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People with a learning disability and autism in the criminal justice system

People with a learning disability and autism in the criminal justice system cover
This report was commissioned by the LGA for the Greater Manchester Health and Justice Steering Group (Learning Disability and Autism). It identifies and collates how the Criminal Justice System and its prevention partners are working to address the challenges faced by people with a learning disability and autistic people, both in the UK and internationally. The report gathers information from publications, research, data and interviews with current practitioners working with people with a learning disability and autistic people in contact with the criminal justice system.

Executive summary

This report was developed using an analysis of a wide range of documents, including relevant local, regional, and national, international policy and strategy documents, reviews of selected local, regional services and evaluations, and published reports.

A literature scan and search for evidence was utilised, along with searches for best practice. Interviews with a wide range of key stakeholders and agencies took place and the report also features the stories and experiences of people with learning disabilities and /or autism who have been in contact with the justice system.

The report is structure around key themes identified by the GMCA Health and Justice group (Learning Disability and Autism). 

As research commenced and relevant resources were identified and grouped under the thematic areas, wider resources have been summarized in an appendix.

The research identified good practice in the Greater Manchester area and elsewhere that supported the lines of investigation identified within the key themes. 

Work that has culminated in useful tools and resources within the police was evident in Nottingham, with some good work taking place in other forces. Wider collaboration and consistent sharing between forces is arguably an unexploited area of potential benefit.

Community and voluntary sector support are exceptionally active in this area, from national organisations to smaller locally based voluntary organisations. Key organisations are listed in Appendix 3.

A reflection on the findings is that the challenge is not related to knowing what to do to deliver services that make a positive difference. Rather, it is the alignment of them within a comprehensive systems pathway that could offer amplified benefit to citizens.

The report offers suggestions about how the use of a Sequential Intercept Model (SIM) might be used as a framework for mapping a pathway that seeks to prevent progression of people into custodial based provision. Whilst the SIM model focuses on the justice system, an added element of community supports from childhood could support the development of a wider prevention model.

Reflections on this work identified the significant cultural assets that are evident in Greater Manchester. Espoused beliefs, values, positive motivations, and structural enablers revealed during interviews and wider conversations indicated that GMCA is well placed to take on the challenges of creating systemic pathways for the future. 

Introduction, context, and methodology


There has been a significant amount of research about our criminal justice system and how this serves people who have a learning disability and autistic people within the UK.

The experience of neurodivergent people has been the subject for a wide range of research papers, recommendations, and policies over the years. Much of this has focussed on what the problems are, with recommendations about how to address these. However, this work is not helpful unless we see the practical application of those recommendations and ideas generated from wider research and thinking.

This report was commissioned by the Local Government Association and the Greater Manchester Combined Authority (GMCA) to identify and collate best practice locally, within the United Kingdom and internationally.

Although the research undertaken included a literature review, desktop exercise of best practice, and semi structured interviews with a wide range of stakeholders, the aim of the report is to collate good practice and easily access information that might help with future planning within GMCA, or indeed other areas across the UK. It also has links to a wide range of useful resources.

The GMCA Health and Justice steering group (Learning Disability and Autism) held a discussion in October 2020 and identified eight themes which reflected the key issues, or areas of challenge which provided the scope for a search of good practice. The purpose of this is that best practice examples might support learning in order to evaluate what next steps the steering group wanted to take in terms of their overall strategic plan.

Key themes and related specific issues

  • Systemic pathway issues from diagnosis, diversion to support and treatment:
    • Autistic people who do not have a learning disability and who need help, but where there are no services that meet their needs due to eligibility criteria. Liaison and diversion services are sometimes left with nowhere to refer people onto.
    • Access to services including inpatient services, where there is a need for early intervention. This includes people who do not fit easily into any service, often people may be vulnerable with a mild learning disability.
    • Youth Justice across GMCA – what is consistent practice? How to establish one way of working across GMCA.
    • Local diversion panels in contact with people. Diversion panels and the use of appropriate pathways, also where links may not be utilised properly
    • Early identification of learning disability or autism
  • Online cybercrime and related activity
    • How this theme impacts on autistic people, who have good IT skills but who may be vulnerable being drawn into IT related crime and/or terrorism.
    • Cybercrime related to sexual incidents learning disabilities resulting in theft or material exploitation
  • Supporting families where relatives are in contact with the criminal justice system as alleged perpetrators of crime, or as victims of crime.
    • Supporting families of young adult offenders, what have they learned and experienced?
  • Policing pathway from custody, arrest, and interviewing. Covers staffing and the environment
    • Staff supporting people in custody.
    • Interviews of autistic people –either as a victim, witness or suspect. Interview techniques and best practice.
    • Point of arrest to sentencing.
    • Making changes to the custody environment, to alleviate stress in the environment. (possibly taking ideas from mental health settings.)
    • Supporting people at the point of arrest, variable police response. The right pathway is not always agreed.
  • Data sharing
    • Data protection issues mean that often information cannot flow and creates blockages. This issue is broader than this project, but it does impact on how agencies can work together around a person, particularly in relation to safeguarding.
  • Prison experience, including networks, discharge and rehabilitation and reoffending
    • People who have a mild learning disability or autistic people who experience a “revolving door”. Cycle of offending behaviour. Prison networking.
    • People leaving prison, rehabilitation. Support to settle and rebuild their lives
  • Potential impact of gender on responses offered
    • Gender – are generic approaches or different approaches offered?
  • Children and young offending and the potential impact of being a looked after child
    • Differences with young people who are looked after children with learning disability, or autistic children. What support do they need?

It is these areas of interest that form the structure of this report providing themed priorities that identify the key issues, selected relevant areas of best practice and a section of resource links whereby readers can access information easily to find out more on these projects and initiatives.

Context and methodology

The purpose of this paper is to be issue driven, evidence based and to provide useful and practical information that can be easily accessed by a wide range of stakeholders.

The stories of neurodivergent people related to the criminal justice system were gathered utilising the existing links established via KeyRing. Most people are from the GMCA area. Difficulties created by the COVID pandemic influenced the ability to do face to face interviews, in addition GMCA had already asked people about experiences in a series of round table events and there was a concern that this would create an overload or repetition of questioning.

Most of the stories concentrate on the significant issues and difficulties that people faced, and these have been distributed throughout the report. The function of sharing people’s experiences is that they often act as an identifier of issues rather than best practice examples, although there are some recorded positive experiences within the body of some stories. As many of the best practice examples show, it has been through asking people about their experience, listening to their voice, and doing what is needed that has made the difference.

The desktop exercise and literature search also produced a wide range of materials and reports in a further list of research at the end of the report in Appendix 1. This may be useful for those interested in reading more about a specific subject.

Appendix 2 also includes some general information such a list of useful key organisations, policy and strategy documents, additional useful resources, and published inspection reports. It exists as a resource for anyone wanting to have a quick reference point for further work in this area.

In addition to the priorities of those working within the steering group semi-structured interviews were conducted with GMCA stakeholders to find out what best practice they had observed these have been allocated according to their alignment with the key areas of interest. These interviews also sought to identify the issues and challenges and highlighted significant best practice within the GMCA area and elsewhere.

Systemic pathway issues from diagnosis, diversion to support and treatment

There is an issue sometimes where people with learning disabilities aren’t Care Act eligible. We have several examples in the Working for Justice group of people who with support have stayed out of trouble, but have gotten into trouble as budget cuts hit and their support reduced”

Areas of consideration

  • Autistic people and no learning disability who need help but where there are no services that meet their criteria. Liaison and diversion services are sometimes left with nowhere to refer people onto possible due to gaps in support.
  • Access to services including inpatient services, where there is a need for early intervention. This includes people who do not fit easily into any service, often people may be vulnerable with a mild learning disability
  • Youth Justice across Greater Manchester. What is consistent? Is there one way of working across Greater Manchester.
  • Local diversion panels in contact with people. Diversion panel, appropriate pathways, links not utilised properly
  • Early identification of learning disability/autism.

The issue highlighted is apparent across the UK and is exacerbated by the differences of eligibility criteria between services, the nature and constraints on funding and the culture and practice of organisations.

A common issue identified by interviewees is that often exclusions occur where a person does not easily “fit” into the existing provisions – of any sort. The needs of people are still evident, and arguably needs can grow when as a system we do not get to the root cause of the issue. When this leads to offending behaviour, there is a potential impact on victims. Over time the demand created by system failure increases, culminating in significant distress to people and communities, and cost to the overall “public purse”.

Addressing the gaps in the system

“We know of a couple who have drug problems, they live in Greater Manchester. They fled the family home and were at risk of domestic violence / honour-based violence. They struggled to get into temporary accommodation (the homelessness officer wanted them to return to the family home despite the risk). Eventually, they were placed in a hotel but then, after all health services were provided, they were moved out of the borough to another part of Greater Manchester. The new temporary accommodation had no cooking facilities, so they started using take-aways. They couldn’t get to their GP or addiction services so started using street drugs again.”

“We know of two people whose first imprisonment was for non-paying a bill, both have a Learning Disability, and one person is also autistic. Neither had the capacity to budget or write and post a cheque as it was then. One person ended up feeling less stressed in prison and deliberately got himself imprisoned for the next twenty years. Both people received a small amount of support with everyday living and have been out of trouble for the last 10 years”

Plymouth Creative Solutions Forum

This initiative in Plymouth brings organisations together to address the needs of individuals, and also provides a valuable feedback loop for chief executive officers of public services to show where the gaps are in the local system.

Interview with Gary Wallace, Plymouth Creative Solutions Forum: Public Health Specialist at the Office of the Director of Public Health Plymouth City Council

When services operate in siloes people who have risky behaviours often fall through the cracks, but if we develop a supportive collaborative culture that engages with risk head on, we can work together around individuals who have very complex needs and improve outcomes for them and our community.

The people that we work with have complex needs, in the early days of the pilot we worked a lot with people who had a label of “Personality disorder” or “Drug abuse problems”. More recently we see people who have a diagnosis of autism, learning disability or acquired brain injury, but we are not really interested in diagnosis, only in making a difference.

Best practice

In response to supporting people effectively we very complex needs and behaviours we developed the creative solutions forum.

Part of this approach in Plymouth was founded upon the integrated commissioning model, we had created one system with integrated governance arrangements, four strategies and have an integrated single health and social care provider for the city.

In addition, we had one budget with section 75 agreements between the clinical commissioning group and the City Council with integrated funds, in addition we had a risk sharing agreement and an established financial framework.

The new forum was built on the good development relationships, trust with the added benefit of colocation in one building.

The creative solutions forum is a multi-agency, multi-level gathering of key agencies who recognise that some people the complex needs need a different personalised solution. It is not interested in “handoffs” with people saying, “this is not our job”. It is also not target driven or based on market competition principles.

The forum reports to the Adult Safeguarding Board and has a core membership of mental health, housing, drugs, police, alcohol services. Referrals to the forum come from agencies who might feel that they are “Stuck” it is a last resort and aimed at designing an integrated and bespoke and integrated plan around the person. It is heavily personalised asking not asking “what is wrong with you?” but “what matters to you?”.

It really does draw on the expertise around the table to find out “what can we do?” The forum does not focus on the label, we look at what is the behaviour, and what is the ask from the person.

The forum has become our single biggest engine for positive cultural change.

The forum started as a six month’s pilot initially but has been running ever since. It is a “forum of last resort” and is used when bespoke solutions are necessary, and where organisational thresholds may have acted as a barrier.

In the six months we supported 52 cases, 27 women and 25 men. Cases are referred by police and other agencies for review and support.

Out of the 52 cases, 47 people who had high risk behaviours showed a reduction in risk. Five were lost to follow up due to moving. Workers carrying risky cases report feeling more supported in managing risk, and there were big reductions of use of emergency services For example, one case went from an average of 3 police or ambulance responses per day to none.

One of the bigger benefits was the contribution to system learning, because it was recognised that around half of these cases could have been avoided if services were ‘joined-up’. Transformation of culture across the health and social care system has been positively impacted upon by the forum as it reports to a System Optimalisation Group, made up of chief executive officers from lead organisations to practice level staff. A feedback loop has been created that informs leaders and staff what needs to change, they can then create the conditions, so it does not happen again.

In the forum itself, data sharing happens in real time around a person with all agencies able to access info via their laptops and share the relevant information they have about the person during a meeting. There is a supportive governance arrangement in place that enables this. The Plymouth alliance for complex needs is a multi-agency body which has a legal partnership agreement. It was created as part of a process that helped to develop trusting relationships across the system. There is a common core confidentiality policy with a list of services that have signed up to it.

Fundamentally the forum is action focused and uses its learning to inform future commissioning across organisations. A good example is the creation of two new police posts called “Problem solving officers” their role is not to arrest but to find alternative solutions. Other initiatives include leadership by our local Chief Inspector on trauma informed work.

The approach used is one of being more permissive with staff in the system, devolving discretion to public facing staff to enable creative solutions to happen. As long as interventions are legal and safe, they are supported. Founded on building trust and identified as a shared endeavour, the approach backs staff, “I leave the meeting feeling safer as a worker and not exposed”

Funding for the work is long term with a 10-year contract funding in the alliance planning in place, creating stability and commitment for the longer term. Over time this approach has influenced everything in Plymouth, changing our working practices and working in a collegiate way to help our citizens.

Related resources

Plymouth Complex needs Alliance

Mapping a pathway: Utilising the Sequential Intercept Model in the United States

Using a model to identify where interventions can take place to avoid escalation and get the right support to people can be helpful.

In the United States of America, The Sequential Intercept Model clarifies five points at which standard processing of crimes can be intervened with community-based actions, so that individuals with ‘mental and psychiatric disorders‘, would not have to further penetrate the Criminal Justice system. Whilst  autistic people and people who have a learning disability will have their own needs, that will require a different approach to treating a mental or psychiatric disorder, the model is useful to create a framework for thinking about wider system intervention and how these can be mapped.

The US State Attorney’s Office report concludes that there are opportunities for reducing silo working, minimizing gaps, and preventing duplication of activity.

Greater Manchester already has a significant amount of good practice, but the recognised challenge is being able to map these and draw a clear proactive pathway together that works across the wider system.

Intercept 1

The first intercept refers to law enforcement and emergency services. Police officers initially make critical decisions to decide whether an individual is innocent or should be arrested.

Intercept 2

The second intercept refers to post-arrest actions during initial hearings or detention, which offer diversion programs for arrested individuals from encountering standard trial and judgement.

Intercept 3

The third intercept occurs after the initial hearings or detention and is associated with prisons and courts.

Intercept 4

The fourth intercept aims to facilitate successful re-entry into the society after the release from prisons by experiencing proper mental illness management from community-based interventions and hence reduce the rates of recidivism.

Intercept 5

The fifth intercept refers to community-based corrections and support, with an emphasis on community control of individuals with mental illness after imprisonment. 

Related resources

  • An overview of the SIM model
  • SIM application. This report from Tulsa County Oklahoma demonstrates how the SIM was used to map existing interventions and services, and gaps in provision. It is a good example of applying the model in practice. Whilst the model has been used specifically in relation to people with mental health needs, it is transferable across other groups of people.
  • The GAINS model identifies ways that people can work together to make the changes identified from the application of the Sequential Intercept Model. In the US these two models have been used side by side to make changes. The GAINS acronym is:

    Gather: Screen for and collect new research findings and best practice

    Assess: Synthesize this information into appropriate and targeted communication for various types of users

    Integrate: Organize facilitated learning and follow through

    Network: Build and strengthen networks and infrastructure

    Stimulate: Identify and use the most cost-effective ways of achieving significant results
  • International autism and CJS project included the sequential intercept model in policy development

Early identification of a person with a learning disability or autistic person

"We have lots of examples of how people have struggled due to a lack of support. someone (not GM) who, unsupported "bought his friends". He was used as a lookout for a burglary that he didn’t know was happening and convicted as he knows right from wrong (he didn’t know what aiding and abetting meant for a long time though!). Later, and still unsupported, he was cuckooed, his flat was raided in the middle of the night, he was rip-tied and put in a van. There, he says he was de-arrested HOWEVER, he has a record for possession with intent to supply a class A drug (he doesn’t seem to understand this conviction and I’ve never got to the bottom of this). He was supported by KeyRing for around 10 years and stayed out of trouble all this time.

As soon as his support was reduced due to budget cuts, he got into trouble again. He had been having a relationship with a woman. They had a falling out and he remembers her approaching him with something in her hand. When he came round from a seizure, he had a lump on his head he found that she had gone thru’ a glass table and was bleeding badly. She survived. He pleaded guilty to what he thought was Aggravated Bodily Harm although he doesn’t remember pushing or hitting her. In telling the event, he says he ‘saw red’. However, he means that everything went blank - it wasn’t an admission of anger.

He later found that he was charged with Grievous Bodily Harm level crime which carried the potential for a custodial sentence. Everyone who knows him suspects that he is autistic as well as having a learning disability. He doesn’t want to be tested as he doesn’t think it will make any difference. His court report dwelt on his mental health but didn’t reflect the person we know. With his consent I contacted his legal team and asked about him having a test for autism. Lawyer was sure that a 42-year-old man would not have gone undiagnosed for so long but said I could write to the judge is I was really concerned. He was eventually convicted but given a non-custodial sentence”

This story outlines the impact a combination of factors can have on an individual, but rooted in this story is an undiagnosed need, which created a vulnerability that others exploited. Subsequent lack of support compounded the problems this man experienced.

Whilst there has been a much stronger focus on diagnosis of autism, in particular, over the last decade, wider systemic support is needed that spots early signs in children.

Good practice: SIGNS (Welsh Local Government Association and Cardiff University)

This award-winning approach in Wales supports professionals working across the wider system in education, health care and social services, as a supplement to a training session. SIGNS is an easy acronym and a way for frontline professionals to identify and understand autistic behaviours in children.

S = Social Interaction and verbal communication

I = Imagination

G = Gestures or non-verbal communication

N = Narrow range of interests, routines and repetitive behaviours

S = Sensory responses

The team developed two key resources that the WLGA’s National Autism Team provide to clinical and educational professionals: posters featuring the SIGNS of autism, and ‘The Birthday Party’, an 18-minute training film based on SIGNS. The success of the film has led to requests for its use in autism training across the world and translations into Spanish, Italian, Latvian and Lithuanian, led by the Cardiff University team.

“The film describes the signs of autism seen in three children at a birthday party. The message of the film is that the same signs can show themselves in different ways. Because of these differences, sometimes the signs can be easy to miss. The signs can also be common in children without autism too, so it is important to look for the pattern in which they present. Two of the children in the film, Jack and Rhys are boys and one, Amy, is a girl. All are quite different and while Amy shows a different profile from both the two boys, this profile is not intended to show a ‘typical’ female profile of ASD; each child is unique, regardless of their gender. No two girls and no two boys will have an identical presentation of the signs.”

Related resources

Supporting families where relatives are in contact with the criminal justice system as alleged perpetrators of crime, or as victims of crime.

Areas of consideration

  • Supporting families of young adult offenders, what have they learned and experienced?

Supporting families of young adult offenders from learning and experience

Some families and carers may have been involved in in depth planning around the needs of their loved one. Specifically, where vulnerabilities have been identified and behaviours that may be perceived as challenging are anticipated to attract the attention of criminal justice this can lead to proactive planning with the police and other services such as forensic psychology or psychology services.

This creates a scenario that helps families have some piece of mind, but for many families the first involvement that they have is just after the first arrest of their family member.

The experiences and views of family members of people with particular needs that are in contact with criminal justice and liaison and diversion services is documented within the Relative Justice report. All the direct quotes in this section are taken from this report.

This report, focused on the views of family members of people who had been in contact with the criminal justice system including those who have a learning disability or autistic people, across the UK. Overall, 30 members participated in focus groups or discussions.

The issues identified by families included the sense of shame at having a relative in contact with criminal justice services came to the fore for a number of family members, this sometimes affected their ability or preparedness to seek help:

…we can become quite unwell, traumatised; then it can be quite difficult, because of the stigma, to get the help we need."

Families sometimes had not been listened to.

  • “Nobody knows the child better than their own parent. They can help to pinpoint problems; they know what happens in their [child’s] daily lives. I’m not saying I know what it [the diagnosis] is, but I know there’s something wrong and I can talk about it. A professional maybe has one or two meetings; they won’t know what it’s like. I know it [getting a diagnosis] takes a long time – what I’m saying is that I can help.”
  • “It’s a bugbear with me; they didn’t listen to a word I said. They wanted to put him on a curfew, and I said, ‘it won’t work because of his disability’ [he doesn’t understand the concept of time]; and he broke his tag. The judge said he should never have been put on a curfew.”

Good practice

In terms of interventions that made a positive difference, diversion and liaison services had been useful.

“Some family members involved in this study had direct experience of the new trial site liaison and diversion services. Their relief at having, as one mother described it, ‘someone on my side’ was tangible. Whether it was help to make sense of the situation and to understand what would happen next, the offer of practical support or ensuring referrals into local services – family members in contact with liaison and diversion services were wholly positive. Those who had no such experience were asked to comment on the model for liaison and diversion and, by reflecting on their own experiences, provided useful feedback.” Lord Bradley

Others noted that families were also a ‘resource’, able to help their relative to change their behaviour and to support their recovery and/or daily living.

