Skip to main content Accessibility help
×
Home
Hostname: page-component-55597f9d44-2qt69 Total loading time: 0.384 Render date: 2022-08-13T10:46:50.802Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

The evaluation of a training course to enhance intellectual disabilities and mental health awareness amongst General Practitioners attending police stations

Published online by Cambridge University Press:  13 May 2022

Gautam Gulati*
Affiliation:
School of Medicine, University of Limerick, Limerick, Ireland School of Law, University of Limerick, Limerick, Ireland
Valerie Murphy
Affiliation:
Department of Psychiatry, University College Cork, Cork, Ireland
Gurjot Brar
Affiliation:
School of Medicine, University of Limerick, Limerick, Ireland
Shane Kilcommins
Affiliation:
School of Law, University of Limerick, Limerick, Ireland
Alan Cusack
Affiliation:
School of Law, University of Limerick, Limerick, Ireland
Colum P. Dunne
Affiliation:
School of Medicine, University of Limerick, Limerick, Ireland
Liam Glynn
Affiliation:
School of Medicine, University of Limerick, Limerick, Ireland
Brendan D. Kelly
Affiliation:
Department of Psychiatry, Trinity College, Dublin, Ireland
*
Address for correspondence: G. Gulati, School of Medicine, University of Limerick, Limerick, Ireland. (Email: Gautam.gulati@ul.ie)
Rights & Permissions[Opens in a new window]

Abstract

Type
Letter to the Editor
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

There is a high prevalence of people with mental illness and intellectual disabilities in Ireland’s prisons. The prevalence of severe mental illness is four times that of the general population and one in three people screen positive for an intellectual disability (Gulati et al. Reference Gulati, Keating, O’Neill, Delaunois, Meagher and Dunne2019; Gulati et al. Reference Gulati, Murphy, Clarke, Delcellier, Meagher, Kennedy and Dunne2018). This overrepresentation is equally manifested in contacts with An Garda Síochána, Ireland’s police force. A recent Garda Inspectorate review of custody risk assessments found that in a sample of 318 custody records, 24% noted “poor mental health or self-harm,” while 5% identified a “learning disability” (Garda Síochána Inspectorate, 2022). These are likely to be underestimates based on incomplete data.

It has been argued that addressing high prison prevalence of intellectual disabilities requires identification, safeguards, and considerations of alternatives to incarceration at the policing stage of the criminal justice pathway (Gulati et al. Reference Gulati, Cusack, Kilcommins and Dunne2020a). People with intellectual disabilities report finding policing interactions variously frightening, confusing, and describe difficulties in understanding and communicating information (Gulati et al. Reference Gulati, Cusack, Kelly, Kilcommins and Dunne2020b). Yet, the challenges in recognizing disability are acknowledged internationally (Young et al. Reference Young, Goodwin, Sedgwick and Gudjonsson2013; Gulati et al. Reference Gulati, Kelly, Cusack, Kilcommins and Dunne2020c; Gulati et al. Reference Gulati, Cusack, Bogue, O'Connor, Murphy, Whelan, Cullen, McGovern, Kelly, Fistein, Kilcommins and Dunne2021a). The ability of police in identifying intellectual disabilities can be assisted by training programs, which need not be onerous or resource-intensive (Reference Gulati, Cusack, Murphy, Kelly, Kilcommins and Dunne2021b). Yet, doctors have a key role to play in assisting Gardai (as the Irish police service is known generally) in identifying vulnerability, providing assessments of fitness to be interviewed and in the judicious application of mental health legislation where this is strictly necessary (Reference Gulati, Kelly, Cullen, Kukaswadia, Cusack, Kilcommins and Dunne2021c). Clarity around the remit of mental health legislation is particularly necessary in the overlap between mental illness and intoxication, particularly in a context where 48% of those attending Garda stations suffer with substance abuse/intoxication (Garda Síochána Inspectorate, 2022) and applications by Gardai remain the most frequent form of application for detention under the Mental Health Act 2001 (Mental Health Commission, 2021).

In contrast with England and Wales, where doctors attending police stations receive specialist training and qualifications to serve as forensic physicians (Sarkar and Stark, Reference Sarkar and Stark2010), there is a paucity of formal training opportunities for Irish General Practitioners (GPs) attending Garda stations in respect of intellectual disabilities and mental illness.

In addressing this lacuna, we designed a pilot training program for GPs with an interest in working at the Garda interface. The content of the program was similar to the strategy undertaken by our research group in designing training for Gardai, grounded in studies evaluating lived experience of people with disabilities (Gulati et al. Reference Gulati, Cusack, Kelly, Kilcommins and Dunne2020b) and focussing on an empirically developed approach based on recognition of intellectual disabilities, communication strategies, the provision of information, and an awareness of the need for supports (Gulati et al. Reference Gulati, Cusack, Murphy, Kelly, Kilcommins and Dunne2021b). This was augmented by learning objectives around the assessment of fitness to be interviewed by the police and relevance of the Mental Health Act 2001 in the setting of the Garda station. GP participants were recruited by open advertisement through the University of Limerick Education and Research Network for General Practice (ULEARN-GP) (O’Regan et al. Reference O'Regan, Hayes, O'Connor, Casey, O'Dwyer, Culhane, O'Donnell, Stack, Cuddihy, O'Connell, O'Flynn, Cullen, O'Doherty, O'Connell and Glynn2020), and CPD approval obtained from the Irish College of General Practitioners. Ethical approval was obtained for evaluation of effectiveness. All participation was voluntary. The training comprised a 90-minute interactive online seminar. Pre- and post-training Likert scales were used for evaluation of effectiveness.

Fourteen GPs completed the pre-training evaluation. Eleven GPs attended the training and seven of these completed the post-training evaluation. The results of the evaluation are outlined in Table 1. Perceptible benefits were reported by the participant group in confidence levels around identifying intellectual disabilities, communication strategies, knowledge around safeguards for people with intellectual disabilities, and crisis management. Perceptible increases were similarly reported in confidence levels around the assessment of fitness to be interviewed and the use of mental health legislation. However, study limitations included a relatively modest sample size and the possibility of selection bias. GPs with a special interest in forensic medical practice were more likely to enrol in this session and equally more likely to be confident in these skills at baseline given their clinical experience. Notwithstanding these limitations, the current study outlines potential evidence that a single training session grounded in the findings of those with lived experience can produce perceptible benefits in confidence levels amongst GPs in important areas of forensic primary care practice.

Table 1. Pre- and post-training evaluation

The right to medical assistance remains a key safeguard for a person detained in Garda custody (Garda Síochána Inspectorate, 2022), and medicine has a critical role to play in addressing the societal challenge where people with disabilities are overrepresented in the criminal justice system. As highlighted by the Council of Europe (2014), much needs to be done to strengthen this valuable safeguard, with training and resources for GPs operating in Garda stations. Psychiatrists have a valuable role to play, not just in collaborating clinically with primary care, but also in training and advocacy. The value of cross-disciplinary partnerships in this area cannot be overemphasised.

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation with the Helsinki Declaration of 1975, as revised in 2008. Ethical approval was obtained from the University Hospital Limerick Research Ethics Committee.

