Eight years of psychiatric examination of detainees by forensic physicians in the Netherlands

Abstract

Background: Forensic physicians are responsible for first-line medical care of detainees (individuals held in custody) in the police station. The Dutch police law contains a 'duty of care', which gives the police responsibility for the apparent mentally ill and/or confused people they encounter during their work. The police can ask a forensic physician to do a primary psychiatric assessment of any apparent mentally ill detainee. The forensic physician determines if the apparent mentally ill behavior of the detainee is due to a somatic illness, or has a psychiatric cause for which the detainee needs admission to a psychiatric hospital. The forensic physician consults the second-line Public Mental Health Care (PMHC).

Objective: This study aims to give an overview of the outcomes of psychiatric assessments of apparent mentally ill detainees in police stations. These assessments were done by forensic physicians over a period of eight years (2005-2013). A distinction is made between mental disorders, social problems, and alcohol/drugs abuse.

Methods: All psychiatric assessments were registered in a medical database. When a secondary public mental health care assessment was performed, the conclusions and/or written feedback were received and included in the medical database. This information was used for this retrospective observational study.

Results: Of all the apparent mentally ill individuals brought by the police into the police station, the forensic physician sent home or referred 51.8% to their own respective caretakers or the individuals were voluntarily admitted to addiction care or other care facilities. When the forensic physician referred a detainee to PMHC, a compulsory admission to a psychiatric hospital was indicated by PMHC in 62.8% of the cases. Ultimately, of the total apparent mentally ill individuals brought in by the police 30.0% was admitted to a psychiatric hospital.

Discussion: Many apparent mentally ill individuals brought to the police station are sent home by the forensic physician. Before the psychiatric assessment, medical causes of psychiatric illnesses, for example excited delirium syndrome and hypoglycemia, drug use (GHB, cocaine, heroin), and cerebral pathology are excluded. The police perform as one of the channels through which the mentally ill get entrance to mental health care. Our data show no changes in the number of psychiatric assessments during 2005-2013.

Keywords: Detainees; Forensic medicine; Forensic physician; Mental health; Police; Primary health care.