What is 'Equivalence' in Police Custody Healthcare?

目前，警察局拘留套房中的医疗保健提供没有明确的标准，管理被拘留者预期的护理水平。预计医疗保健提供者应在其专业机构概述的标准范围内工作；然而，这些标准是模糊的，对拘留工作人员也没有明确的标准，他们执行大多数拘留保健工作。这是令人不安的，因为有精神健康和药物滥用问题的人被警方拘留的比率很高，以及被拘留期间的死亡率；这两个比率在族裔界限上分布不均。它也与刑事司法系统的其他部分(例如监狱)形成对比，在刑事司法系统的其他部分，等同标准是常态，即期望被关押在监狱的人得到与在押人员相同的医疗保健。没有这种标准有两种常见的解释：警察拘留是一个执法空间；个人只被拘留几个小时，这意味着他们在获释后可以获得传统的医疗保健。传统上，警察拘留期间的医疗保健被理解为解决紧急情况(包括将那些在拘留期间无法治疗的人送往医院)，并确保被拘留者适合接受采访。然而，在精神健康危机期间被拘留的人的比率很高，以及被拘留者的“混乱的生活方式”，这意味着警察拘留空间中被拘留者的医疗保健需求变得越来越重要。目的和目标由于这些变化，该项目旨在发展关于警察拘留工作人员(警察、拘留官员和医疗保健提供者)的医疗实践的知识，以便制定同等标准，并为其在拘留工作中的实施提供指导。该项目将提出四个关键问题：1)监管人员(警察和医疗保健人员)如何与被拘留者互动，以及这些互动如何影响被拘留者在警察羁押期间的健康和福祉体验？被拘留者的可观察特征(年龄、身体大小、肤色、性别)如何影响这些互动？2)被拘留的警察和医护人员如何相互作用，以及需要什么才能实现最佳的多机构工作并在医疗保健方面提供对等服务？3)警察拘留环境的年龄和空间在提供医疗保健方面发挥什么作用？4)关于被拘留者的哪些健康信息在警察拘留期间被访问、记录、管理和共享；如何做到这一点？如何保护信息？为了回答这些问题，我们将开展以下社会科学研究方法：-在四个警察拘留室进行长达500小时的观察--对60名拘留工作人员和40名在押人员进行半结构化访谈--审计1600份警察拘留风险评估文件，并就他们的风险评估程序采访20名警察拘留服务台警长潜在的好处研究的主要结果将是一份政策简报，概述警察拘留的同等标准将包括什么以及如何实施。我们预计，这将包括关于被拘留者与工作人员(警察、平民和医疗保健)之间的互动、被拘留者接收信息的形式以及他们接收信息的方式的建议。此外，我们还希望就在押工作人员之间的互动发表评论，特别是在他们讨论被拘留者跨越职业界限的时候。例如，被拘留者的个人信息在工作人员之间的转移应该是高度机密的，因此我们将就如何处理此类信息制定指导意见，以保持患者的机密。预计与当前羁押套房做法相适应的等值标准的产生将改善那些接受警方羁押的人的医疗保健结果，同时也降低在羁押期间死亡的可能性。

ContextAt 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 ObjectivesAs 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 proceduresPotential BenefitsThe 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.