  • “There is a natural disposition in the family to support, to cooperate… to help with transitions and to overcome any innate hostility in the person who is in custody. It’s foolish to discard that. By using people around, them [their relative] you’re saving services. You’re enabling people who love and support them to help.”

Valued support

Most family members said they would have liked more information about the process to which their relative was subject, having staff proactively sharing information was important and valued.

  • “Fortunately, our solicitor told us what would happen, just all the procedures, otherwise how would you know?”
  • “The sergeant was ringing me, kept me informed about his health, his progress and what was going to happen to him, and when he was going to be released. It made me feel better, so I wasn’t worried about him.”

Following arrest, family members said it would be helpful to be kept informed, on an ongoing basis, about what was happening to their relative and what was expected of them, for example bail requirements and other appointments.

Really good feedback was received about diversion and liaison services again, in this respect.

  • “She [the liaison and diversion worker] said I could call her and in the early days I did phone a lot. “
  • “They [the liaison and diversion worker] sat down and talked to you and let you know what would happen and what they could do.”
  • “They [liaison and diversion] put everything in place; the ADHD team has pulled their finger out, and I’ve got the children’s team. They’ve opened the door, things I couldn’t get before, I can now. I tried, but it was too hard – you don’t know where to go.”
  • “My son is now doing an apprenticeship. He was talked to by [the youth liaison and diversion worker] and they are, like, friends. He’s doing really well. He hadn’t been to school for two years and was back within a month of [youth liaison and diversion] being involved. If it wasn’t for this service, my son would be in prison.”

Having a human and non-judgemental approach was helpful to people.

  • “She wasn’t in any way judgmental. It was like she understood what we were going through. (Liaison and diversion) If you’re from a council estate and are a single parent, other people judge you, put a label on you.”
  • They are at the same level; they understand. (Liaison and diversion)
  • The people here are normal people; they put you at your ease and don’t look down on you. (Liaison and diversion)

Community and voluntary sector organisations input was valued also, here the feedback relates to Partners of Prisoners (POPS).

  • You need somebody to be down to earth, and they are.
  • They ask about you first.
  • They try and get you to do things, but they will also do things for you. And if they says they will, then they do. 

The types of support that made a positive difference included

  • financial advice, including benefits and debt, especially if it is the main wage earner/recipient of benefits who has been arrested:
  • family support
  • Peer support
  • personal and emotional support:
  • Consistency of a “kind” approach makes a difference “One family member said: He [the police officer] talked to me like I was a human being… I was in a right state, and it was a very kind thing to do. The contrast when a different [police] force came – it was horrific.”

One parent reflected it was better to get an early diagnosis and the right help.

My son had problems before he got involved with the police and I tried to get help through the school and doctors. You should have somewhere to go before they get in trouble. If we’d had access to [youth liaison and diversion] before it came to the arrest, it might all have been stopped before it started. But now he’s got a record.”

Suggestions made by families

Knowing what help is available was important. There were a number of suggestions about how liaison and diversion services could be ‘advertised’, and these include:

  • Posters in police custody, and leaflets that should be given out as a matter of routine including getting information via defence lawyers and duty solicitors
  • Posters and leaflets in advice centres, and in women’s centres
  • Written information contained in local council tax notices
  • Through organisations that work with families of prisoners, such as POPS and Pact
  • Greater use of technology: a website with local liaison and diversion service contact details, and information about liaison and diversion and the criminal justice process, including ‘frequently asked questions

Related resources

Key organisations and their contact details, further references are also listed in the appendices, including Partners of Prisoners (POPS)

Talbot, J., Cheung, R. and O'Sullivan, S., 2015. Relative Justice. [online] Prison Reform Trust and POPS: Relative Justice. [online] Prison Reform Trust and POPS

Policing pathway from custody, arrest, and interviewing including staffing and environment

One gentleman from Manchester who was arrested for a crime when in London. The Force Medical Examiner didn’t recognise his Autistic Spectrum Disorder and he was denied an Appropriate Adult”.  

Hidden disabilities are difficult. We are hearing a lot from people who don’t really understand how their condition affects them in the Criminal Justice System context. On hindsight, they will recognise that they needed support but at the time, they may not recognise their needs”.

Areas of consideration

  • Interviews of autistic people either as a victim, witness or suspect. Interview techniques and best practice.
  • Staff supporting people in custody.
  • Point of arrest to sentencing.
  • Making changes to the custody environment, to alleviate stress in the environment. (possibly taking ideas from mental health settings.)
  • Supporting people at the point of arrest, variable police response. The right pathway is not always agreed

Improving interviewing: Interview with Dr Katie Maras. Researcher at Bath University.  Area of focus Avon and Somerset Police interviewing processes.

Hampshire police wanted to develop better processes for the interviewing of autistic people.

There was a focus on two groups of people-

  • Autistic people who are interviewed as witnesses
  • Police officers who are autistic interviewed when applying for job roles/promotions within the force

Best practice

A study/survey across England and Wales, was used to ask people about their interview experience, both police officers and autistic people, which provided information about the current situation. Less than half of police officers were satisfied about how they had worked with autistic people, for various reasons. Even though 37 per cent of officers had received some training this had not been role specific. Similarly, autistic people and carers were largely dissatisfied and agreed that changes were needed in training.

This then developed when the question was asked “how do we adapt what we do?” to improve experiences and outcomes.

Results from the survey and other work carried out at the Centre for Applied Autism Research at the University of Bath led to bespoke role specific guidance being developed for all frontline police staff in Avon and Somerset police force, including detectives and police officers on the ground. Guidance was delivered as a range of videos but also as text.

The work done internally at Avon and Somerset, informed by the research carried out at the University of Bath, with human resources to improve interview techniques for autistic officers enabled improvements in promotion prospects for autistic officers. Before the changes 13 per cent of neurodivergent and disabled officer applicants were successful in their promotions, after adapting interviews 75 per cent of autistic officer applicants achieved promotion.

The research and outcomes provide a compelling case for the long term and several forces are now looking at improving their processes for interviewing autistic people.

Related resources

The link to the toolkit developed for police interviewers, as part of a wider project on supporting autistic adults in interviews are listed below. They were developed by Bath University.

Point of arrest to sentencing. The gap for autistic people who do not have a learning disability. Making changes to the custody environment, to alleviate stress in the environment.

The University of Nottingham have some good materials, listed in the resource section below.  Prompts include suggesting how officers can minimise sensory related stress by asking people what they can do to help, such as dimming lighting, trying to keep noise down etc

Police custody suites can be very frightening places for autistic people, but for an autistic person the distress can be considerable environmental stressors such as:

  • harsh lighting
  • strong smelling cleaning agents
  • loud noises which can cause actual pain and feelings of nausea

Some autistic people have specific food issues, for example:

  • not being able to eat food of a certain colour or texture
  • not being able to eat food that has touched other food

There is a need to make sure that staff are fully aware of the sensory impact of the environment. This is true of all environments in the criminal justice pathway including courts. Links to materials produced by the advocates gateway are in Appendix 2 that provide guidance to courts and legal professionals.

Improving custody experiences. Interview with Becky Davies, Custody Sergeant, Exeter.

Devon and Cornwall constabulary have undertaken a specific piece of work in relation to the use of sensory aids in custody.

I took up the mental health single point of contact custody role for Exeter in 2018. The diversion and liaison staff were part of the embedded team in custody and were co-located with police.

I noticed a stretch ball on a desk and asked how it was used. Diversion and Liaison staff explained that for some people it helped to act as a distraction technique to reduce anxiety, self-harm, and violence towards staff. I thought it would be a good idea to explore this area more and over time started to look at different distraction techniques that might be used in custody. I approached my line manager who asked me to put in place a risk assessment process, and over time we proceeded to utilise a number of distraction techniques in practice.

Some of the items used in custody with things like a foam football, mindful colouring books, stress balls, puzzle packs and large jigsaws. Particularly useful for people with ADHD. In addition to this, the use of ear plugs were helpful for people with hypersensitivity to noise to help them reduce sensory inputs that might cause them distress or alarm.

In terms of working with people who have a diagnosis of unstable personality disorder, custody staff worked closely with the liaison and diversion staff, an approved mental health practitioner and also identified a person who has unstable personality disorder, who kindly offered to help police.

I went to the expert by experience’s house and recorded a conversation about her experiences, and things that had worked for her in the past when she was in custody.

The video was edited and was utilised as part of a 2 1/2-hour training session for staff working in the custody suites across Devon and Cornwall, about how best to support and work with people in custody who have a diagnosis of unstable personality disorder.

During training officers had good opportunities to discuss “uncomfortable” issues like self-harm through engaging and animated conversation, and understand rationales better about agreed approaches to behaviours.

This significant contribution by the expert by experience was recognised through the nomination for and achievement of the Superintendent Commanders’ Award.

A further training package is now being developed alongside the Autism and ADHD services at Devon Partnership (NHS) Trust. This is hoped to culminate in some face-to-face training with experts utilising videos of people with lived experience. Currently this has been put on hold in the meantime due to COVID, but it is hoped that this package of training will be delivered as a webinar moving forwards.

Looking forwards, the force is looking to purchase some IT kit, using “tough tablets”. These will not have internet capability initially but will have preloaded apps that people can us to play games and keep occupied whilst in custody. Consideration is also being given about selecting intuitive apps that may be used to assess detainees learning needs.

Currently there has been much discussion on Twitter, and interest shown by a number of forces around the country, about the use of distraction items in custody.

Related resources

Supporting people at the point of arrest, mitigating variable police responses and pathways.

Consistency of approach across a force has been identified by the health and justice steering group. There is some evidence that adopting mandatory training approaches and the use of flow charts is helpful to reinforce application of learning in practice for custody staff but having reciprocal information for detainees creates a smooth process that is fully understood by all parties.

Improving experiences in custody

Interview with Dr Chloe Holloway Research Fellow at the School of Law, University of Nottingham. Now a Teaching Associate in the same department.

Further research is definitely needed as there is a lot of good stuff out there happening, but people are not systematically sharing, consequently people are reinventing the wheel. Part of the issue is about getting people on the same page in relation to autistic people and the criminal justice system.

Driven by the lack of information in research on the direct experiences of autistic people in police custody as told from their perspective Dr Holloway, Dr Munro, Professor Jackson and Dr Ropar, conducted a participative walkthrough of custody, involving two autistic people to tell us how things were. This was conducted with the assistance of Nottinghamshire Police. Findings were shared including any negative experience in police custody.

We looked at three areas

  • The custody environment
  • Changing custody practise by understanding what was happening, gathering information, improving communications and having a clearer process.
  • Looking at custody policy and national policy. Ad hoc changes have not been easy and any development has to be systematic and approved.

In Nottingham, this piece of work was driven strongly by Inspector Tracy Lovegrove who was leading an initiative to further develop their internal vulnerability strategy. Additionally, inspector Duncan Collins was developing a new custody suite in Nottinghamshire which was the perfect opportunity. We could utilise coproduction to help with the planning of this the delivery and evaluation.

Working closely with the East Midlands Learning and Development Team, the initial training was delivered to custody staff in Nottinghamshire. The improved training was developed once we recognised that more specific information was needed, and that training needed to be tailored to the custody role.

The improved training was designed specifically for custody staff. The improved training was developed with autistic people and the police custody staff together. This was facilitated through the Nottinghamshire Autism Police Partnership which was created first with the view to develop the training and work to create positive changes in custody utilising training was one the codeveloped outputs.

This enabled us to have an ongoing focus, working in partnership to make positive change.

Regular meetings enabled us to

  • agree priorities
  • address prescient issues
  • helped us understand what is needed to make positive change happen.

The improved training, we developed included face to face training, a training video, a visual toolkit (this is used in the custody suites to help autistic people understand what is happening). Police officers use the toolkit on the job including information on legal rights, and clear process flow chart that staff could follow.

The full toolkit was launched on the 10th of January 2020. It is already being distributed ad hoc and is freely available to everybody. We aim to build awareness about the toolkit and now 27 forces and over 55 criminal justice organisations have a copy. We believe the toolkit is translatable to other areas and we are looking to see now how it has been used and how effective it has been.

The training has been piloted in five forces now - Nottinghamshire, Leicestershire, Lincolnshire, Northamptonshire and Gwent.

So far 150 officers received the initial training based on the Nottinghamshire research, as facilitated by LDT, and 150 officers have now received the improved training at the 5 forces specified above.

Now we hope there will be a national policy push for consistent approaches especially with the administrative justice focusing on neurodiversity. Evaluation findings have not been published yet but anecdotally we have had good impact on officers who have found the training useful. We believe it contributes to the saving of resources because there is less distress, -people are not anxious and the process is now taking less time. Fundamentally our aim would be to see this happening as business as usual across all forces.

Funding for this programme of work came from University of Nottingham and the Economic Social Research Council (ERSC). We also sought an internal grant and got further funding from the ERSC after winning the Celebrating Impact Prize Future Promise Award.

For further information

Nottinghamshire Police Autism Partnership

Newspaper coverage of Nottinghamshire custody suites

Research into making custody suites more autism friendly

Related resources


  • This guidance from the National Autistic Society provides further information about best practice in police custody, and includes information on the environment, communication, and interviewing.
  • Beyond Words for people who have a learning disability there are resources that are useful to provide visual aids, one is titled “You’re under arrest”

Streamlining the Mentally Vulnerable Offenders Panel

Interview anonymous

There are two potential issues related to ensuring a fair criminal justice system where neurodivergent people may have mental health needs.

The first is that sometimes people are not prosecuted when they should be, this could happen when a person has capacity, but interventions sometimes mean that the person’s crime is not heard in court or acted upon. This can potentially lead to a scenario where the same thing happens again and again as opportunities learning and rehabilitation are absent. In addition, victims suffer and can feel a sense of injustice. Even though people could be prosecuted they could still get help, and this may also be a missed opportunity.

The second is that we need to identify those people who lack capacity and need help. They need to be offered the right support in order that the chances of reoffending are reduced by helping manage the causes of their actions and behaviour.

The MVOP (Mentally Vulnerable Offenders Panel) operates to identify individuals who can benefit from diversion from the criminal justice system. In Greater Manchester, this process is currently being streamlined alongside an improvement initiative to ensure that the voice of the person is heard as part of the panel discussion. The interview is conducted by members of staff from the mental health teams and provides a more rounded view of the person helping to understand what is going on for that person at the time of their alleged offence and why.

In Bolton, mental health team staff are collocated with police twice a week enabling prompt interviewing to take place. This speed up the process and can help with early intervention.

Good relationships exist between panel members enabling them to have open and frank discussions which ultimately ensures that decision making is undertaken that fully accounts for a wide range of views and opinions and is based on a sound knowledge about the individual.

One interesting development during COVID has been the use of interviewing people away from the police station to reduce transmission of potential COVID infection. Interviews can be undertaken using the same rigorous process that is followed in the station including PACE compliance, but by using specific mobile phone software (Axon capture/audio) people can be interviewed at home, potentially reducing the anxiety of being in the police station for some individuals. This practice is being considered in the future as a reasonable adjustment for neurodivergent individuals who find the police environment difficult.

Related resources

Probation best practice: Interview with Derek Rhoden, Operations manager Greater Manchester Probation service.

Support for autistic people needs to be evident at all points of contact with services, including after court and/or custodial sentences spent in prison. This means having the right help in probation services, with adjusted environments and knowledgeable staff.

Best practice

In Oldham, Bury and Rochdale there are autism champions in each probation office.

Autism champions work to create autism friendly offices with lighting and sensory adjustments. Autistic people and their families gave feedback about what could be improved and supported training.

The service is supported by Derek Rhoden, Greater Manchester operations manager and also a parent of an autistic son, who worked with the National Autistic Society relating to the quality of the interventions introduced.

Champions act as a point of contact for advice and support and maximise opportunities when there are national events in the calendar, which are utilised for cascading information to other workers in the office to develop awareness and share knowledge.

By having people who are autism aware in the probation service, staff can identify small signs that someone may be autistic and further support or assessment can be offered.

The links extend beyond probations services into other support forums where young people and families can get help- sometimes this can be at the point of identifying early concerns raised via Education, Health and Care Planning process and signposting people to get the right help and support.

Oldham has a shared aspiration to become an autism friendly town which will include involvement of many shops and businesses. For children, young people, and parents this has been important and opportunities to help parents keep in touch has been critical to ensure their engagement. The Council actively supports co-production to ensure that planning for services are meaningful and effective, and academic institutions support awareness training and events.

Related resources

  • Wider support for autistic people living in the community take place supported by Manchester’s academic institutions. This national event planned for 2022 is a good example.

Understanding behaviour and getting the right support. Interview with James Jones. Strategic lead for out of court disposals

Currently a review is taking place regarding warnings that are given out of court. At the moment these can result in a fixed penalty notice, cannabis or khat warning, community resolution, simple caution or conditional caution. A fixed penalty notice is not usually helpful as all it does is add more debt to other reasons the person offended increasing the likelihood of further offending. Conditional Cautions are also given; these can be a formal outcome or a community resolution which is an informal outcome. The latter has a lower threshold and as an informal outcome does not leave a criminal footprint.

If, as a society, we want people to rehabilitate and stop reoffending then we need to really understand what is driving the behaviour in the first place and seek to help people with these issues.

Best practice

It is critical to understand why offenders do the behaviour that they do to get to the root cause of the unwanted activity. Conditional cautions and community resolutions trigger a referral for staff in NHS Liaison and Diversion services to undertake a holistic assessment of the individual. They conduct a needs assessment over the phone or face to face if in custody, and the form of information is shared with the out of court disposal staff so that the police will have information to be able to seek the right help. The focus should be on rehabilitation and understanding the diagnosis.

In Salford we have run a six-month pilot to utilise this approach of understanding what individuals have experienced, and what drives their behaviour. This pilot is now being extended for three months and we are currently gathering data. Early indication from those receiving either a conditional caution or a community resolution via this process shows but every metric has improved with positive qualitative feedback from stakeholders, including victims. It is still early days, and so it is exceedingly difficult to get hard longitudinal data on reoffending rates, because the project is so young.

Part of our challenge is to get the awareness from police officers on the ground to boost the referrals to the programme. Although undertaking this approach saves time in the long run it can sometimes feel administration heavy in the short term for officers on the ground. Part of our longer-term plan is to gather the data to demonstrate that referral to this programme of work reaps benefits as longer term as reoffending rates reduce.

A good example is when people are charged with “drunk and disorderly conduct” which often leads to a £5 a week fine but does not resolve the issue. There may be a multitude of reasons why people drink. What we are doing is educating custody sergeants to get them to ask for out of court disposal instead.

Sometimes across services we work in silos so we might only be looking at one particular need a person has, having a holistic needs assessment really helps is understand what matters to the person and we undertake a proper objective assessment.

Seeing individuals and their vulnerabilities first rather than as an offender we can change practice. In turn this will save money in courts as less people would be processed through that system, but fundamentally we can help people get the right help and live better lives in our community as an outcome in the longer term.

Even if a vulnerability is identified in court, courts will often send people to statutory services rather than to the community and voluntary sector. By utilising an out of court disposal, we can be more bespoke and sensitive to people’s needs, this includes specific needs of people such as women, veterans, people have a learning disability such as Autism for example. The police cannot always understand everybody's needs but they can refer onto the people who do!

Supporting people in the community: Interview with Rowena Lewis - Triple A Project

Autistic people sometimes experience difficulties with understanding because the services and supports offered use information or ways of communication that is not meaningful or is exceptionally opaque. Having the right support in relation to people who have offended or are at risk of offending is critical.

Autistic people experience isolation in many ways. The geography of Cumbria can exacerbate that, particularly in relation to social isolation.

Very often support services “lump” people together who have a learning disability with autistic people- what is needed is a skilled response that meets the needs of people in an individual and holistic way.

Finally, not all interventions are ambitious for the person- there is a need to raise expectations and make a significant difference in line with the aspirations of the person. In some cases, bad advice is given which can create negative long-term effects on a person’s life.

Triple A Project: best practice

The Triple A Project works funded through Police and Crime Commissioner and charitable funding for anyone who has had a diagnosis of autism. Input can be spot purchased by organisations who want our support. The Triple A Project works with individuals to have a focus on what autism means to them, sometimes this can be via groups, or if that is difficult through 1:1 discourse.

Referrals come via Liaison and Diversion, Probation, Prison via the gate or by prison officers. Triple A Project offers specialist advisors who can support people with a broad range of specific issues from benefits to sleep problems, a criminal justice lead. The Navigator programme is researched and evaluated by University of Cumbria. Navigator role is to support people to access support from the right place including signposting to other agencies and uses internal specialists to enable this.

Some staff are experts by experience and provide support on a voluntary or freelance basis and are utilised as and when needed, reducing waste. The organisation is incredibly agile and able to flex support around needs.

Specifically, Triple A Project seeks to work to understand people and increase knowledge in others advising on adaptations to make the system more accessible for autistic people.

The support uses a holistic approach, aiming to create a bond of trust.

Cumbria has a broad and challenging geography with communities that are sometimes isolated. Social groups are dotted around Cumbria called “Positive Pals” that help people create good relationships and help to create accepting communities and an understanding of the person’s position in the world and how they interact with it. There are 3 social groups in the south of Cumbria and 7 in the north. Navigators are peripatetic and move to where they are needed and work on a 1:1 basis.

Positive social contact helps dispel myths and fixed ideas about themselves and others. “If you have met one autistic person, you have met one autistic person!”.

Hampshire best practice

Separate to the Triple A Project, in Hampshire, probation funded the delivery of autism services utilising a specialist consultant. This offered a “short, sharp” approach working with probation services staff to guide them in helping autistic people that was professional and supportive.

The scheme used the rehabilitation activity requirement (RAR) days allocated by the court to support some offenders to help them and reduce re-offending.

Funding for the programme was long term and annually reviewed, creating stability and an ability for longer term planning.

The Ministry of Justice had a contract and specification that clearly set out the responsibilities of the organisation. The funding enabled valued contributions from a range of specialists that was helpful, particularly from forensic psychology offering probation staff useful insights into behaviour.

Autism Hampshire also used a range of materials to support people including a phone app. Pamphlets such as “How do I get through Court?” were also useful.

An autism passport, a small card that could be placed in a wallet or purse and some people described it as a “talisman”, provided some personal information and listed triggers for behaviour which was useful. Agreements with the police force about its use were helpful and supported the embedding the use of the card. In addition, awareness training was delivered to officers by autistic people.

Problems with long term funding creates instability and serious implications for people who have benefited from input that can then be no longer there.

Late or absent diagnosis can impact on individuals getting the right help when they need it.

Some diagnostic overshadowing is taking place that is very unhelpful, particularly people diagnosed with personality disorder who have autism. Overmedication can also create problems and may be symptomatic of GP’s or some medical staff not fully understanding how autism can present. In addition, some traditional treatment programmes are not helpful for autistic people and some people have reported being traumatised by this.


Data sharing

Areas of consideration

  • Data protection issues mean that often information cannot flow and creates blockages in the system

This issue impacts on how agencies can work together around a person- There are two main aspects that are considered in respect to working with autistic people and those who have a learning disability in the criminal justice system- safeguarding related to the prevention of crime.

An additional issue of data and information sharing with families has also been identified.


In the past lack of sharing information between agencies has created significant safeguarding risks for individuals and has been a high-profile issue in several serious case reviews.

The case of Steven Hoskins who was murdered in Cornwall in 2006 identified issues with a lack of information sharing.

Messages for practice from the serious case review into the murder of Steven Hoskins summarised that

  • Sharing information and partnership working between agencies is vital for the effective safeguarding of adults.
  • People who are on the margins of social care eligibility criteria and receiving little or no support may highlight their need by repeatedly calling on emergency services.
  • Such people may be at risk of either being abused or abusing others more vulnerable to abuse than themselves.
  • Staff in all front-line health and social care services should be trained in the identification of indicators of abuse.

Crime prevention: Section 115 of the Crime and Disorder Act 1998 establishes…

The power to disclose information is central to the Act's partnership approach. The Police have an important general power under common law to disclose information for the prevention, detection and reduction of crime. However, some other public bodies that collect information may not previously have had power to disclose it to the Police and others. This section puts beyond doubt the power of any organisation to disclose information to Police authorities, local authorities, Probation Service, Health Authorities, or to persons acting on their behalf, so long as such disclosure is necessary or expedient for the purposes of crime prevention. These bodies also have the power to use this information.

Part 3 of the Data Protection Act 2018 covers the processing of personal data for 'law enforcement purposes'. It covers processing for the prevention, investigation, detection or prosecution of criminal offences, or the execution of criminal penalties, including the safeguarding against and the prevention of threats to public security.

Best practice

A good example about how data is used and shared in practice across a system is shared in the Creative Solutions Forum in Plymouth. (Section 5.2) of this report. The forum’s direct feedback given to the CEO leads of statutory organisations has indicated a gap in practical support on the ground- this has now culminated the funding and recruitment of two problem solving police officer roles in the city.

Problem solving policing is now also taking place and a neighbourhood beat team have a harm register (to highlight concerns) in Cornwall. Identifying “clusters of calls” is now common practice in Cornwall, it also focussed on Minor Injury Units where nurses can activate a safeguarding alert and computers can activate an alert when frequent visit thresholds are breached. In addition, information is cross referenced with adult social care, and information is shared with the South West Ambulance Trust.

Related resources

Families and data sharing

The Relative justice report recognised that sometimes young adults don’t want to share information with their parents. It is a matter of privacy for young adults, and it can be hard for families in this scenario.

In this report, discussions centred on the balance between respecting an adult’s right to choose or choose not to give permission for family members to be involved in conversations about them and ensuring that the individual concerned understood why it might be helpful to give that permission. A support worker who attended one of the focus group discussions described it thus:

“All the lads I work with who are over 18… part of the work I do is explaining why we need that permission to discuss their case with their parents. We’re not going to share information willy nilly; information will only be shared when it’s relevant.”

One family member said that asking permission to share information should be like asking for an individual’s ‘next of kin’. He went on to say: “It should be a matter of routine, part of the procedure; and if they say ‘no’ then it should be explained to them, and they should be told they can change their minds later on, if they want to.”

Their recommendation was that a clear, standard explanation as to why consent to share information is helpful, and when sharing information with a named person might be necessary, should be developed. This would be used routinely by frontline liaison and diversion staff and be written in an accessible format such as ‘easy read’.

Talbot, J., Cheung, R. and O'Sullivan, S., 2015. Relative Justice. [online] Prison Reform Trust and POPS. Available at: Relative Justice

Prison experience, including networks, discharge and rehabilitation and reoffending

GK was arrested a lot for drunk & disorderly when he was 18 and within 6 months of leaving home. He went through the courts twenty plus times and racked up community-based sentences including violent disorder and possession of an offensive weapon.

He was on probation just twice, the first time was good, but he broke his probation order by getting into trouble again and his probation term got longer.

Regarding court, he didn’t understand it to start with, but learned to ask. He learnt to find his way around, always at magistrates’ court. He never had an Appropriate Adult or any reasonable adjustments. His solicitor was good and really worked for him.

In terms of carrying an offensive weapon, he got knifed during a mugging whilst walking home late at night, so he started carrying a knife and went looking for the perpetrator, he went to a club and used the knife, ‘without damaging anyone, during a disagreement. He got 120 hours community service. He worked in kennels but had reaction to chemicals and then went with a crew, he said that was okay and he felt supported.

His prison sentence was due to non-payment of fines racked up due to the many court appearances. His violent disorder was related to an incident in a club when he had an argument.

He said that he didn’t understand what prison might be like before he went. He couldn’t picture himself in prison and was badly assaulted whilst there. However, this was a catalyst to dealing with his addiction, and he got into a dry house.

This was before his autistic spectrum disorder and learning disability was recognised, he went to mainstream school, had no additional support, and had no statement.

He said that “my drug & alcohol worker was ‘like a dog with a bone and eventually I got a diagnosis, I was scared – I thought I might be made to take medication but then I got into KeyRing as I needed my own space and started with the Shaw Trust, employment, at the same time. I also got Disability Living Allowance which meant that I had a bit more money and could cope financially.”

Areas of consideration

  • People leaving prison, rehabilitation. Support to settle and rebuild their lives
  • People who have a mild learning disability or autistic people who experience a “revolving door”. Cycle of offending behaviour. Prison networking.

People leaving prison and rehabilitation, including having the right, good quality support to settle and rebuild lives.

Interview with Dene Donalds. Company Director, Pathways associates

Pathways is a community interest company funded by local authorities and clinical commissioning groups in the North West region. People are involved in co-production and self-advocacy. They work through three sub regional Challenge Groups including Lancashire and South Cumbria, Greater Manchester, and Merseyside and Cheshire. The work involves consulting with and involving experts by experience- engaging in connections with a wide range of organisations. We have a conference once a year and have over 250 by people who are experts by experience involved, they link with people like MPs or senior civil servants who also attend to make positive change happen.

Welcome values: This quality checker programme involves spending time with people who have experience a range of services and is funded through specialist commissioning. Pathways works with 12 people in the criminal justice system or secure mental health services.

In 2018 to 2019 we were working with people in Merseycare NHS Trust (Whalley) some had come from prison or were on Ministry of Justice restrictions. We worked closely with people and their needs, this included focussing on resolving problems with finance, so people had enough to live on when they were discharged on MHA aftercare (Section 117) This involved having discussion with the DSS.

When people are in prison it is important to ensure that there is a good understanding of needs. When autistic people had health related needs, we found that the learning disability liaison nurses were helpful. They had an extended role of assessing and training in some prisons e.g. Walton

Identifying people who have a learning disability and autistic people is critical, so people get the right help. One man told us the life was awful in prison, and he was transferred to a hospital where long-standing needs started to be met for the first time after he received a diagnosis.

Greater Manchester have just commissioned Pathways, to do work relating to youth offending, supporting the strategy to ensure that people from Black and Minority Ethnic communities get the right support. The best practice aspect here was in having a loose specification that allowed us to tailor our response according to the things that we discovered when we just listened to people’s stories.

Other innovative and essential work has included use of “Pro Real” technology, using avatars to help people express themselves. Another area of work is helping people my introducing mindfulness skills to help people self-manage in the community and throughout their lives.

Related resources

  • This paper describes Mindfulness for parents of people who have learning disabilities and its impact.
  • This report is an evaluation of Introduction to Mindfulness Workshops for people with learning disabilities in Manchester. Part of the report describes how Mindfulness was used to disengage people who had a learning disability from thoughts of sexually offending, and others who had feelings of aggression.

One man says that his mental health declined as he was in a cold damp flat with no money and that he was depressed and lonely. He went on to committed fairly serious crimes. He was convicted and spent time in prison, struggled to get the help he needed. Eventually he was transferred to a hospital. During his 39 years of experience of receiving a variety of services including medium, low and enhanced secure services he experienced varying degrees of care and treatment and all forms of restraint.

He says that in police custody he was interviewed with no appropriate adult present. He didn’t understand the way things were explained and that words were put into his mouth, trying to persuade him into admitting something. He says that he was not allowed to see his family, not fed during custody, and bullied into saying things.

His court trial was very confusing and drawn out.

In Prison it took too long to be assessed (Learning Disability and Mental Health, being in prison when mentally ill made him feel full of anxiety and stress and he was suicidal. Being locked in prison cell for 23 hours consecutively in prison conditions and locked in with two other prisoners was difficult for him. The length of time it took to go to court to be sentenced was long and he did not get to see his solicitor or barrister enough. However, he got the help he needed by himself, by writing to a doctor in Calderstones, who intervened. They should have known about his history with mental health and learning disability, then it would not have taken that long to get the necessary help”

Improving experiences in prison

Interview with Debbie Poles. Debbie is a key link into the prisons which house offenders from Greater Manchester and will have links to other prisons. She is the reducing reoffending lead for Greater Manchester Merseyside and Cheshire.

Recognising that people have learning disabilities or autism in prison can be challenging. Often, we rely on hereditary documents, court reports that may or may not have relevant information in them and self-disclosure. Sometimes someone may have a need that hasn’t been identified in the past but that comes to light during a prison sentence.

In prisons we may not always have the right interventions that are needed to help autistic people or those who have a learning disability. Prisons can be noisy, unpredictable places. It is also hard for prison staff who don’t always know a person really well, especially if someone has a particular trigger for behaviour.

Prisons are places where demand for resources can fluctuate day to day so having consistency can be challenging. Sometimes people can be locked up for up to 23 hours of their day if they are in care and separation units, and there is no individual management plan in place if they have learning difficulties or disabilities. The physical environment is not always conducive to supporting prisoner with learning disabilities and staff do not always have the required knowledge or training to support their needs.  

Prison staff don’t always have a working level knowledge of what to do when someone who has learning difficulties is distressed, and we are not always clear about what is commissioned in respect of specialist health staff input or know who should intervene. Greater clarity about roles in these circumstances would be helpful.

Sometimes custodial sentences are not the right thing and that people need alternative approaches to prison.

We do have a keyworker, named officer system which is helpful. Staff have dedicated time to engage with individuals. This allows prisoners and staff to build up a professional relationship. The more we talk to prisoner the more we can learn about their needs and behaviours.

There are dedicated equalities teams within prisons that arrange forums for groups of prisoners with protective characteristics which are useful and help men to discuss and raise issues and concerns.

In some prisons there are specific health services for people with specific diagnosis, for example in HMP Hindley there is a service for people who may have a diagnosis of personality disorder. It has been noted that in some cases mental health support in prisons can be more comprehensive and consistent than for those in the community and some prisoners have identified that they may indeed receive a poorer service on discharge.

Staff offering education services within prisons have a better grasp of people who may have a learning disability or autistic people and what their learning needs might be. The majority of prisoners are screened on arrival by the education provider who identifies and records any learning disabilities and provides specialist support in response to the need.

Looking forward it would be helpful to have mandatory training for all prison officers in behaviour such as identifying triggers and understanding helpful interventions to minimise distress an improve outcomes for people. Commissioning of healthcare in prison could be reviewed with a better focus consistent screening for autism or learning disability/difficulties taking place so that the right help can be offered.

Related resources

  • Pro Real Technology provide a virtual reality communication tool using gaming technology.
  • This practitioner guidance covers working with people with a known or suspected learning disability, autism or both. It includes useful information about working with this group of people, along with case studies, recommended actions and signposting to other resources and services.
  • Joint inspection of the treatment of offenders with learning disabilities within the criminal justice system - phase 1 from arrest to sentence
  • Service specification Primary care service – medical and nursing for prisons in England (learning disability and autism objective)
  • This presentation covers prevalence of ASD in prisons, it has holds useful data

Potential impact of gender on the responses offered

A woman was diagnosed with a Borderline Personality Disorder, but when she eventually got an Autistic Spectrum Disorder diagnosis, things fell into place for her. There still seem to be quite a few professionals in the general criminal justice system who believe in the male autism is four times higher myth”

Women in prison (Taken from Out of the Shadows)

Areas of consideration

  • Gender – are generic approaches or different approaches offered?

Women in the justice system are a minority group, and the Transforming Lives programme has clear recommendations to reduce the number of women sent to prison. Often lack of identification of learning disability and/or autism compounds the problems of women, who also may have additional roles such as having a primary caring responsibility for children or older family members.

Autistic women may struggle to get an accurate diagnosis, and this is shown in a range of studies looking at the ratio of male to female prevalence, more recent studies indicate that the male-to-female ratio was nearer 3:1.

In addition to the problems identifying needs, women generally are more likely to have caregiving roles, in the main because they are caring for children. This can compound the impact of interfaces with the criminal justice system, particularly when a woman is issued a custodial sentence by the court. Maintaining positive contact with children can be challenging- particularly if that relies on support from partners or other family members.

For women who have a learning disability/difficulty, understanding the details of rules within our wider system can lead to specific problems, and in this case lead to a custodial sentence, as Caroline’s story indicates.

Potential in utilising women’s centres

During the course of this research, it has been reported by several interviewees that women’s centres are a valued resource to support women who have a learning difficulty and autistic women. The commitment made by Manchester to ensure all services are Autism friendly is critical in ensuring that mainstream offers to specific groups are adjusted to meet the needs of all citizens. The Greater Manchester Autism Consortium offers support to professionals to provide advice and support via its website.

In Greater Manchester, the ‘whole system approach to women offenders’ has been successful through the network of nine women’s centres across Greater Manchester supporting vulnerable and marginalised women to reduce the risk of reoffending and drive-up health outcomes. In 2020, a funding initiative was put in place to support Greater Manchester Women’s Alliance to address live issues such a domestic and sexual violence and improving the links between health and justice. Women who attend and receive support from women’s centres are less likely to reoffend than those who do not

  • Between 76-83 per cent of women who have been assessed by a GM Women’s Centre have mental health issues
  • 55 per cent of women who have accessed GM Women’s Alliance Partnership services have a child under 18
  • 25 per cent of women who have accessed GM Women’s Alliance Partnership services have a physical health issue

By utilising this resource in practice and ensuring that autistic women and women who have a learning disability can access women’s centres, - outcomes are likely to be improved.

Related resources

[1] What is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis

[2] Ministry of Justice (2015) Justice Data Lab Re-Offending Analysis: Women’s Centres throughout England. London: Ministry of Justice

Ministry of Justice (2017) Justice Data Lab Analysis: Re-Offending behaviour after participation in the Brighton Women’s Centre Inspire programme. London: Ministry of Justice

[3] Extending the health offer for vulnerable women who are accessing support via the Greater Manchester Women’s Alliance (2019)

Children and young people offending and the potential impact of being a looked after child Reflections

Areas of consideration

  • Differences with young people who are looked after children with learning disability, or autistic children. What support do they need?

This issue was raised by the Criminal Justice heath and justice steering group. There was also a request to look at the impact that may happen when a child has been in care and if there are any consequences for children getting drawn into offending behaviour. They wanted to understand if there were differences with young people who are looked after children with learning disability and/or autistic children, and how we should be offering the right support.

In the general population it has been found that looked after children are more likely to be convicted of a crime than other children.

Research from the Prison Reform Trust and National Children’s Bureau (NCB) indicates that looked after children are far more likely to be convicted of a crime and end up in custody than other children. According to the Department for Education fewer than 1 per cent of all children in England were looked after on 31st March 2011. (Children looked after by local authorities in England year ending 31 March 2011, Department for Education 2011.) The 2010-11 annual survey of 15–18-year-olds in prison found that more than a quarter of boys (27 per cent), and over half of girls (55 per cent), had been in care at some point before being sentenced to custody.

It is important to note that this is general data and does not indicate whether it includes children who have a disability or a diagnosis of autism. In much of the data about looked after children there is little breakdown that provides helpful information in this area. The most likely reason for this gap in data is that screening and recording does not always happen consistently across systems.

It may be helpful to look at the issue from recent work related to the Transforming care programme. Beyond the High Fence was piece of work commissioned by NHS England and focused on the experiences of people in secure hospitals and forensic services.

The main things identified for people with a learning disability and autistic people were:

  • Problems starting as a child/teenager
  • It was quite common to have been in care
  • To have mixed with the ‘wrong’ people
  • To have been in and out of trouble with police
  • There was a lack of assessment or diagnosis at school, in the community and in prison.
  • A lack of understanding from teachers, staff, police and others
  • We needed more support, not punishment

John’s story: Good support keeps me out, I want to have a life, not just a service in the community “From two years old I’ve been in care. I’ve been abused but this has been looked into and dealt with.

At 12 years old I got into trouble with the police for making prank calls to them. From 12 to 16 years, I was in a children’s home. At 16 years I was charged with arson. I lit some fires. I was easily led by friends who encouraged me to do it.

I went to The Crown Court. I didn’t know what was going on. Then I went to the Appeal Court with three judges. My case was quashed. I went to a prison where there was no therapy available. I was very unwell.

Prison is violent, as sometimes there would be four or five people restraining me on the ground. I don’t think restraint needs to be used as you can talk to people to calm them down or just have a person holding them on each side on a sofa.

At 25 I was in a high secure mental health hospital. I wasn’t diagnosed with mild learning disability and psychosis until then. I did some therapy there which was helpful.

The first time I was discharged into the community from hospital there was no support and no proper housing. I was given very little money. I was sleeping on the floor!

When I got arrested again, I was put on a section 37/41. I didn’t know what it was. The barrister and social worker didn’t tell me what it was but a learning disability hospital in the north explained it to me. At the hospital I had cognitive behavioural therapy for three years and it was helpful.

I’m on license from probation now. I don’t want to drink. If they had given me the forensic support years ago, I wouldn’t be here now. The fires were a cry for help.

Now I’m with a provider and I get good support. I get 24-hour support, but I get two hours a day on my own if I want. I go to work and in my spare time I like fishing and cycling. I have had two holidays. I took my second move back into the community slowly. I had housing, the care was person centered and now I get a bit of freedom.

It’s important I have a life and not just a service. The support I get is emotional support. Somebody needs to be there just in case so I can’t be left on my own. I need support or I will lose everything I have worked for.”

Within the report there are some good examples of what worked well for people Jon’s story identifies the things that helped him (Taken from Beyond the High Fence)

From Jon’s story it is clear that his life improved when he got the right help, and that sustaining support is critical, he also valued the therapy he received and having a stable home.

Young people, drugs and alcohol

One of the compounding issues that may affect children and young people who have a learning disability is the use and abuse of drugs and alcohol that may also lead to contact with the criminal justice system.

Children with learning disabilities are more likely to experiment at an early age with potentially harmful levels of alcohol[2]. People with learning disabilities have an increased risk of substance misuse if they have borderline/mild learning disabilities, are young and male, or have mental health problems.[3]

Good practice

The case study of Steve describes how a young man with a diagnosis of autistic spectrum disorder (ASD) was supported by his local substance misuse service using a range of successful personalised and adjusted interventions by the substance misuse support worker.

