This study examined cases for possible mental health issues based on a study of 43 deaths in custody that had been supervised by the PCA between 1998 and 2002 involving the use of drugs. In 18 of the 43 cases, there was evidence of one of three groups of mental health symptoms - in five cases, there was evidence of psychosis, in five of previous self-harm or suicidal attempts, and in a further eight, there were indications of anxiety or depression. This constitutes a total of 42% of the cases studied. Those with mental health factors were more likely to have swallowed the drugs used, were more likely to have used prescription drugs and were more likely to have been believed to be faking their symptoms by the officers involved in these cases. While it is recognised that mental health problems are widespread in the criminal justice system, the diversity of conditions and the marked overlap with the use of alcohol and illicit drugs has not been sufficiently recognised, either in the training of officers or in the procedures for intervention in the custody suite.