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BEHAVIOUR THAT CHALLENGES:
Planning services for people with learning
disabilities and/or autism
who sexually offend
With support from:
DR ANDREA HOLLOMOTZ (University of Leeds) and JENNY TALBOT (Prison Reform Trust)
with ELLIE GORDON (Independent Clinical Advisor),
CLARE HUGHES (National Autistic Society),
DAVID HARLING (NHS Improvement)
PUBLISHED APRIL 2018
This work was supported by the Economic and Social Research Council
[grant number ES/L010534/1]
ACKNOWLEDGEMENTS
Many people contributed to the success of our seminar day, held in May 2017, and to this brieng paper. We are especially
grateful to Lord Bradley for providing the seminar opening address and for writing one of the two forewords to this brieng
paper; to Niles for sharing his personal story in his presentation and foreword; to all the other important contributors who
made seminar presentations (Janette McCormick, Kate Davies OBE, Joe Rafferty, Janice Grant, Danielle Kenney, Monika
Egli-Alge, Paul Jennings, Ben Hughes); and to the table chairs (Glynis Murphy, Kerensa Hocken, Alison Giraud-Saunders),
seminar note takers (Zoe Burton, Karina Hepworth, Caroline Allnutt, Kimmet Edgar, Les Smith) and other seminar
delegates, many of whom shared case studies and other material to inform the seminar and this brieng paper.
We are obliged to our critical readers, Kerensa Hocken, Alison Giraud-Saunders, Salma Ali, Pam Mount with Michelle
Anwyl, Prof Anna Lawson and Dr Lisa Buckner. We would also like to thank the many helpful people who have answered
our questions whilst we were writing this brieng paper, including James Haaven, Phil Jarvis, John Hutchinson, Richard
Curen, Chris Bath, Rachel Riddy, Tania Tancred; and all those who helped to write and review their case study text boxes.
Special thanks go to the Economic & Social Research Council and the Leeds Social Sciences Institute, without whose
support neither the seminar nor this brieng paper would have occurred.
CONTENTS
FOREWORDS
The Rt Hon Lord Bradley .................................................................................................................................................................................................................................... 1
Niles, service user representative ................................................................................................................................................................................................................ 2
1. INTRODUCTION ....................................................................................................................................................................................................................................................................................................................................................... 3
1.1 About this brieng paper .......................................................................................................................................................................................................................... 3
1.2 About our seminar ......................................................................................................................................................................................................................................... 3
1.3 Structure of the brieng paper ............................................................................................................................................................................................................ 3
1.4 Methods and reections on the process of writing this paper ..................................................................................................................................... 3
2. BACKGROUND ........................................................................................................................................................................................................................................................................................................................................................... 5
2.1 Key denitions .................................................................................................................................................................................................................................................. 5
2.2 Prevalence of learning disability and autism, and behaviour that challenges ................................................................................................ 5
2.3 Prevalence of sexual offending ............................................................................................................................................................................................................ 6
2.4 Psychological treatment for sex offenders with learning disabilities and/or autism ................................................................................... 7
2.5 Different pathways for people with learning disabilities and/or autism ........................................................................................................................ 9
3. LEGISLATIVE AND POLICY FRAMEWORK ..........................................................................................................................................................................................................................................................................11
3.1 The Mental Health Act 1983 ................................................................................................................................................................................................................ 11
3.2 Transforming Care .......................................................................................................................................................................................................................................... 11
3.3 Criminal justice responses ...................................................................................................................................................................................................................... 12
4. THE CASE FOR CHANGE .......................................................................................................................................................................................................................................................................................................................... 14
5. OUR EVENT - ACHIEVING IMPROVED OUTCOMES .............................................................................................................................................................................................................................................. 15
5.1 Prevention ............................................................................................................................................................................................................................................................ 15
5.2 Early intervention ........................................................................................................................................................................................................................................... 15
5.3 Criminal justice responses and different routes of incarceration .............................................................................................................................. 17
5.4 Community support and treatment ................................................................................................................................................................................................... 18
5.5 Settling into a community home after prison or hospital ................................................................................................................................................ 18
5.6 Workforce development ............................................................................................................................................................................................................................. 21
6. RECOMMENDATIONS .......................................................................................................................................................................................................................................................................................................................................23
Prevention and early intervention ................................................................................................................................................................................................................ 23
Contact with criminal justice services ...................................................................................................................................................................................................... 25
Further research ........................................................................................................................................................................................................................................................ 26
REFERENCES ................................................................................................................................................................................................................................................................. 26
LEGISLATION .................................................................................................................................................................................................................................................................. 28
APPENDECES ..................................................................................................................................................................................................................................................................................................................................................................... 29
Appendix 1: Seminar Day Programme ..................................................................................................................................................................................................... 29
Appendix 2: List of seminar day delegates .......................................................................................................................................................................................... 31
Appendix 3: A brief overview of the Autism Act 2009 ................................................................................................................................................................ 33
FOREWORD
The Rt Hon Lord Bradley
1
Compared to the general population, offenders have
disproportionately higher burdens of health and social care
needs and people with a learning disability and/or autism can
face even greater burdens.
They frequently experience disadvantage and discrimination alongside a
multitude of pressures, such as poor housing, hate crime, nancial exploitation,
and difculties in developing friendships and relationships; while many will
struggle to cope, more generally, with the demands of daily living.
They may also experience poor physical and mental health and problems with
alcohol and drugs misuse. Some will have experienced poor parenting as a child
and had a limited or inadequate education, including sex education.
Their needs are often multiple and complex, requiring professional services to
provide a highly responsive, well-coordinated approach, which can be hard to
deliver. Collaborative working across health, social care and justice agencies
is essential to better understand how to improve outcomes for people with a
learning disability and/or autism who sexually offend.
Joint training between health, social care and justice agencies can help identify
shared priorities and break down some of the barriers and misunderstandings
that often exist between different professional groups and sectors. For example,
having a shared understanding of ‘risk’ and the factors that can impede positive
risk taking, are especially pertinent.
Timely access to care at times of distress or crisis in a person’s life, as well
as care that fosters independence, are important in developing an integrated
framework of support. Proactive and preventative approaches to service provi-
sion can greatly reduce the likelihood of an offence occurring and help keep our
communities safe. However, should a person come to the attention of the police,
liaison and diversion services are a good example of an early intervention model
that can help coalesce support around the individual and help to inform criminal
justice decision making.
Holding individuals to account for their behaviour by supporting them to learn
new and adaptive skills, and to understand the implications of their behaviour, is
an important principle in improving outcomes for people with learning disabili-
ties and/or autism who sexually offend, and in enabling them to live full, valued,
and meaningful lives.
Building on a seminar held in May 2017, this brieng paper provides a stimulus
for further discussion. It brings to the fore the plight of an especially marginal-
ised group of people, and the challenges they face, describes positive practice
examples and proposes recommendations for improved outcomes.
The Rt Hon Lord Keith Bradley
FOREWORD
Niles, Service User Representative
2
Niles has been convicted of a serious sexual offence. He is a
young man with learning disabilities and autism who attended
our event and shared his story. This is not his real name.
After being arrested and being in prison I was in hospital for 4 years. After completing
treatment, it was agreed I was ready for discharge. After a lot planning and bridging I
was discharged. It took nearly 2 years!
I now live in my own house (I am the tenant). I currently have staff support with
me all the time. I also get support from my forensic nurse, responsible clinician
(psychiatrist), social worker and the police monitoring ofcer (Sex Offender
Management Unit). My dreams for the future are to have a decent job, a decent car,
to work towards living on my own, with no service (or just a little bit of support) and to
keep out of trouble.
The following four things, I feel, have helped me to stay out of trouble, increased my
condence and understand things:
• The sex offender treatment I did in hospital made me look at life in a different way
and understand where I went wrong. It gave me tools to use, such as cards and
code words to help me not to reoffend. I still use these tools today.
• The help I get from my support service (a specialist forensic supported living
service) helps me enjoy life. My staff are always there to listen to any problems
and they help me work through them. They support me with my daily life and help
me nd new activities to do. They also remind me about how to stay safe and stay
out of trouble. If I put myself in a difcult situation, my staff will help me work
out a way out of it.
• I need to keep busy, so I don't get bored. This helps me keep safe. Being busy
helps me not to think about the bad side of things. Things I do to keep busy
include going to college, cycling, socialising, visiting the library and cinema.
• My family is very important to me. I look forward to weekly visits to mum’s home
and mum visiting me at my home. I am very protective over my mum because she
stood by me when I kept getting in trouble.
I am very grateful for the support I have and I think other people like me should be
given a chance. The most important thing for me is having someone who is always
there when I need them to listen to any problem I may have and help me work
through them. If I could tell the Prime Minister one thing about what I would like to
see done better, it would be to get people out of hospital quicker. Often too much
time passes from when a person is ready to leave to actually leaving. This is often to
do with legal stuff and sections.
Signature witheld
3
1. INTRODUCTION
1.1 ABOUT THIS BRIEFING PAPER
There are people with learning disabilities and/
or autism in every community, some of whom
will engage in sexually offending and risky
behaviour.
Already a highly marginalised group, many will themselves
be at risk of exploitation and abuse. Several local, regional
and national authorities and multi-agency partnerships have
overlapping responsibilities for their health and wellbeing –
whether as a statutory duty or because supporting people who
are vulnerable is integral to their role.
The array of support agencies can be confusing and hard to
access – both for individuals with learning disabilities and/
or autism and family members seeking help on their behalf.
Early intervention and support can improve outcomes for the
individuals themselves, make communities safer and reduce the
number of victims, and lessen the high cost of crisis intervention.
This brieng paper sets out the case for change: it draws on
presentations and discussions from a seminar we held in May
2017. It includes practice examples and suggests practical ways
forward and makes recommendations to improve outcomes for
some of the most vulnerable citizens in our society.
1.2 ABOUT OUR SEMINAR
The seminar was led by the University of Leeds, in
collaboration with the Prison Reform Trust, The National
Autistic Society and NHS Improvement. Our seminar was
divided into two parts: rst, we considered health and justice
pathways for people with learning disabilities and/or autism
who display sexually offending behaviour and we heard about
some of the challenges and possible solutions from the
perspective of national leaders.
Second, we focussed on practice within service design and
delivery, including practical examples and a ‘whole system’
approach. Two structured group discussions provided the
opportunity for delegates to share practice ideas, raise concerns,
and to explore solutions. The seminar programme is shown in
Appendix 1, and the list of delegates is in Appendix 2.
1.3 STRUCTURE OF THE BRIEFING PAPER
Chapter 2 provides background information. Learning
disabilities and autism, challenging behaviour and sexual
offending are dened and an estimate of the number of people
with learning disabilities and/or autism who are currently
known to have committed sexual offences is given.
Psychological treatment that is currently offered to this
population is briey described and different pathways that they
may take, through the criminal justice, forensic or social care
systems, are outlined.
Chapter 3 provides more detailed background information
of the legislative and policy framework that underpins these
pathways, including how the Mental Health Act 1983 and the
Transforming Care agenda shape current forensic pathways and
responses, as well as criminal justice responses. In chapter 4
we pause for a moment to reect on these current frameworks
and practices and we briey consider the case for change.
Chapter 5 summarises the substance of what was discussed at
our event. Just like the event itself, this focuses on solutions
and avoids a rehearsal of the difculties we have summarised
in chapter 4. The discussion follows the ‘journey’ that a person
with learning disabilities and/ or autism may take once they
have been identied as at risk of sexually offending.
We begin by considering how we can move beyond crisis
driven responses to sexually offending behaviour and working
to prevent such behaviour from occurring. Next, we consider
criminal justice responses to alleged sexual offences by health
and social care services, and police discretion. We discuss
diversion into inpatient settings. Delegates were in agreement
that community support and treatment can have positive
outcomes, but there were mixed views about the availability
of interventions and treatment options. We highlight some
of the positive examples delegates discussed. The following
section highlights some of the difculties that people with
learning disabilities and/or autism face when settling back into
the community after they leave prison or inpatient care and
it provides a number of creative examples of ways in which
different types of support have helped them. The subsequent
section offers some brief reections on workforce development,
including opportunities for sharing practice.
Chapter 6 features our 13 key recommendations arising from
the day. These relate specically to prevention and early
intervention, contact with criminal justice services and further
research.
1.4 METHODS AND REFLECTIONS ON THE PROCESS OF
WRITING THIS PAPER
This paper was written collaboratively by Dr Andrea Hollomotz
and Jenny Talbot OBE. Ellie Gordon, Clare Hughes and David
Harling helped to organise and facilitate the seminar and
offered further input into this paper on their specic areas
of expertise. In writing this paper, we were guided by the
materials we gathered at our seminar and from our delegates.
This includes the PowerPoint presentations from the speakers,
notes taken during those presentations, any materials that
delegates have sent to us about their work prior to and
4
following the event, and detailed table discussion notes. Each
table had an allocated note taker who recorded the two table
discussions (note takers were: Zoe Burton, Karina Hepworth,
Caroline Allnutt, Kimmet Edgar, Les Smith). The rst table
discussion gave delegates the opportunity to get things 'off
their chest'. We were looking for brickbats (uncomplimentary
remarks), bugbears (causes of annoyance), and bright ideas.
We encouraged this debate because most of us will have ideas
about the cause of the 'problem' and pet ideas about what
would help to solve that problem and we wanted to get these
out in the open, not least because others present in the room
might be perceived as being part of the problem (so we needed
to hear their perspective) or the solution. The brickbats and
bugbears are reected in chapter 4, the case for change. Many
brickbats and bugbears were caused by contextual factors and
the notes therefore also guided us in terms of what to include
in the background and legislative policy framework sections.
The second table discussion focussed on 'achieving best
outcomes'. The idea was to capture and present relevant
legislation, policy levers, good practice, and ideas/solutions for
overcoming challenges, as part of a 'seamless' whole. Many of
the ndings from this discussion are captured in chapter 5 but,
as with the rst discussion, the pointers provided by delegates
also helped us decide what to include in the literature and
policy review.
Hence, in the writing of this paper, we worked back and
forth from data to literature as we needed to insert precise
information to set the context, to enable the reader to make
full sense of the discussions that have informed chapters 4
and 5. Moreover, the literature we used throughout the paper
features materials produced or recommended by our seminar
delegates, along with further sources that help to elucidate or
contextualise points that were raised on the day.
During our event we structured the speaker contributions
so that they reected the ‘journey’ a person with learning
disabilities and/or autism who has committed a sexual offence
may take from being arrested, through to going to court and
then prison, or being diverted into inpatient care and then
release into the community. This structure guided us in
organising the debates in chapter 5. However, the reader will
note that there are vastly different perspectives represented
within each section.
Delegates did not always agree and offered different
perspectives that reected their professional role and
positioning along the ‘journey’. We attempted to capture this
diversity and have incorporated the points noted by the scribes
into this brieng paper. In other words, we decided that all of
the data that note takers recorded on the day would go into
the brieng paper. Whilst this means that note takers had
some control in prioritising what contributions to write down
during table discussions, once they had made the decision to
note it, we would ensure that the information was used. Where
this was useful, Hollomotz brought in further examples to
elucidate points made by delegates from her current research
project, which asks: ‘what works, for whom and under what
circumstances, on treatment programmes for sex offenders
with learning disabilities?’
Once we had produced a full draft, our critical readers
(Kerensa Hocken, Alison Giraud-Saunders, Salma Ali, Pam
Mount, Michelle Anwyl, Prof Anna Lawson, and Dr Lisa
Buckner) pointed to any issues within the paper that needed
clarifying. They helped to draw out and develop our list of
recommendations and further points were added to the
substance of the discussion.
We aimed for a ten-page paper and to spend a week or so
writing this. After several discussions over the summer,
Hollomotz and Talbot worked on the paper for four months in
between other commitments (November 2017 to February
2018). At times we worked separately on different sections and
at times we worked together on the whole draft.
There were more than forty different versions of this paper
before we arrived at this version, a vast number of e-mails
exchanged, many phone calls and one face-to-face meeting.
What this reects is that we did not realise when we started
writing just how detailed the notes by our excellent scribes
were, which reected the thoughtful comments by our
enthused and talkative delegates, much to the credit of the
table chairs who facilitated these discussions (Glynis Murphy,
Kerensa Hocken, Alison Giraud-Saunders, Ellie Gordon, and
Clare Hughes).
It also indicates that, even though we realised that this was a
complex area of practice, we did not appreciate the full extent
of this complexity and how much care needed to be taken to
reect the vast range of issues to be considered when planning
services for people with learning disabilities and/or autism
who sexually offend. (We have covered many, but we are not
claiming that we have covered all of them.) We were at times
left unsure and had to seek further clarications. Again, this
shows just how complex this area of practice is; if even we, the
so-called ‘experts’, are left puzzled at times.
To conclude, this paper had to end up this long, because we
are bringing together such vastly different sectors of practice
and we believe that all the points found herein will be useful
in some way when services are being planned for people with
learning disabilities and/or autism who sexually offend.
We hope that this paper puts an end to some of the confusions
that were reported by our delegates and that it can inspire more
creativity and real improvements for individual cases, at local
and at national level.
5
2. BACKGROUND
2.1 KEY DEFINITIONS
The World Health Organisation (WHO, 2018) denes
learning disabilities1 as:
‘a signicantly reduced ability to understand new or complex
information and to learn and apply new skills (impaired
intelligence). This results in a reduced ability to cope independently
(impaired social functioning), and begins before adulthood, with a
lasting effect on development.’
However, thresholds to qualify for support vary and sometimes
people with a diagnosis of learning disabilities are excluded.
Our paper is about all those people with learning disabilities
to whom the WHO denition above can be applied, regardless
of whether they meet thresholds for local services. As we will
argue throughout this paper, even and perhaps especially those
people with learning disabilities and/or autism who are not known
to services need personalised and specialist interventions at
certain times in their lives.
In many policy documents that mention learning disabilities
and autism in a criminal justice context, autism, learning
disabilities and, at times, specic learning difculties2 and even
mental health are conated, which is unhelpful and there is a risk
that the issues that affect those with a specic condition are not
always clearly distinguished. This paper is about both learning
disabilities and autism.
We adopt the National Autistic Society’s (2016) denition
of autism, which is a lifelong, developmental disability that
affects how people perceive the world and interact with others.
Autistic people see, hear and feel the world differently to other
people. Autism is a spectrum condition. All autistic people
share certain difculties, but being autistic will affect them
in different ways. Some autistic people also have learning
disabilities, mental health issues or other conditions, meaning
people need different kinds of support. The statutory rights
of people with autism to receive support to meet their needs
within health, criminal justice and social care settings are
further enshrined and protected through the Autism Act 2009.
This does two things: It places a duty on the Government to
produce a strategy for autism and to underpin the strategy with
statutory guidance for councils and the NHS which resulted in
several key outputs in this area (Department of Health, 2010,
2014, 2015, 2016). The criminal justice system actions
within the Think Autism strategy and statutory guidance are
summarised in appendix 3.
2.2 PREVALENCE OF LEARNING DISABILITY AND AUTISM,
AND BEHAVIOUR THAT CHALLENGES
The National Autistic Society (2016) state that:
‘there are around 700,000 autistic people in the UK - that's
more than 1 in 100’.
It is furthermore estimated that between 44-52% of people
with autism also have learning disabilities. An estimated
1.2 million people in England have learning disabilities,
which is about 2-3% of the general population (children
and adults). Administrative prevalence (i.e. the number of
individuals known to services as having learning disabilities)
drops signicantly from around 2.5% among children in
education, to around 0.6% among adults aged 20-29 years. It
is estimated that only 21% of adults with learning disabilities
are known to services (Emerson et al., 2012). According to
Public Health England (2016, pp. 13-14), there are a number
of likely reasons for this:
• an increased threshold used for health/disability
identication and surveillance by post-education
health and social care agencies;
• the operation of eligibility criteria to access specialised
social care supports for adults with learning disabilities;
• the stigma associated with learning disabilities leading to
an unwillingness to use specialised services or self-identify;
• the less obvious impact of the intellectual impairments
associated with learning disabilities in non-educational settings.
Behaviour that challenges is generally understood to be exhibited
by 10-15% of adults with learning disabilities known to services,
peaking between the ages of 20-49 (Emerson et al. 2001, cited
in NHS England, 2017a, p. 12). It is noteworthy that:
‘Many of those people who are admitted to secure inpatient
settings may not have previously been known to adult services
prior to their contact with the criminal justice system, and may
not have received a formal diagnosis of learning disability and/
or autism until admission to hospital.’
(NHS England, 2017a, p. 26).
A report by the Royal College of Psychiatrists, British
Psychological Society, and Royal College of Speech and Language
Therapists (2007, p. 10) said that:
‘Behaviour can be described as challenging when it is of such an
intensity, frequency or duration as to threaten the quality of life
and/or physical safety of the individual or others and is likely to lead
to responses that are restrictive, adverse or result in exclusion.’
Sexual offending covers a range of behaviour, and includes a
person exposing their genitals, if they intend that someone else
will see them and if they intend to cause 'alarm or distress';
viewing abusive images, touching someone with sexual intent,
if the other person has not consented to such touching;
sexual assault by penetration; and rape (which can only be
committed by a man).
1: WHO use the term ‘intellectual disability’. In the UK, the term ‘learning disabilities’ is more commonly used than ‘intellectual disability’,
but it applies to the same condition. Learning disabilities will therefore be used throughout this brieng paper.
2. Specic Learning Difculties affect the way information is learned and processed. It is an umbrella term used to cover a range of difculties,
including Dyslexia, Dyspraxia and A.D.H.D. (British Dyslexia Association, 2018)
3: Theory of Mind is the ability to put yourself in someone else’s shoes, to understand what other people think, feel and believe and to predict behaviour and outcomes based on those thoughts, feelings and beliefs.
Context blindness is the inability to adjust behaviours or perception based on the context. This meant that he was unable to predict what the response of the parents would be and what the outcomes could be for him.
4. Multi-Agency Public Protection Arrangements (MAPPA) are a set of statutory arrangements to assess and manage the risk posed by certain sexual and violent offenders (Ministry of Justice, 2017b, p. 1).
5. A rise from 30,416 to 55,236 between 2006/07 and 2016/17 (Ministry of Justice, 2017b, p. 7).
6
There are several reasons why people with learning disabilities
and/or autism may get into trouble over an alleged sexual
offence. At times their actions may be inuenced by factors
that are similar to those affecting non-disabled offenders, such
as lack of empathy, poor impulse control, attachment problems
and cognitive distortions (Lindsay, 2009; Marshall, Anderson,
& Fernandez, 1999). Some of these issues can be caused by a
person’s own experiences of being victimised and people with
learning disabilities have a signicantly increased risk to of
such experiences (Fisher, Baird, Currey, & Hodapp, 2016).
Other reasons that are particular to the experiences of people
with learning disabilities and/or autism may include a lack of
opportunities for appropriate sexual expression, limited knowledge
about sex and sexuality (Grifths, Hingsburger, Hoath, & Ioannou,
2013) or a poor understanding of the social sanctions attached
to sexual offending. These difculties are often linked to a lack of
early learning and education about sex and relationships, but they
may also be linked to a person’s impairment.
For instance, autistic people often have difculty recognising
or understanding the feelings and intentions of others and as a
consequence they may appear ‘to be insensitive’ or to behave
'strangely' or in ways thought to be socially inappropriate
(National Autistic Society, 2016). Box 2.2 discusses the case
of a man whose invasive behaviours had not been understood
in the context of his autism and this meant that opportunities
to intervene early were missed and behaviour escalated.
2.3 PREVALENCE OF SEXUAL OFFENDING
In the year ending March 2015, there was a 37% increase of
police recorded sexual offences compared with the previous
year. This ‘should be seen in the context of a number of high
prole reports and inquiries which are thought to have resulted
in police forces reviewing and improving their recording
practices’ (Ofce for National Statistics, 2016, p. 12).
Moreover, the number of people sentenced to custody for
sexual offences has risen by 54% over the last decade. In
September 2017, 13,456 people were serving a custodial
sentence for a sexual offence – 18% of the sentenced prison
population (Ministry of Justice, 2017c).
The vast majority are men, accounting for 99% of people
currently serving a custodial sentence for a sexual offence
(Ministry of Justice, 2017a). On average, people in prison for
sexual offences serve longer custodial sentences than any other
offence group, with the exception of murder which carries a
mandatory life sentence (Ministry of Justice, 2017a). On 31
March 2017, there were 55,236 registered sexual offenders
in England and Wales eligible for MAPPA4 arrangements in
the community, some of whom are individuals with learning
disabilities and/or autism. This number marks an increase of
82% within the last decade.5 This reects:
‘sentencing trends, in which the number of people convicted
of sexual offences is increasing. Additionally, many sexual
offenders are required to register for long periods of time, with
some registering for life.’ This has a cumulative effect on the
total number of offenders required to register at any one time
(Ministry of Justice, 2017b, p.8).
The vast majority of people managed by MAPPA (99%) are under
Level 1 supervision, the lowest level (Ministry of Justice, 2017b).