Steve’s story was taken from a Public Health England report that focussed on how mainstream drug and alcohol services could make reasonable adjustments to help improve access. [4]

There may be wider learning in considering appropriate reasonable adjustments for people with learning disabilities.

Steve referred himself to the service when he felt his drug use had become a problem. He was using cannabis, MDMA, new psychoactive substances, ketamine and LSD. The service arranged an assessment at the family home, and, at this, Steve discussed the wider issues he experienced in relation to his ASD.

These included finding it a struggle to say ‘no’ to substances and difficulties in relating to family and friends and understanding the consequences of his behaviours. He also talked about his hobbies, particularly his love of music.

The initial care plan focused on harm reduction, supporting Steve to reduce the use of substances and offering access to the 24-hour support/crisis line that is staffed by substance misuse practitioners.

Together Steve and Julian (substance misuse service support worker) developed a care plan tailored to Steve’s needs: providing psychosocial interventions including drug education; harm reduction to address poly-drug use and routes and patterns of use; exploring the risks of both physical and psychological health. The substance misuse service support worker focused on:

  • harm reduction, supporting Steve to reduce the use of substances and offering access to the 24-hour support/crisis line staffed by substance misuse practitioners
  • working with Steve to develop a care plan tailored to his needs
  • providing psychosocial interventions including drug education
  • harm reduction to address poly-drug use and routes and patterns of use
  • exploring the risks of both physical and psychological health Sessions were provided weekly with additional support by phone. Steve struggled initially with reducing his drug use. Julian encouraged Steve to focus on his interest in music and his relationships with family and friends, in order to increase his self-confidence and resilience.

Steve was supported to explore career development and prospects within the music industry. This included the service arranging a meeting with a sound engineer and other visits, to a local radio station, for example. This gave Steve a positive distraction from using substances and he was able to start to focus on making positive choices and explore the negative effects of substance misuse. As he reduced his use of substances, he became more determined to be drug free.

Music became a coping mechanism to help reduce his cravings. Steve reduced his use of MDMA, ketamine and research chemicals. His cannabis use has significantly reduced, and he has improved his relationship with his parents and peer group and developed more confidence.

What worked for Steve was:

  • tailoring care plans and approaches to meet his individual needs and wider vulnerabilities
  • incorporating harm reduction, wider psychosocial interventions and advice into his care plan
  • supporting him to find positive activities to focus on – this helped develop Steve’s resilience and self-worth.

Working with young adults

Interview with Helen Latham, Interchange Manager. Justice Devolution Lead and Young Adult Strategic lead.  Focusing on activities post sentencing including the statutory supervision of people who have a wide range of needs- especially young adult men.

Young adults constitute less than 10 per cent of the general population but make up one third of those involved in the criminal justice system (CJS). Gathering effective information about needs is an important part of getting a full picture of a person, but even so currently flagging on caseloads is low in relation to learning disability or autistic people.

Very often young people might not even know if they have had a diagnosis in the past or remember it. As a lot of information is reliant on service user disclosure this can be problematic for young people and for staff trying to record reliable and useful information.

Recording information across the criminal justice system is variable and there is no clarity about how staff are mandated to record what information. Whose role is it to record needs? and What should be collected? remain big questions. Some questions on assessments may be optional that really should be asked such as “have you ever had a traumatic brain injury?”

It has been observed that where health needs or behavioural needs are significant recording is very good, and the flow of information by the through the gate team and healthcare takes place effectively in these circumstances.

One of the biggest issues that we have is across our system is that many of the good practice examples may be down to personality specifically and working in a small part of the process. Very often different services will have different language that they use which can make understanding across us wider system difficult. We cannot always easily establish the impact of the good practice that happens over time because people move geographically, or they use different services.

As a system we lack a clear, consistent approach and interagency work needs to be promoted.

Best practice

1. Guidance has been written to help staff working in Cheshire and Greater Manchester Community Rehabilitation Company (CGMCRC) about how to work with young adults using a full team approach. It aims to give practice staff a framework and tools to deliver a more effective approach to young adults. It includes a section that reminds staff to effectively record neurodiversity, traumatic brain injury, learning difficulties/disability, autism and dyslexia.

2.The CRC are using a really good communication screening tool developed by Calderstones that is used for all young people. This tool assists how to develop more effective approaches to working with offenders who have communication needs. The objective of the tool is to support staff to reflect on offender’s communication needs in order to:

  • Inform risk assessment
  • Make simple adjustments to their communication in order to support offenders to engage with the Criminal Justice system intervention
  • To fulfil duties under the Equalities Act
  • Promote inter-agency work

The communication tool has helped, in a sample of 109 screens, just under 60 showed communication needs, of these 13 percent of people had ADHD and 13 percent had Dyslexia. This is important to know because it helps staff understand how best to communicate and/or get the right help for young people.

However, whilst such a tool has been helpful in practice, the young adults strategic lead highlights still do not have a wider mechanism for quantifying the abundantly apparent range and prevalence of neurodiversity needs for the young adult cohort. Therefore, we welcome MOJ 2020 white paper ‘A smarter approach to sentencing’. The paper sets out the government’s proposals for important changes to the sentencing and release framework in England and Wales including a greater focus on neurodiversity and the development of a toolkit for probation practitioners.

3.        The work undertaken between the Youth Offending Team and adult offender management teams help with the transition between services. People are identified in advance and meetings take place to hand over cases properly. This helps to reinforce the “young adult approach” outlined in the guidance accounting for the “stage” of maturity a person is at rather than simply looking at their “age”.

This focus on developing work and skills is helpful, with small groups offering peer led support. Young adults find this approach helpful, and it also helps offender with compliance with rehabilitation plans. The skill set of the current Community Rehabilitation Company probation staff dedicated to exclusively working with young adults has allowed for in-house group work and peer sessions to develop organically, taking into account responsivity, learning styles, kinesthetic approaches and those which acknowledge maturity and brain development.

Ongoing work includes developing practice development days for staff, and one is being planned that focuses on learning disability and autism. This will be about raising awareness, using the evidence base available and sharing the information.

Interview with Leah Warwick, National Development Manager, Circles UK.

Circles of support and accountability

Sex offending is a growing problem. As of March 31, 2018, there were 58,637 registered sex offenders being monitored by police across England and Wales. This was a 6 per cent rise compared to 55,236 offenders being managed in March 2017. The number of registered sex offenders has risen by 87 per cent over the past 10 years, from 31,392 in 2006/07 (MAPPA statistics). There has been a significant rise in offences related to online activity enabled potentially to the “Triple A” of accessibility, affordability, and anonymity. In 2019 a 700 per cent increase of Child Sexual Exploitation Material reported to the national crime agency in the previous five years.

Most studies show that sexual offences are more common than other types of offending behaviour among people with an ID/ASC. At HMP Whatton, the largest prison in Europe to exclusively house men who have committed sexual offences, it is estimated that 25 per cent of the population have an IQ below 80 (Hocken, 2013). Recidivism rates also tend to be higher (Craig and Hutchinson, 2005)

The volumes of imagery and child sex exploitation material on the internet is immense and almost too big to investigate for police services, arresting and criminalising all individuals involved with this is too big a task, detection and closing down channels can be challenging, and working with people accessing it nearly impossible.

Funding for Circles, also known as Circles of Support and Accountability, is not centralised. It comes from various sources and is distributed unevenly across the country. A Circle cannot be run unless sufficient funds exist for it to continue for at least 12 months. The constant need to source new funding also impacts upon the long-term planning of development and delivery of the service overall. Having properly funded Circles as part of a longer-term strategic plan would be helpful in increasing the number and availability of Circles.

Best practice

Adapted circles for autistic spectrum conditions and intellectual disability

Circles were originally developed for adult neurotypical men convicted for high- risk of harm sexual offences. The model has since been adapted for other sub-groups of sexual harm causers, including people with Intellectual Disabilities or Autistic Spectrum Conditions. The approach is based on the Good Lives Model. Each Circle is supported by a professionally employed coordinator. They recruit, train, organise, and closely supervise volunteers to regularly meet with someone who has committed a sexual offence. This person becomes known as the ‘Core Member’ of the Circle

The Circle supports protective functions, promotes wellbeing and hold the Core Member accountable for their actions. Circles feed into the statutory agencies such as, MAPPA, probation police, health services and accommodation/housing.

Circles help people develop their own appropriate networks rather than relying on prisoner/other offender related networks and can effectively support rehabilitation.

Circles also provide a benefit for volunteers. Their contribution is highly valued, and they are well trained and closely supervised. Many also gather skills that they can use in their own future employment.

Some looked after children who are at risk of or who have sexually offended benefit from Young Peoples Circles. This is a trauma informed approach. Young people are often referred by Children’s Services or other specialist support services such as Glebe house in Cambridgeshire. Glebe House supports young men in care who have exhibited harmful sexual behaviour up to the age of 18 years old. Being a member of a Circle is part of their pathway when they leave Glebe house.

Best practice in America: utilising Juvenile Mental Health Courts[5]

In America specialist courts exist to hear cases of children and young people who have mental health needs. Whilst this is not specifically looking at children who have a learning disability or autistic children, it is an interesting model that offers a specialised approach and has yet to be evaluated however it has already been shown to have contributed to an overall reduction in the number of children sentenced to custody in the county.

The juvenile court clinic in Cook County, Illinois, is a good example of how the clinics have improved the quality of decision making. It focuses on several areas:

  • Co-ordination. Clinical co-ordinators are assigned to each youth courtroom to assist sentencers, lawyers and probation officers to request and obtain useful clinical information. Their role is to address common problems found in youth courts including ‘vague’ referral questions that in turn produce generic clinical responses, inappropriate requests for clinical evaluations, untimely receipt of requested information, and insufficient communication between mental health services and the court’. The coordinators act as the main contact between the court and mental health agencies, documenting requests for information and ensuring a timely response.
  • Forensic evaluations. The clinics are also responsible for conducting forensic clinical assessments. After a family has been ordered to undergo a clinical evaluation, the clinical coordinator facilitates the process, which includes evaluating the information request, documenting the request, and arranging an intake interview. The assessment is conducted by a psychologist or psychiatrist who is a member of the clinic’s staff and is delivered to court before the family’s next court date.
  • Linking with community based mental health services. The clinic does not provide clinical intervention services. Instead, it responds to requests for service provision by providing information on community-based services and linking children and their families to these services. To facilitate this process, the clinic regularly gathers information on community clinical mental health intervention resources on an interactive database. This enhances the likelihood of the court referring children to recommended community-based services.
  • Advice, guidance and training. The clinic plays a vital role in advising the court about the need for clinical assessment and evaluation. It also provides education and training for all court staff to help them to better understand and analyse the clinical information they receive.

