The ‘appropriate adult’: what they do and what they should do in police interviews with mentally disordered suspects

Background: In almost all countries worldwide, the first point of contact with the criminal justice system is with the police. A large proportion of these individuals may have vulnerabilities, such as mental health difficulties. Given the complexities associated with vulnerable suspects, such interviews may be compromised, which could lead to a miscarriage of justice. In England and Wales, the Police and Criminal Evidence Act (PACE) 1984 and its accompanying Codes of Practice lay down requirements for interviewing vulnerable suspects and provide for attendance of ‘appropriate adults’ to support communication between police and the vulnerable suspect. To date, however, their role has been under-researched. Aims/Hypotheses: To explore the role of appropriate adults in police interviews and test the hypotheses first that appropriate adults more commonly remain passive during interview than expected from guidance and, secondly, that any interventions are more likely than not to follow examples in current guidance. Methods: Transcripts of police interviews conducted with suspects with possible mental disorder and an appropriate adult present (N = 27) were analysed using a specially developed coding framework. Results: Appropriate adults were significantly more likely to remain passive than to intervene, even when current guidance would suggest intervention. When they did intervene, however, such interventions were significantly more likely than not to follow from guidance and the vulnerable suspect’s needs. Conclusions/Implications for practice: In our sample, appropriate adults were not fulfilling their role as outlined in the Police and Criminal Evidence Act (PACE) 1984 and accompanying Codes of Practice, specifically, they appeared to know what to do but not when to do it. There is a heightened risk of a miscarriage of justice in such circumstances without improvements

A randomised controlled trial and cost-effectiveness evaluation of "booster" interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design: Study candidates (n = 1500) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600) will be randomised into the study. These participants will receive either a "mini booster" (n = 200), "full booster" (n = 200) or no booster (n = 200). The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities. A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10% sample.Discussion: The choice of study population, study interventions, brief intervention preceding the study, and outcome measure are discussed

The mental health consequences of dealing with self-inflicted death in custody

The impact of dealing with a death in custody was explored in 49 prison officers who had dealt with such an event in the period 3-7 months prior to the study. A 36.7% incidence rate of post-traumatic stress disorder (PTSD) was identified. Optimism, avoidance problem solving style, prior experience of suicide and level of involvement in the incident were direct mediators of the impact of the event for the total sample, while perceived control, emotional support and other aspect of problem-solving style had an indirect effect. Separate analysis of the PTSD and non-PTSD groups showed that the only mediator for the PTSD group was prior experience. For the non-PTSD group a range of variables mediated the impact. It is argued that this provides a case for preventive rather than treatment interventions

Learning from 'near misses': interviews with women who survived an incident of severe self-harm in prison

This article describes qualitative research with women survivors of potentially lethal self-harm in prison. In-depth interviews were carried out during 2002/03 with 15 women, (adults and young offenders), from six establishments. The interviews focused on the women's own accounts of the 'near miss' incident, including intentions and motivations, factors leading up to the incident, experiences of care and support, current self-harm and suicidality, and suggestions for prevention. Recommendations include: improvements to the general prison regime; training and support for staff; specialist help for women with histories of abuse, mental illness, or borderline personality disorder; improved support following stressful life events