Deaths Related to the Phases of the Custodial Process

In an attempt to add some clarity to the situation, it is possible to state that whatever national definition of "in custody" is used, numerous phases of the custododial process can be identified, and the types of deaths that occur during these phases can be analyzed. Clearly, a death, whether sudden or delayed, may

Table 1

Expected Types of Deaths in Different Phases of Custody

Accidental Self- Deliberately

Table 1

Expected Types of Deaths in Different Phases of Custody

Accidental Self- Deliberately

Natural

trauma

Alcohol

Drug

inflicted

inflicted

Prearrest

++

+++

++

++

±

±

Arrest

++

+++

++

++

±

+++

Detention

+

+

+++

+++

++

++

Interview

+

+

++

++

+++

++

Charge

+

+

-

-

+++

±

occur for many reasons even in the absence of police, but because it is the involvement of police that is the sine qua non of "in custody," deaths in the first phase must be considered to be the presence of police officers at the scene. Subsequently, an arrest may be made with or without the use of restraint techniques and the prisoner will then be transported to a police station. This transport will most commonly involve a period within a police vehicle, which may be a car, a van with seating, or some other vehicle. Many factors may determine the type of transport used and the position of the individual in that vehicle. Detention in the police station will be followed by an interview period interspersed with periods of time incarcerated, usually alone, within a cell. After the interview, the individual may be released directly, charged and then released, or he or she may be detained to appear before a court. It is at this point that custody moves from the police to other authorities, usually to the prison service.

When considering the types of death that can occur during each of these phases, six main groups can be identified based on the reported causes of death. The groups are composed of the following:

• Deaths associated with accidental trauma.

• Deaths related directly to the use of alcohol.

• Deaths related to the use of other drugs.

• Deaths associated with self-inflicted injury.

• Deaths associated with injuries deliberately inflicted by a third party.

It is clear that different factors may lead directly to or play a major part in the death of an individual while in custody and that different factors will play their part at different phases in the period of custody (see Table 1).

Acute alcohol intoxication or the deleterious effects of drugs are, in most cases, likely to have a decreasing effect because they are metabolized or excreted from the individual's body. Therefore, they are most likely to cause death in the postarrest and early detention phases, and it is important to note that their effects will be least visible to those with the "duty of care" while the individual is out of sight, detained within a cell, particularly if he or she is alone within that cell. Similarly, the effects of trauma, whether accidentally or deliberately inflicted, are most likely to become apparent in the early phases of detention, and it would only be on rare occasions that the effects of such trauma would result in fatalities at a later stage, although this has occurred on several occasions, particularly with head injuries (7). Conversely, death resulting from self-inflicted injuries is unlikely to occur in the prearrest and arrest phases of detention but it can and does occur when the individual is placed in a cell and is not under immediate and constant supervision.

On the other hand, deaths from natural causes can occur at almost any time during the arrest and detention period. It is possible that the stress (whether emotional, physical, or both) associated with the initial phases of arrest and with the subsequent, more emotionally stressful phases during detention are likely to precipitate the death of the susceptible individuals through the effects of sympathetic stimulation and adrenalin release. Deaths from natural causes should be reduced by the medical examination and supervision of detainees from the time of initial detention and throughout the period of detention (see Chapter 8).

However, it is quite clear that the deaths described in many reports are not "pure" (i.e., they are not attributable to any one single category). Individuals with heart disease may also be under the influence of alcohol; individuals under the influence of alcohol or drugs may also have suffered trauma, either accidental or deliberate, before or during their detention. In determining the cause of death, it can therefore be extremely difficult to weigh each of the factors that could be identified during the period of detention. There is great need for early assessment and accurate diagnosis of natural disease (physical or psychiatric),alcohol or drug intoxication, and for the identification, documentation, and treatment of all types of trauma.

The removal of an individual's freedom places on the police a duty of care to that individual, and it is only by the active assessment of each and every person entering police custody and the continuing care of that individual that the number of deaths in custody can be reduced.

Beat The Battle With The Bottle

Beat The Battle With The Bottle

Alcoholism is something that can't be formed in easy terms. Alcoholism as a whole refers to the circumstance whereby there's an obsession in man to keep ingesting beverages with alcohol content which is injurious to health. The circumstance of alcoholism doesn't let the person addicted have any command over ingestion despite being cognizant of the damaging consequences ensuing from it.

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