016) FFLM Head injury warning. Accessed 11 Apr 2019

  54. Payne-James JJ, Keys DW, Wall I, Dean PJ (1994) Prevalence of HIV factors for individuals examined in clinical forensic medicine. J Clin Forensic Med 1:93–96

    CrossRef  CAS  PubMed  Google Scholar 

  55. McKinnon IG, Grubin D (2012) Health screening of people in police custody—evaluation of current police screening procedures in London, UK. Eur J Pub Health 23:399–405

    CrossRef  Google Scholar 

  56. Royal College of Psychiatrists and Faculty of Forensic & Legal Medicine (2019) Substance misuse in detainees in police custody—guidelines on clinical management. (Fifth edition) Report of a Medical Working Group.

  57. Young S (2007) Forensic aspects of ADHD. In: Fitzgerald M, Bellgrove M, Gill M (eds) Handbook of attention deficit hyperactivity disorder. Wiley, Hoboken

    Google Scholar 

  58. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL et al (1990) Comorbidity of mental disorders with alcohol and other drug abuse: results from the epidemiologic catchment area (ECA) study. JAMA 264:2511–2518

    CrossRef  CAS  PubMed  Google Scholar 

  59. Weaver T, Madden P, Charles V, Stimson G, Renton A, Tyrer P, Barnes T, Bench C, Middleton H, Wright N, Paterson S, Shanahan W, Seivewright N, Ford C, on behalf of the Comorbidity of Substance Misuse and Mental Illness Collaborative (COSMIC) Study Team (2003) Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. Br J Psychiatry 183:304–313

    CrossRef  CAS  PubMed  Google Scholar 

  60. Carrà G, Johnson S (2009) Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK. A systematic review. Soc Psychiatry Psychiatr Epidemiol 44(6):429–447

    CrossRef  PubMed  Google Scholar 

  61. Carrà G, Johnson S, Bebbington P et al (2012) The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European schizophrenia cohort (EuroSC)’. Eur Arch Psychiatry Clin Neurosci 262(7):607–616

    CrossRef  PubMed  Google Scholar 

  62. EMCCDA (2016) Perspectives on drugs. Comorbidity of substance used and mental health disorder in Europe. Accessed 27 Apr 2019

  63. Ingram A, Johnson G, Heyes I (1997) Self harm and suicide by detained persons: a study. Police Research Group Publications, Home Office, London

    Google Scholar 

  64. Norfolk GA (1998) Deaths in police custody during 1994: a retrospective analysis. J Clin Forensic Med 5:49–54

    CrossRef  CAS  PubMed  Google Scholar 

  65. The National Institute for Clinical Excellence (NICE) (2004) Self harm. The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. CG16 Quick reference guide. Accessed 28 Apr 2019

  66. IOPC. Deaths during or following police contact: Statistics for England and Wales. 2017/18. Accessed 28 Apr 2019

  67. Centers for Disease Control and Prevention (n.d.) Intellectual disability fact sheet. Accessed 27 Apr 2019

  68. Accessed 27 Apr 2019

  69. Centers for Disease Control and Prevention. Accessed 24 June 2019

  70. Holmes J, McKinnon I (2017) Assessment of people with learning difficulties and disabilities in police custody. FFLM. Accessed 27 Apr 2019

  71. Reddy RG, Aung T, Karavitaki N, Wass JAH (2010) Opioid induced hypogonadism. BMJ 341:c4462

    CrossRef  PubMed  PubMed Central  Google Scholar 

  72. Gandon V, Outh-Gauer S, Chariot P (2018) The health of female arrestees in police cells, a descriptive study. J Forensic Legal Med 57:86–90

    CrossRef  Google Scholar 

  73. Reyes H (2018) Chapter 8: Management of hunger strikes in detention. In: Payne-James JJ, Beynon J, Nuno Vieira D (eds) Monitoring detention, custody, torture and ill-treatment. A practical approach to prevention and documentation. CRC Press, Boca Raton, FL

    Google Scholar 

  74. Schnieden V, Stark MM, Payne-James JJ (1995) Violence in clinical forensic medicine. Med Sci Law 35:333–335

    CrossRef  CAS  PubMed  Google Scholar 

  75. Schnieden V, Maguire J (1993) A report on violence at work and its impact on the medical profession within hospitals and the community. British Medical Association, London

    Google Scholar 

  76. Johns A, Clarke S, Stark MM (1997) Management of potentially violent detainees. J Clin Forensic Med 1:139–144

    CrossRef  Google Scholar 

  77. Royal College of Psychiatrists (1997) Using the mental health act—a training resource for doctors. Gaskell, Royal College of Psychiatrists, London, p 72

    Google Scholar 

  78. Department of Health & Social Care. The Medical Care of Suspected Internal Drug Traffickers—Independent Report of the Chief Medical Officer’s Expert Group. January 2013. Accessed 16 Mar 2019

  79. Traub SJ, Kohn GL, Hoffman RS, Nelson LS (2003) Pediatric ‘body packing’. Arch Pediatr Adolesc Med 157:174–177

    CrossRef  PubMed  Google Scholar 

  80. Hayhurst C (2014) The College of Emergency Medicine Best Practice Guidelines: Caring for adult patients suspected of having concealed illicit drugs. Accessed 28 Apr 2019

  81. Stark MM (2017) Recommendations for healthcare professionals asked to perform intimate body searches. Guidance for doctors from the British Medical Association and the Faculty of Forensic and Legal Medicine. Accessed 28 Apr 2019