Financial support

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

References

Council of Europe (2014). Report to the Government of Ireland on the visit to Ireland carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 16 to 26 September 2014 (https://rm.coe.int/1680696c9a). Accessed 2 January 2022.Google Scholar
Garda Síochána Inspectorate (2022). Delivering custody services: a rights based review of the treatment, safety and wellbeing of Persons in Garda custody, July 2021 (https://www.gsinsp.ie/delivering-custody-services/). Accessed 8 March 2022.Google Scholar
Gulati, G, Murphy, V, Clarke, A, Delcellier, K, Meagher, D, Kennedy, H, Dunne, CP (2018). Intellectual disability in Irish prisoners: systematic review of prevalence. International Journal of Prisoner Health 14, 188196.CrossRefGoogle Scholar
Gulati, G, Keating, N, O’Neill, A, Delaunois, I, Meagher, D, Dunne, CP (2019). The prevalence of major mental illness, substance misuse and homelessness in Irish prisoners: systematic review and meta-analyses. Irish Journal of Psychological Medicine 36, 3545.CrossRefGoogle ScholarPubMed
Gulati, G, Cusack, A, Kilcommins, S, Dunne, CP (2020a). Intellectual disabilities in Irish prisons: could article 13 of the UNCRPD hold the key? International Journal of Law and Psychiatry 68, 101540.CrossRefGoogle ScholarPubMed
Gulati, G, Cusack, A, Kelly, BD, Kilcommins, S, Dunne, CP (2020b). Experiences of people with intellectual disabilities encountering law enforcement officials – a narrative systematic review. International Journal of Law and Psychiatry 71, 101609.CrossRefGoogle ScholarPubMed
Gulati, G, Kelly, BD, Cusack, A, Kilcommins, S, Dunne, CP (2020c). The experience of law enforcement officers interfacing with suspects who have an intellectual disability – a systematic review. International Journal of Law and Psychiatry 72, 101614. DOI 10.1016/j.ijlp.2020.101614.CrossRefGoogle ScholarPubMed
Gulati, G, Cusack, A, Bogue, J, O'Connor, A, Murphy, V, Whelan, D, Cullen, W, McGovern, C, Kelly, BD, Fistein, E, Kilcommins, S, Dunne, CP (2021a). Challenges for people with intellectual disabilities in law enforcement interactions in Ireland; thematic analysis informed by 1537 person-years' experience. International Journal of Law and Psychiatry 75, 101683.CrossRefGoogle Scholar
Gulati, G, Cusack, A, Murphy, V, Kelly, BD, Kilcommins, S, Dunne, CP (2021b). The evaluation of a training course to enhance intellectual disability awareness amongst law enforcement officers: a pilot study. Irish Journal of Psychological Medicine 70, 15. DOI 10.1017/ipm.2021.80.Google Scholar
Gulati, G, Kelly, BD, Cullen, W, Kukaswadia, S, Cusack, A, Kilcommins, S, Dunne, CP (2021c). What is the role of doctors in respect of suspects with mental health and intellectual disabilities in police custody? Irish Journal of Psychological Medicine 5, 16 DOI 10.1017/ipm.2021.25.Google Scholar
Mental Health Commission (2021). Mental Health Commission, 2020 annual report (https://www.mhcirl.ie/sites/default/files/2021-06/MHC-Annual-Report-2020.pdf). Accessed 8 March 2022.Google Scholar
O'Regan, A, Hayes, P, O'Connor, R, Casey, M, O'Dwyer, P, Culhane, A, O'Donnell, P, Stack, G, Cuddihy, J, O'Connell, B, O'Flynn, J, Cullen, W, O'Doherty, J, O'Connell, M, Glynn, L (2020). The University of Limerick Education and Research Network for General Practice (ULEARN-GP): practice characteristics and general practitioner perspectives. BMC Family Practice 21, 25.CrossRefGoogle Scholar
Sarkar, U, Stark, MM (2010). The role of the independent forensic physician (https://fflm.ac.uk/wp-content/uploads/2020/12/ARCHIVED-Role-of-the-Independent-Forensic-Physician-October-2010.pdf). Accessed 8 March 2022.Google Scholar
Young, S, Goodwin, EJ, Sedgwick, O, Gudjonsson, GH (2013). The effectiveness of police custody assessments in identifying suspects with intellectual disabilities and attention deficit hyperactivity disorder. BMC Medicine 11, 248.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Pre- and post-training evaluation

You have Access

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The evaluation of a training course to enhance intellectual disabilities and mental health awareness amongst General Practitioners attending police stations
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

The evaluation of a training course to enhance intellectual disabilities and mental health awareness amongst General Practitioners attending police stations
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

The evaluation of a training course to enhance intellectual disabilities and mental health awareness amongst General Practitioners attending police stations
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *