People with Autism Spectrum Disorder in Criminal Justice and Mental Health Systems: Improving Recognition and Developing Preliminary Guidelines

Background: People with autism spectrum disorder (ASD) are vulnerable to social and mental health difficulties that can result in contact with the criminal justice system (CJS) as victims of crime, offenders, or because of misunderstandings in communication and behaviour. Although ASD is common, the number of people with ASD who offend is unknown.  However, it is thought likely that ASD is over-represented and under-recognised in the CJS. Moreover, despite increasing ASD awareness, in the UK there is no tailored ASD training for criminal justice mental health service (CJMHS) staff at a local (or national) level. Hence interactions between the CJS and people with ASD may be unnecessarily distressing, unsuccessful and costly.

Objectives: To improve recognition of ASD in South London amongst mental health and CJS teams and, with the ASD community, to draft the first guidelines for support of people with ASD within the CJS. Further, to produce a free-access film regarding ASD and the CJS for widespread dissemination.

Methods: To facilitate joint working, professionals working with people with ASD and in the CJS (including barristers, police, probation, prison and youth offending) were invited to an ASD CJS workshop. The workshop included invited speakers and small group sessions to gather expert opinions for inclusion in the guidelines. Additionally, views of people with ASD with experience of the CJS and their families were gathered via a focus group. The workshop and family focus group were filmed. Finally, training in ASD was provided to local CJMHS staff and their views on ASD and the CJS were compared in pre-and post-training focus groups. 

Results: Recommendations and opinions gathered during the workshop and family focus group were included in local guidelines regarding best identification and management of people with ASD in the CJS. The free-access film will also be widely disseminated. Pre- and post training questionnaires completed by CJMHS staff indicated they felt significantly more able to identify people with ASD in the CJS, communicate with people with ASD in the CJS and to safely manage anxiety and agitation in people with ASD in the CJS. Further, CJMHS staff reported significant improvements in their understanding of the comorbid mental health difficulties of some people with ASD that may contribute to behavioural difficulties and misunderstandings in the CJS. They also were better informed on routes to access specialist clinical care and support groups for people with ASD.

Conclusions: Brief training can be effective in raising awareness and safe management of people with ASD in the CJS. This may lead to short-term (development of sustainable, on-line, free training materials) and long-term (reduced costs to the individual, judicial and health systems) cost savings. Guidelines including identification of barriers to awareness and care for people with ASD in the CJS, solutions to overcome barriers and increased awareness of ASD will enable people with ASD who become known to the CJS to be better understood and have their needs met. This, with better direction to appropriate care pathways, may result in significant cost savings to the individual and society.