ADHD and prisoners in England & Wales

Attention deficit hyperactivity disorder or ADHD, as it is commonly known, is a condition that affects people’s behaviour, makes them restless, inattentive and impulsive.

A study in 2019 found that around 25% of England & Wales prisoners have ADHD. This number may very well have increased by now. Around 96% of prisoners with ADHD also suffer from substance misuse, conduct and personality disorders.

Evidence shows that ADHD is linked to criminal offending in a number of ways, such as:

• an increase in offending from a young age;
• an increased likelihood of re-offending;
• an increased link to aggressive incidents compared to prisoners without ADHD, of up to 8 times;
• an increased risk of having multiple psychiatric disorders compared to prisoners without ADHD;
• a significant association with self-harm and suicide, particularly in women, compared to people without ADHD.

Prisons Strategy White Paper

The Ministry of Justice (MOJ) published the Prisons Strategy White Paper in December 2021 which set out ways to support prisoners to ensure their reintegration to society when released.

Following this, an expert policy roundtable took place and discussed the ways in which our criminal justice system can improve ADHD diagnosis and care. The main areas identified to require change were the following:

Screening for ADHD

Currently there is no agreed screening tool used as standard across the system and when screening does take place, it is inadequate and of poor quality.

Screening should be taking place on entry into prisons in order to recognise who should be referred for a full diagnostic assessment for ADHD. Individuals can also be screened across other areas, including courts and Probation.

Training on ADHD

Untrained prison staff and healthcare professionals on ADHD can miss out on signs in a prisoner’s behaviour that are indicative of ADHD. This could lead to a missed diagnosis and, subsequently, non-treatment.

Therefore, training of staff within the criminal justice system is essential to ensure that prisoners with ADHD are properly supported and have access to treatment.

Appropriate ADHD care pathway

Currently, there is no consistent approach to diagnosing and providing care for ADHD in England & Wales prisons. There is also insufficient data collection to understand the scale of the challenges that prisoners with ADHD face.

To rectify this, an ADHD pathway could be integrated into existing mental health services that are currently available in prisons. This could help increase referrals for ADHD diagnoses and access to treatment more efficiently. Consistent data collection would also help in understanding the challenges faced by prisoners with ADHD so that further services could be offered to them.

Continuity of care

Treatment of neurodivergent prisoners is equally important when they get released back into the community. This, in fact, would reduce reoffending.

Some areas, unfortunately, do not offer specialist ADHD services and, those areas that do, currently have long waiting lists. Often, when released from prison, individuals will be provided with only one week’s supply of medication. If they stop taking their medication, they have to be re-referred to specialist services with long waiting lists.

If the prison ensure that the released individual’s ADHD diagnosis and care plan are transferred to their GP on release, this would allow for a smooth transition and continued care provided to that individual. It would also save the GP or specialist services’ time in undertaking a second assessment to diagnose ADHD and the risk of the individual reoffending due to the lack of treatment would decrease.

MOJ Action Plan

The MOJ provided an action plan in June 2022, not specific to ADHD, but about neurodiversity in the criminal justice system in general. This included trialling neurodiversity specialists as part of the Community Sentence Treatment Requirements, which include treatment for mental health, drugs and/or alcohol.

With regards to individuals released from prison, the MOJ started to develop a resettlement passport which will adopt a personalised approach involving taking into account prisoners’ neurodiversity including ADHD. This passport will indicate what help a prisoner will need when released.

The following have been implemented:

• All prisoners have a health check in their first week;
• Some prisons have special wings for neurodivergent prisoners;
• Any new prisons built will be adapted in a way that is best for neurodivergent prisoners;
• Four prisons trialled Neurodiversity Support Managers (NSMs) which will be rolled out to other prisons.

September 2023

The MOJ published an update to their action plan in September 2023. They confirmed what had been achieved since their action plan was submitted. In relation to prisoners, they confirmed that more than 100 NSMs were recruited across prisons in England & Wales which had the following positive impact:

• Introducing ‘Neurodiversity Reps’ in some prisons which are paid roles offered to neurodivergent prisoners to raise awareness of the support available;
• NSMs collaborating with prison and mental health provider to create a space in the prisons that focused on the sensory and mental health requirements for prisoners with complex needs;
• Producing Easy-Read versions of key prison documents, including a Prison Induction Handbook for prisoners with low literacy; and
• Integrating neurodiversity training into the staff induction process to ensure new staff is knowledgeable

Update May 2024

The MOJ published their latest update to their action plan in May 2024. They have confirmed achieving the following:

• 180,000 screenings have been conducted since April 2021;
• NSMs are now in place in all 105 public prisons in England & Wales. NSMs ensure that neurodiverse prisoners are identified and have access to the right education and training opportunities which help reduce reoffending;
• NSMs prepare prisoners for interviews and ensure that employers are aware of their neurodiversity which gives prisoners better job prospects on release.

The MOJ will hopefully continue improving on the support provided to neurodivergent prisoners including those with ADHD. Diagnosis and appropriate care could massively help in reducing criminality.