Title: What is 'Equivalence' in Police Custody Healthcare?
Funder: Economic and Social Research Council

Abstract: Aims: This research aims to investigate the need for, and produce guidance on, a healthcare equivalence standard in police custody. At present there is no clear expectation of the standard of care that should be provided in police custody, except that Healthcare Professionals (HCPs) should perform their practices in line with their own professional norms and values. This is in opposition to other elements of the criminal justice estate (for instance prisons), where a clear standard is in place, and detainees are expected to be treated in the same ways and to the same standards as persons at liberty. Given that an equivalence standard is established in other parts of the criminal justice system, why is the same not applied in police custody? To this end, this study aims to: 1) Develop new knowledge and understandings around: the treatment of those detained with mental illness and the ways it may vary due to detainees' personal characteristics; personal health data usage during police custody; and multiagency collaboration in the Emergency Services 2) Conduct an analysis of risk assessment practices, including implementation of electronic risk assessment tools 3) Produce a comprehensive policy brief outlining the easiest way to implement an equivalence standard into police custody healthcare Objective 1: Develop new knowledge and understandings around: the treatment of those detained with mental illness and the ways it may vary by detainee personal characteristics; personal health data usage during police custody; and multiagency collaboration in the Emergency Services Up to 500 hours of custody suite observation and 100 semi-structured interviews (with law enforcement staff, healthcare staff, and detainees) will be conducted in order to ascertain how healthcare needs are identified and addressed in police custody healthcare. Particular attention will be paid to the multiagency professional relationships between law enforcement staff and healthcare staff, as well as the interactions and relationships between detainees and custody staff, especially those known to have a mental health condition or substance abuse disorder. Objective 2: Conduct an analysis of risk assessment practices, including implementation of electronic risk assessment tools 1,600 desk sergeant risk assessments of detainees (made as they are being checked in and processed) will be analysed in order to identify the healthcare conditions that are regularly encountered in police custody, as well as the ways that confidential information is collected, secured, and transmitted during a person's stay in custody. This analysis will inform interviews with 20 desk sergeants, focusing on the affordances and limitations of electronic-based risk assessment protocols, their implementation, and their ease of use. In doing so, we will explore the information security of healthcare data within police custody. Objective 3: Produce a comprehensive policy brief outlining the easiest way to implement an equivalence standard into police custody healthcare Using Normalisation Process Theory (NPT), an approach that draws attention to the meanings of users in accepting new procedures, we will produce a policy brief based upon our findings, explaining how to introduce an equivalence standard into police custody with minimal disruption to current procedures and relationships. Prior to the launch of the policy brief, we will workshop the brief at feedback events with police constabularies, forensic healthcare providers, and detainee stakeholders.

Lay abstract: Context At present, there is no clear standard for healthcare provision in police station custody suites governing the level of care expected by those detained. Healthcare providers are expected to work within the standards outlined by their own professional bodies; however, these are vague, and no clear standard exists for detention staff, who perform most custody healthcare. This is troubling due to the high rate of persons in police custody with mental health and substance abuse concerns and the rate of deaths in custody; both these rates are unequally distributed along ethnicity lines. It also stands in contrast to other parts of the criminal justice system (for instance prisons), where an equivalence standard, i.e. an expectation that persons detained in prison will receive healthcare equivalent to those at liberty, is the norm. There are two common explanations the absence of such a standard: police custody is a law enforcement space; and persons are only detained for a few hours, meaning that they can access traditional healthcare upon release. Traditionally, healthcare in police custody is understood as resolving emergencies (including sending those that cannot be treated in custody to hospital) and ensuring that detainees are fit to be interviewed. However, the high rate of persons who are detained during a mental health crisis, as well as the 'chaotic lifestyles' of those detained, means that the healthcare needs of detainees in police custody spaces are increasingly important. Aims and Objectives As a result of these changes, this project aims to develop knowledge about the healthcare practices of police custody staff (police officers, detention officers, and healthcare providers) in order to inform an equivalence standard and provide guidance for its implementation into custody work. The project will ask four key questions: 1) How do custody staff (police and healthcare) interact with detainees, and how do these interactions impact detainees' experiences of health and wellbeing in police custody? How do detainees' observable characteristics (age, body size, skin colour, gender) influence these interactions? 2) How do police and healthcare staff in custody interact with each other, and what is needed to achieve optimal multiagency working and deliver equivalence in healthcare? 3) What role does the age and space of police custody environments play in the delivery of healthcare? 4) What health information about detainees is accessed, recorded, managed, and shared within police custody; how is this done, and how is the information secured? To answer these questions, we will carry out the following social science research methods: - Up to 500 hours of observations in four police custody suites - Semi-structured interviews with 60 custody staff and 40 detainees - Audits of 1,600 police custody risk assessment files and interviews with 20 police custody desk sergeants about their risk assessment procedures Potential Benefits The chief outcome of the research will be a policy brief outlining what an equivalence standard in police custody would include and how it could be implemented. We expect that this will include advice on the interactions between detainees and staff (police, civilian, and healthcare), the forms of information that detainees receive and the ways in which they receive it. In addition, we also expect to comment on the interactions between staff in custody, especially as they discuss detainees across professional boundaries. For instance, the transfer of personal information about a detainee between staff should be highly confidential, and so we would introduce guidance on the handling of such information in order to maintain patient confidentiality. It is expected that the production of an equivalence standard that works with current custody suite practice will improve healthcare outcomes for those who attend police custody, while also reducing the potential for deaths in custody.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE