The prevalence of psychiatric disorders in police cells: service provision implications and associations with criminal victimisation

In contrast to the extensive body of literature that has investigated the occurrence of mental illness in jails and prisons, there is limited research that has investigated psychopathology among people detained in police cells. It is critical to extend research at the front end of the criminal justice system as many detainees are released back to the community at this point and do not reach the latter parts of the criminal justice system, such as prisons, where people experiencing mental illness may be identified for further assessment and treatment. The police cell setting, therefore, serves as an ideal opportunity to identify those in need of clinical care at an earlier stage of the criminal justice system. The aims of the current study were to investigate: (1) rates of psychiatric disorders and individual needs in a sample of recently arrested police cell detainees; (2) personal factors (from importation model), situational factors (from deprivation model), and their interactive effect, to account for the occurrence of mental illness in police cells; (3) the accuracy of current police practices in identifying those with a mental illness in custody, and the predictive utility of two standardised screening tools for mental illness in police cells; and (4) the criminal victimisation experiences among police cell detainees. A cross-sectional descriptive study was conducted, in which 150 detainees were recruited from a series of consecutive admissions to two metropolitan police stations in Melbourne, Australia. Measures included a structured diagnostic clinical interview, standardised screening tools for mental illness, individual needs assessment, measures of the environmental effects of police cells, and a standard coding sheet recording demographic information. Participant records were also extracted from the Victoria Police contacts database and the public mental health database. The four studies that comprised this thesis demonstrated that rates of psychiatric disorders were disproportionately high among detainees as compared to rates of mental illnesses in the community. Those experiencing mental illness also reported more ongoing difficulties in broad life domains (e.g., money and daytime activities) as compared to those with no diagnosed mental illness. While situational factors were not associated with mental health problems in custody, personal factors, such as prior psychiatric hospitalisation, were associated with psychopathology. Current police practices were variable and found not to be effective at identifying those experiencing mental illness; however, detection rates were improved when standardised screening tools for mental illness were applied. In addition, participants with a diagnosed mental disorder were more likely to be victims of a violent crime; however, sub-groups of people experiencing mental illness, such as those diagnosed with psychotic disorders, were not over-represented among those who had officially reported their victimisation experiences to the police. These findings imply that psychiatric distress might be better detected by standardised screening tools, and could inform healthcare services in the development of novel treatment strategies based on the ongoing difficulties that detainees commonly reported. Limitations and future research directions are discussed. It is hoped that this thesis has made progress in addressing the real-life afflictions that detainees present with in police custody.