The number of people with learning disabilities and/or autism
who are known to be convicted of a sexual offence and serving
either a prison sentence or under supervision in the community
is shown at Table 2.3. The gures have been taken from the
National Probation Service (NPS) case record system, which
records information on learning disabilities and autism based
on self-reporting. Some reasons that will inevitably lead to low
BOX 2.2: CASE STUDY OF AN AUTISTIC SEX OFFENDER
Peter (not his real name) is an individual with circumscribed interest in, and sensory need for, children’s garments, their
dimensions and fabrics. As a child Peter lived in a children’s home and he used to take the other children’s clothes and
collected them. He used this as a coping strategy and it became his special interest. As he became a young adult and no longer
lived with children, he started to become captivated by children in public wearing specic coloured, textured and sized clothing.
As he did not have the money to buy such clothes, he decided to stop children with their parents and ask them for their clothes
(theory of mind and context blindness contributing3). The parents understandably reacted very strongly to this and threatened
to call the police. Peter therefore decided to seek children on their own to ask for their clothes. They would run away or struggle
away when he tried to pull their clothing. He then decided to abduct children and hit them until they stopped struggling, in
order to take their clothes. Each step in the escalation was a practical step further to literally overcome the last hurdle.
When arrested and charged Peter could not understand why the police thought his actions were sexually motivated. He was
not interested in the children, just their clothing. He received his autism diagnosis in prison, after the offence. His behaviours
have only been seen in the context of his autism since then and probably only because the person who carried out his
diagnostic assessment drew attention to it.
Contact: Clare Hughes, Criminal Justice Manager, National Autistic Society, clare.hughes@nas.org.uk
6. The reader will note the difference between the gures cited in table 2.3 and the 55,236 MAPPA registered sexual offenders (Ministry of Justice, 2017b) cited earlier. The MAPPA gures are inated as these include
people who are not necessarily under supervision/licence by the NPS. Thus, there are people still registered as MAPPA Category 1, but who are not actively serving a sentence or licence period with NPS involvement.
7. This gure applies to 30 June 2017 and with this it differs from the 13,456 cited earlier on in this section, as that referred to the most recent statistics from 30 September 2017.
8. http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Lords/2017-12-06/HL3929/
9. For further information contact Dr Hollomotz: A.Hollomotz@leeds.ac.uk
10. James Haaven was interviewed by Dr Hollomotz for her current study and has given permission to be named in this paper.
7
levels of self-reporting were discussed in section 2.2.
The data, therefore, cannot be taken to give a complete picture
of the prevalence of individuals with learning disabilities and/or
autism amongst sex offenders in custody or supervised by NPS
in the community.
We know that this population is vastly over-represented in
prisons. Between 20-30% of offenders are estimated to have
learning disabilities or difculties that interfere with their ability
to cope within the criminal justice system (Loucks, 2007).
It would seem, however, that many individuals with learning
disabilities and/or autism are not identied and do not,
therefore, receive the necessary support to meet either their
social or offending behaviour needs.
This implies that whatever examples of good practice we will
highlight later on in this paper, these accommodations are
likely to be available to only a small number of sex offenders
with learning disabilities and/or autism for whom there is NPS
involvement. It is important to emphasise here that there is
currently no conclusive evidence that there is a higher rate
of sexual offending amongst people with learning disabilities
(Craig, Stringer, & Sanders, 2012), compared to the non-
disabled population. Rather, it has been suggested that this
population may conduct their offences with less sophistication
than those without learning disabilities, causing higher rates of
detection (Craig & Hutchinson, 2005) and this in turn explains
their assumed overrepresentation amongst the population of
sex offenders in prison.
In other words, there are not proportionally more sex offenders
with learning disabilities and/ or autism represented in our society
per se, but from the population of people who have committed
sexual offences those with learning disabilities and/ or autism are
more likely to be detected and thus to end up in prison.
2.4 PSYCHOLOGICAL TREATMENT FOR SEX OFFENDERS
WITH LEARNING DISABILITIES AND/OR AUTISM
Group cognitive behavioural therapy-based sex offender
treatment has been developed to meet the needs of men with
what are considered to be mild learning disabilities, which is
usually dened by IQ scores ranging between 60 and 80. The
main purpose of these programmes is the prevention of future
sexual offending. The key objective is therefore to change a
participant’s thoughts and actions in such a way that they will
not offend again.
A current ESRC funded study by one of the authors9 seeks to
establish what works, for whom and under what circumstances
on these programmes. Preliminary ndings suggest that best
outcomes are achieved by a whole system approach, whereby
the whole support system that works with an individual
collaborates to develop individualised pro-social daily routines
and puts in place support structures that help a person to stay
safe. This approach is standard practice in a community based
Swiss programme; see Box 2.4A.
There are two available routes into group treatment in the
UK. It is available either in select prison or probation trusts
(Williams & Mann, 2010) or within community based or
forensic healthcare settings (e.g. Hordell et al., 2008;
SOTSEC-ID, 2018). HMPPS run three relatively new
accredited programmes for men with learning disabilities,
which are available in both custody and community. These are:
• New Me Strengths
• Becoming New Me Plus
• Living as New Me
The programmes have been designed to be responsive to the
communication styles and abilities of people with learning
disabilities. ‘Becoming New Me Plus’ is for offenders who
have been convicted of a sexual, intimate partner violence,
TABLE 2.3: TOTAL NUMBER OF SEX OFFENDERS FOR WHOM THERE IS NPS INVOLVEMENT AS AT 30 JUNE 20176
Autism Spectrum Learning Disability Learning Difculties Total Sex Offenders
In Community 37 12 823 14,820
In Custody 22 21 615 13,324*
Total 59 33 1,438 28,144
These gures have been taken from the National Probation Service case record system as of 30 June 2017, with the exception of the one marked with *, which was
taken from the Ministry of Justice (2017d) Statistics bulletin that captured the same date.7 This information is in response to a written parliamentary question asked by
Lord Bradley on 6 December 2017, and was answered by Lord Keen on 19 December 2017; reference: HL39298
11. Personal communication 14-12-2017.
12. Victim empathy refers to ‘a cognitive and emotional understanding by a sexual offender of the experience of the victim of his or her sexual offense, resulting in a compassionate and respectful emotional response to
that person’ (Mann & Barnett, 2013, p. 284). Victim awareness is thought to be a precondition to empathy and focusses on enabling ‘group members to understand the harm they are likely to have caused to the
victim’ (Williams & Mann, 2010, p. 303). They will also consider consequences for themselves and their own families.
13. This is discussed later on, in section 5.4.
8
BOX 2.4A: FORIO’S SUPERVISION AND SOCIAL CARE NETWORK
Forio is a forensic healthcare provider in the north-east of Switzerland. They deliver outpatient group therapy for young men
with learning disabilities who have sexually offended. The Forio therapists work closely with the supervision and social care
network of the men in their treatment programmes. This includes the referrer (generally the prosecution service), parents or
other family carers, key workers (for instance from their home or workplace), as well as any further persons that are involved
in planning and delivering supervision or care. The network makes recommendations on personalising treatment, jointly
monitors progress, helps to reinforce lessons learned and supports individuals in putting these into practice and in identifying
potentially risky situations. They will also work to ensure that any community sentence requirements are met.
The network meets before treatment commences and then at regular intervals throughout. How often these meetings are held
is determined on a case-by-case basis and varies between monthly and every 6-8 months. Additional meetings are arranged
on an ad hoc basis in response to major issues, such as a breach of community sentence requirements. Contact within the
network is maintained via e-mails and phone calls and information shared whenever this is deemed necessary.
After treatment completion, participants and their network are offered aftercare in the form of risk-circles. These are not to be
confused with circles of support (see box 5.5c). The Forio risk-circles are principally a continuation of an active information
exchange between all members of the supervision and social care network. The standard format is to offer this for one year
after treatment concluded and to hold meetings every three months. Central to risk-cycle discussions is the transfer of lead
risk management responsibilities to social care.
Contact: lic. phil. I Monika Egli-Alge, Director, Forio, monika.egli-alge@forio.ch
or general violent offence, and have been assessed as high
or very high risk. ‘Living as New Me’ is a skills maintenance
programme, or ‘booster’ for people who have already completed
‘New Me Strengths’ or ‘Living as New Me’.
A screening tool has been developed to assess a person’s
suitability for the programmes. This is made up of information
from the Offender Assessment System (OASys), the Adaptive
Functioning Checklist – Revised (AFC-R), and clinical
observation. The assessments are not designed to diagnose
learning disabilities, but to provide indicators of the presence
of cognitive and adaptive functioning decits, typically found in
populations with learning disabilities.
There is currently no accredited group programme available
for men with autism and some attend groups designed for
men with learning disabilities, although these have not been
developed with autism in mind. James Haaven10, a key
originator of modern group treatment (e.g. Haaven, 2006;
Haaven, Little, & Petre-Miller, 1990) believes that the needs of
men with autism cannot be fully met by these groups because
intellectually they are generally functioning at a higher level,
and the specic issues they need to address through treatment
are often different.
For instance, on rare occasions, the criminal actions of people
with autism can be misunderstood and are in fact not sexually
motivated, as illustrated in box 2.2 (case study of an autistic
sex offender). James Haaven11 further advises:
‘There needs to be caution in using group therapy with people
with autism since they may have signicant problems in
processing and sharing information in a group setting. In
addition, they may lter information in a group process very
differently from what the intent of the information was for.
Because of a myriad of issues, individual therapy is generally
a more appropriate therapy modality, especially, during
the initial stages of therapy. Clearly, there needs to be a
comprehensive assessment done on such an individual prior to
any consideration for placing them in a group therapy setting.’
BOX 2.4B: MEN WITH A DUAL DIAGNOSIS OF
LEARNING DISABILITIES AND AUTISM IN GROUP
TREATMENT
Men with autism are assessed for their ability to
function in group settings by attending non-offence
related group activities. We work on victim awareness, not
empathy12, as we have found these topics to be difcult
for most of our men, especially those with autism or
personality disorder.
The Good Lives Model of Offender Rehabilitation13 works
for some men with autism, especially around the forging
of new identities and healthy narratives that go with them.
Unlearning old rules can be tricky for men who have rigid
thought processes, but equally new rules for life help to
contain anxiety when lack of knowledge and lack of social
understanding provokes high levels of uncertainty.
