Overall themes

The report found that most interviewees had not been educated about their neurodiverse condition or how it impacts their emotions, feelings, or ways to communicate. The majority had continuously been labelled ‘stupid’, ‘bad’ or ‘naughty’ when they were children and “lived their lives according to this label”.

Contact with police

Only two of the 104 people interviewed said that police officers had made adjustments for their neurodiverse condition when interviewing them. Some people said they disclosed their neurodiversity and asked for an appropriate adult but were denied this.

Interviewees felt they were being criminalised for their neurodiverse conditions. Autistic meltdowns were interpreted by the police as someone being aggressive or out of control due to drug or alcohol consumption. There was no understanding from the police that flashing lights, loud sounds and being approached by multiple police officers can be overwhelming for someone who is neurodivergent.

The court experience

Just three interviewees said that the court had made adjustments for their neurodiverse condition. Many said that because of their criminal records, they feel they are perceived as not deserving of any support, and therefore their neurodiverse:

” I got a full psychologist report done and when I went to court the judge picked it up, he had a flip through and said ‘I don’t believe a word of this I’m not going to take it into consideration’ and then through it over the side — literally just threw it.”

Life in prison

Fifteen interviewees said the prison service had made adjustments for them while inside and nine had had their neurodiverse condition diagnosed while in prison

Confirmed or self-diagnosed neurodiverse service users face several challenges in prison; they are forced to share their space and to communicate with people who often also have different challenges in communicating and in regulating their emotions. They are forced to try to stay on the good side of prison staff, who often do not have enough understanding about the behaviour and needs of different neurodivergent people.

Interviewees said they did not have the freedom to decide or design their routines and activities that help them to manage life outside. Instead, they need to try adjusting their life and needs to prison schedules and activities. Some found this easier to do than others.

Their health and medical needs are in the hands of the prison health care system, which many felt is neither sufficiently knowledgeable about, nor properly resourced to support neurodivergent individuals.

Single cells were the most talked about and sought after adjustment in prison, especially amongst service users with autism. Most service users with autism preferred single cells to avoid sensory overload and confrontations, and to maintain their routines and cleanliness standards. Some mentioned they prefer single cells to avoid being manipulated by their cell mate, which had happened to some in the past where they were asked to fight, steal, or conceal contraband.

Although some individuals spoke about the loneliness of being in a single cell, they still preferred it to having to share.

Coping methods

Routines and to-do lists were important for many people with autism and dyslexia, whereas training and exercise to burn energy was mentioned by most people with ADHD and ADD. Many interviewees had self-medicated to ‘block out’ their condition and calm themselves down. Only a few mentioned masking their condition and trying to appear ‘normal’. One person said he is constantly loud to stop himself thinking about bad things and hurting people. Only a few mentioned controlling their behaviour as a coping mechanism.

Healthcare

Many people were undiagnosed and not getting the support they needed. Some people were disappointed that the only support they received was medication and there were several instances of people not getting the same medication as they were prescribed in the community – sometimes because these were classified as controlled substances.

Probation and healthcare

A number of people said they had been recalled because no adjustments had been made for them. Several individuals mentioned that they missed appointments due to changes in appointment times, locations, and officers which they found difficult to process. Appointment times were said to be too short by some who felt rushed by their probation officers and therefore did not have enough time to go through all the issues and paperwork and fully understand the requirements of being on licence.

Good practice

There were some examples of good practice; three people cited HMP Pentonville’s neurodiverse ‘wing’ as an example of good practice because it is less crowded, people have more freedom, and staff had better understanding of neurodivergent people. 

One interviewee mentioned Feltham YOI where psychologists had explained to him about autism and identified triggers and coping mechanisms together. For example, he could ask officers to lock his door or to take him for a walk when he was having a bad day.

Recommendations

The report concludes with a number of recommendations, most of which are reproduced below:

• Where possible, prisons should provide single cells for those neurodivergent individuals who benefit from them.
• More one-to-one learning opportunities should be provided for neurodivergent individuals in prison who are not able to learn in group settings.
• More physical activities (i.e. gym and other sports) should be provided for neurodivergent individuals in prison who identify the need for exercise to stay calm, to sleep, and to burn energy to avoid being agitated.
• Prisons should organise more peer support activities (group sessions, listeners, champions) for neurodiverse service users.
• The NHS and HMPPS should commission the coproduction of accessible and engaging self-learning resources for neurodivergent service users in prisons and the wider justice sector.
• Prisons should employ more NHS staff (including clinical psychologists) with qualifications and lived experience of neurodiversity.
• Health care induction in prisons should include more thorough and consistent assessments / screening / diagnosis for neurodiversity. The induction should also be provided for those in remand.
• The probation and police services should introduce staff training with a particular focus on consistency, flexibility and service users’ different literacy and digital literacy levels.
• Courts should offer better assessment for neurodiversity, and fully take into consideration service users neurodiversity diagnoses when sentencing. 
• HMPPS and the NHS should consider employing individuals with lived experience of neurodiversity for roles that include interacting with neurodivergent service users.