  82. Stark MM (2016) Body cavity searches: practical issues and consent. In: Payne-James J, Byard RW (eds) Encyclopedia of forensic and legal medicine, vol 1, 2nd edn. Elsevier, Oxford, pp 433–436

    CrossRef  Google Scholar 

  83. Faculty of Forensic and Legal Medicine (2017) Intimate searches in police custody flowchart. Accessed 28 Apr 2019

  84. Heinemann A, Miyaishi S, Iwersen S, Schmoldt A, Puschel K (1998) Body-packing as cause of unexpected sudden death. Forensic Sci Int 92:1–10

    CrossRef  CAS  PubMed  Google Scholar 

  85. Koehler S, Ladham S, Rozin L, Shakir A, Omalu B, Dominick J, Wecht C (2005) The risk of body packing: as case of a fatal cocaine overdose. Forensic Sci Int 151:81–84

    CrossRef  PubMed  Google Scholar 

  86. Glass JM, Scott HJ (1995) “Surgical mules”: the smuggling of drugs in the gastrointestinal tract. J R Soc Med 88:450–453

    CAS  PubMed  PubMed Central  Google Scholar 

  87. Das D, Ali B (2003) Conservative management of asymptomatic cocaine body packers. Emerg Med J 20(2):172–174

    CrossRef  PubMed  PubMed Central  Google Scholar 

  88. F v West Berkshire Health Authority 2 All ER 545, 1989

    Google Scholar 

  89. Norfolk GA (2007) The fatal case of a cocaine body-stuffer and a literature review—towards evidence based management. J Forensic Legal Med 14:49–52

    CrossRef  CAS  Google Scholar 

  90. Bucke T, Teers R, Payne-James JJ, Stark MM (2008) Near misses in police custody: a collaborative study with forensic medical examiners in London. IPCC Research and Statistics Series: Paper 10. IPCC.

  91. Independent Advisory Panel on Deaths in Custody. Common Principles for Safer Restraint 2013. Accessed 28 Apr 2019

  92. McGorrigan J, Payne-James J (2017) Irritant sprays: clinical effects and management. Faculty of Forensic and Legal Medicine. Accessed 28 Apr 2019

  93. Gorton AJ, Evans JV (2019) Recommendations: medical care of persons detained under the Terrorism Act 2000.

  94. Police and Criminal Evidence Act 1984 (2018) Code H revised 2018. Her Majesty’s Stationery Office, Norwich

    Google Scholar 

  95. The Istanbul statement on the use and effects of solitary confinement. Adopted on 9 Dec 2007 at the International Psychological Trauma Symposium, Istanbul. Accessed 28 Apr 2019

  96. Shalev S (2008) A sourcebook on solitary confinement. Accessed 28 Apr 2019

  97. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    CrossRef  CAS  PubMed  Google Scholar 

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Original co-author Dr. Guy Norfolk not involved in this edition.

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Correspondence to Alex J. Gorton .

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Appendix 1: Glasgow Coma Scale




Eye opening response



To speech


To painful stimulus




Best verbal response





Inappropriate words


Incomprehensible sounds




Best motor response

Obeys commands


Localises to painful stimulus


Withdraws from pain


Abnormal flexion (decorticate)


Abnormal extension (decerebrate)




  1. From Jennett and Teasdale [49]

Appendix 2: Detained Person: Observation List

1. If any detainee fails to meet any of the following criteria, an appropriate healthcare professional or ambulance must be called

2. When assessing the level of rousability consider:

Rousability—can they be woken?

• Go into the cell

• Call their name

• Shake gently

Response to questions—can they give appropriate answers to questions such as:

• What’s your name?

• Where do you live?

• Where do you think you are?

Response to commands—can they respond appropriately to commands such as:

• Open your eyes!

• Lift one arm, now the other arm!

Remember—take into account the possibility or presence of other illnesses, injury, or mental condition, a person who is drowsy and smells of alcohol may also have the following:

• Diabetes

• Epilepsy

• Head injury

• Drug intoxication or overdose

• Stroke

  1. From: Home Office. Code C. Annex H [16]

Appendix 3: The Mini-Mental State Examination




What is the (year) (season) (date) (day) (month)


Where are we: (country) (state) (county) (town) (police station)



Examiner names three objects (e.g., orange, key, ball)


Patient asked to repeat the three names


Score one for each correct answer


Then ask the patient to repeat all three names three times



Serial 7’s. Stop after 5 correct answers


Alternatively, if patient makes errors on serial subtraction: Spell


“World” backwards: D L R O W


Score best performance on either task



Ask for the names of the objects learnt earlier



Show and ask the patient to name a pencil and a watch


Repeat the phrase “No ifs, and, or buts”


Give a three-stage command. Score one for each stage (e.g., “Take this piece of paper in your right hand, fold it in half, and place it on the chair next to you”)


Ask patient to read and obey a written command on a piece of paper stating: “Close your eyes”


Ask the patient to write a sentence. Score correct if it has a subject and a verb



Ask patient to copy intersecting pentagons. Score as correct if they overlap and if each has five sides


Total score


  1. From Folstein et al. [97]

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Stark, M.M., Gorton, A.J., Chariot, P. (2020). Care of Detainees. In: Stark, M. (eds) Clinical Forensic Medicine. Springer, Cham.

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