Court clinics that have been developed in America provide an example of how community-based mental health treatment could be improved for children appearing in court in England and Wales. What both models explored in this chapter have in common is a problem-solving approach utilising the court’s authority to encourage and monitor juveniles. There is undoubtedly scope for extending such an approach to the youth court whether or not specific courts are established.

Related resources

[1] Blades. R. Hart. D. Lea. J. Wilmott. N (2015) The Prison Reform Trust. Care: - A Stepping Stone to Custody? (Online)

[2] Simpson M. (2012) Alcohol and intellectual disability: Personal problem or cultural exclusion. Journal of Intellectual Disabilities; 16(3): 183–192

[3] Emerson E, Robertson J, Baines S and Hatton C. (2016) Predictors of self-reported alcohol use and attitudes toward alcohol among 11-year-old children with and without intellectual disability. Journal of Intellectual Disability Research; 60(12): 1212-1226

[4] Marriot. A. (2017) Public Heath England. Substance misuse and people with learning disabilities: making reasonable adjustments to services. (Online)

[5] Out of Trouble- lessons from abroad (2009)

Out of Trouble- An independent review (2012) per cent20of per cent20Trouble per cent20reviewfinal.pdf

Appendix 1: Research

  • Evaluation of the Offender Liaison and Diversion trial schemes. [RAND Europe. Disley, e., 2016
  • Experiences of people with learning disabilities in the criminal justice system, Author(s): Hyun, Elly; Hahn, Lyndsey; McConnell, David Source: British Journal of Learning Disabilities; Dec 2014; vol. 42 (no. 4); p. 308-314 Publication Date: Dec 2014
  • The evolution of a therapeutic community for offenders with a learning disability and personality disorder: Part two —Increasing responsivity Author(s): Taylor, Jon Source: Therapeutic Communities; 2013; vol. 34 (no.
  • No One Knows: The bewildering passage of offenders with learning disability and learning difficulty through the criminal justice system Author(s): Jones, Glyn; Talbot, Jenny Source: Criminal Behaviour and Mental Health; 2010; vol. 20 (no. 1); p. 1-7 Publication Date: 2010
  • The first critical steps through the criminal justice system for persons with intellectual disabilities Author(s): Mercier, Céline; Crocker, Anne G. Source: British Journal of Learning Disabilities; Jun 2011; vol. 39 (no. 2); p. 130-138 Publication Date: Jun 2011
  • Diversion from custody: An update Author(s): Birmingham L.; Awonogun O.; Ryland H. Source: BJPsych Advances; Nov 2017; vol. 23 (no. 6); p. 375-384 Publication Date: Nov 2017
  • Developing criminal justice liaison and diversion services: research priorities and international learning. Author(s): Srivastava, Samir; Forrester, Andrew; Davies, Steffan; Nadkarni, Rajesh Source: Criminal behaviour and mental health: CBMH; Dec 2013; vol. 23 (no. 5); p. 315-320 Publication Date: Dec 2013
  • Learning disabilities: supporting people in the criminal justice system. Author(s): Marshall-Tate, Karina; Chaplin, Eddie Source: Nursing Times; Jul 2019; vol. 115 (no. 7); p. 22-26 Publication Date: Jul 2019 Publication Type(s): Periodical
  • Are Liaison and Diversion interventions in policing delivering the planned impact: A longitudinal evaluation in two constabularies? Author(s): Kane, Eddie; Evans, Emily; Mitsch, Jurgen; Jilani, Tahseen Source: Criminal behaviour and mental health: CBMH; Oct 2020; vol. 30 (no. 5); p. 256-267 Publication Date: Oct 2020 Publication Type(s): Evaluation Study Journal Article
  • Effectiveness of criminal justice liaison and diversion services for offenders with mental disorders: a review. Author(s): Scott, David A; McGilloway, Sinead; Dempster, Martin; Browne, Fred; Donnelly, Michael Source: Psychiatric Services; Sep 2013; vol. 64 (no. 9); p. 843-849 Publication Date: Sep 2013
  • Alternatives to custodial remand for women in the criminal justice system: A multi-sector approach Author(s): Forrester, Andrew; Hopkin, Gareth; B, Linda; Slade, Karen; Samele, Chiara Source: Criminal Behaviour and Mental Health; Jun 2020; vol. 30 (no. 2-3); p. 68-78 Publication Date: Jun 2020
  • Diversion in youth justice: A pilot study of effects on self-reported mental health problems Author(s): Whittington, Richard; Haines, Alina; McGuire, James Source: Journal of Forensic Psychiatry & Psychology; Mar 2015; vol. 26 (no. 2); p. 260-274 Publication Date: Mar 2015
  • Implementing a court diversion and liaison scheme in a remand prison by systematic screening of new receptions: A 6 year participatory action research study of 20,084 consecutive male remands Author(s): McInerney, Clare; Davoren, Mary; Flynn, Grainne; Mullins, Diane; Fitzpatrick, Mary; Caddow, Martin; Caddow, Fintan; Quigley, Sean; Black, Fergal; Kennedy, Harry G.; O'Neill, Conor Source: International Journal of Mental Health Systems; Jun 2013; vol. 7 Publication Date: Jun 2013 Publication Type(s): Journal Peer Reviewed Journal Article
  • Information pathways into prison mental health care Author(s): Samele, Chiara; Urquía, Norman; Slade, Karen; Forrester, Andrew Source: Journal of Forensic Psychiatry & Psychology; Jul 2017; vol. 28 (no. 4); p. 548-561 Publication Date: Jul 2017 Publication Type(s): Journal Peer Reviewed Journal Article
  • Court diversion for those with psychosis and its impact on re-offending rates: Results from a longitudinal data-linkage study Author(s): Albalawi, Olayoung adults; Chowdhury, Nabila Zohora; Wand, Handan; Allnutt, Stephen; Greenberg, David; Adily, Armita; Kariminia, Azar; Schofield, Peter; Sara, Grant; Hanson, Sarah; O'Driscoll, Colman; Butler, Tony Source: BJPsych Open; Jan 2019; vol. 5 Publication Date: Jan 2019 Publication Type(s): Journal Peer Reviewed Journal Article
  • A nursing alternative to prison. Author(s): Dean, Erin Source: Nursing standard (Royal College of Nursing (Great Britain): 1987); 2013; vol. 28 (no. 6); p. 20-22 Publication Date: 2013 Publication Type(s): Journal Article
  • Nurse support in police stations could help reduce reoffending. Author(s): Norman, Ann Source: Nursing standard (Royall College of Nursing (Great Britain): 1987); Feb 2014; vol. 28 (no. 23); p. 12 Publication Date: Feb 2014 Publication Type(s): News PubMedID: 24494877
  • Screening for learning disabilities in the criminal justice system: a review of existing measures for use within liaison and diversion services. Author(s): Silva; Gough, Karen; Weeks, Hannah Source: Journal of Intellectual Disabilities & Offending Behaviour; Jan 2015; vol. 6 (no. 1); p. 33-43 Publication Date: Jan 2015 Publication Type(s): Academic Journal
  • Liaison and diversion services: embedding the role of learning disability nurses Author(s): Shaw, Vanessa Louise Source: Journal of Intellectual Disabilities and Offending Behaviour; 2016; vol. 7 (no. 2); p. 56-65 Publication Date: 2016 Publication Type(s): Journal Article

Appendix 2 Key reports

Additional resources

  • Positive practice positive outcomes: a handbook for professionals in the criminal justice system working with offenders with learning disabilities. Department of Health, 2011 An introduction for criminal justice staff to working with offenders with learning disabilities. It covers essential information to help staff identify and understand this group of people. It also covers relevant legislation that outlines the duties and obligations of criminal justice staff, and also health and social care staff, with regards to offenders with learning disabilities.
  • People with learning disabilities in the criminal justice system: a guide for carers and learning disability servicesARC England, 2016 A guide for those who support someone with a learning disability who is in trouble with the law. The guide is aimed at service providers, family carers, and advocacy services
  • UN Convention on the Rights of persons with disabilities. Covers human rights of people who have a disability
  • Guidance relating to the NHS England Transforming Care programme, including guidance on building the right support and various service specifications
  • Building the right support (2015) A national plan to develop community services and close inpatient facilities for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition.
  • The Advocates Gateway has produced a wide range of guidance, questionnaires, and communication tools. These include a series of toolkits that provide practical guidance on all aspects of supporting someone with communication needs or vulnerability as a witness or defendant. There are several toolkits related to people with a ‘learning disability’ or people with ‘autism spectrum disorders’ as well as topics like making reasonable adjustments and using a remote link.  

Liaison and diversion services

NHS England website with links to overview, service specification, latest developments in Liaison and Diversion services, case studies, and resources.

NHS England, 2014 Liaison and Diversion Operating Model 2013/14

List of screening tools:

  • The Learning Disability Screening Questionnaire (LDSQ)
  • The Hayes Ability Screening Index tool (for screening for learning disabilities)
  • The Hayes Ability Screening Index non-verbal (for screening foreign nationals for learning disabilities)
  • The ‘AQ10’ by the Autism Research Centre (available for free - screening for autism: both adult and adolescent versions) note: this has not been validated with a forensic/prison population.
  • Additional tools to assess background information for autism include the Empathy Quotient, the Friendship Quotient and the Relationship Quotient.
  • The ‘Do-It Profiler’ (screens for learning disabilities and learning difficulties and other needs).
  • OASys

United Nations Criminal Justice Assessment Toolkit

The Criminal Justice Assessment Toolkit is a standardized and cross-referenced set of tools designed to enable United Nations agencies, government officials engaged in criminal justice reform, as well as other organisations and individuals to conduct comprehensive assessments of criminal justice systems.

Further resources related to police interviews of autistic people

Police experiences

Adapting interview techniques

Research related to sex offending


This report funded by the Local Government Association was fully supported by the Greater Manchester Combined Authorities (GMCA) Health and Justice steering group (Learning Disability and Autism) and the relevant stakeholders in the area. Thanks go to them for their support, particularly Mari Saeki and Bethan Deardan for their helpful introductions.

The stories told, were often moving, and hold a wealth of useful learning. Thanks to those who told their stories so candidly and to Tracey Hammond of KeyRing who kindly collated many of the experiences in this report.

Thanks go to all those busy people interviewed who gave of their time freely and gave helpful opinions and views about what needs to change and also for making good things happen in their sphere. Thanks to those researchers from Universities who had existing knowledge and had already worked to find relevant evidence and had shared it with those working in services to make good decisions that make real change happen.

During this research it is evident that there are people who battle to do what is right, sometimes feeling as though the odds are stacked against them but continuing to make a difference. This is not an easy area of work, and the values shared and modelled by individuals were real beacons of light during a dark lockdown."

Helen Toker-Lester