Contact: Pam Mount, clinical nurse specialist, Mersey Care, pamela.
mount@merseycare.nhs.uk
9
Unsurprisingly, higher recidivism rates are reported amongst
men with autism who completed these treatments, compared
to those without (Heaton & Murphy, 2013). However, case
studies such as Niles (see foreword) demonstrate that some
men with a dual diagnosis of autism and learning disabilities
can benet from group programmes written for men with
learning disabilities. Box 2.4B features some observations on
supporting their participation.
Like men with autism, for whom groups designed for non-
disabled men or men with learning disabilities are not
suitable, female sex offenders with learning disabilities and/
or autism are only able to access individual therapies, as
numbers are generally considered too low to make groups
viable. For instance, Respond14 offer individualised and
psychodynamically informed therapies to outpatients. They
have treated a small number of female sex offenders (8 in
the last 15 years). HM Prison and Probation Service uses the
Women Sex Offender (WSO) Framework:
‘The WSO Framework provides a step-by-step guide on how
to assess, manage and develop work and treatment plans
for WSOs in a manner and style that is likely to enhance the
woman’s motivation and co-operation and reduce shame-led
resistance. It outlines a relational approach to developing
an effective working alliance between the WSO and the
practitioner, which encourages openness and disclosure,
thereby promoting pro-social behaviour.’15
Resources for working with female sex offenders are available
from the Lucy Faithful foundation16. Due to low numbers less
is known about women who sexually offend. More research is
necessary to understand the needs of this group.
2.5 DIFFERENT PATHWAYS FOR PEOPLE WITH LEARNING
DISABILITIES AND/OR AUTISM
Figure 2.5 displays the ‘bewildering sequence of events’
(Royal College of Psychiatrists, 2014, p. 18) that a person with
learning disabilities and/or autism may be subject to following
contact with the police due to an allegation of sexually
offending behaviour. It shows that they may be treated and
managed within health and social care, dealt with through the
criminal justice system, or a combination of both.
How a person is dealt with, and what pathway is followed, can
differ according to who the victim is, with offences towards
male child victims having the highest chance of being reported
(Green, Gray, & Willner, 2002), and where the alleged offence
took place, with incidents within specialist disability services
and towards victims with learning disabilities being less likely
to be referred (McBrien & Murphy, 2006). It also differs
depending on what services are already working with a person
at the time of the offence (Wheeler et al., 2009).
This, in turn, can have profound implications for the person
concerned. For example, evidence demonstrates that people
14. Respond works to lessen the effect of trauma and abuse on people with learning disabilities, their families and supporters. Amongst others they provide psychotherapy for people with learning disabilities and/or
autism. For more information, see: http://www.respond.org.uk
15. Personal correspondence on 22 December 2017 with Phil Jarvis, Head of Sex Offender Team, HMPPS Safer Custody and Public Protection Group
16. https://www.lucyfaithfull.org.uk
10
with learning disabilities and/or autism are frequently
discriminated against and failed by the criminal justice
system (HM Inspectorate of Probation, 2015; Talbot, 2008).
A specialist services route, on the other hand, can deny the
person the opportunity to defend themselves in a court of law,
and can commit them to an indeterminate time spent in secure
healthcare.
Inclusion in society of people with disabilities is an important
principle.18 It means that people with disabilities should, with
the necessary reasonable adjustments and wherever possible,
be able to participate in society in much the same way as
people without disabilities including, in the context of this
paper, the criminal justice process.
FIGURE 2.5: PATHWAY OF AN OFFENDER WITH LEARNING DISABILITIES THROUGH THE CRIMINAL JUSTICE SYSTEM
(reprinted with minor edits from Royal College of Psychiatrists, 2014, p. 18)17
In 2016, after a thorough consultation and review on Untness
to Plead, the Law Commission said:
‘At the heart of our recommendations lies our belief that the
normal criminal trial is the optimum process where a defendant
faces an allegation in our criminal justice system. We consider
that full trial is best not just for the defendant, but also for
those affected by an offence and society more generally.
This is because the full criminal process engages fair trial
guarantees for all those involved… [and] offers the broadest
range of outcomes in terms of sentence and other ancillary
orders’ (Law Commission, 2016, p. 4).
17. Abbreviations used in gure 2.5:
S, Section (of the Mental Health Act 1983).
a. Appropriate adult (Police ad Criminal Evidence Act 1984).
b. Special measures (Youth Justice and Criminal Evidence Act 1999).
c. Criminal Procedure (Insanity) Act 1964, Criminal Procedure (Insanity and Untness to Plead) Act 1991 (CPIA).
18. See Equality Act 2010 and UN Convention on the Rights of Persons with Disabilities (United Nations, 2006).
Index
event Health service
Improvement
(primary care)
Specialist
learning
disability
services
Hospital care;
formal/
informal/
voluntary
Police
Involvement
Arrest (and
caution +
interview)
Court Disposal Prison
Voluntary treatment
Verbal warning?
Absolute
discharge
Discharge
planning
Discharge
planning
Absolute discharge
probation and/or health
service
Voluntary treatment
S2, 3
S135, 136
S35, 35, 38, 48/49
S37, CPIA (both +/-
restriction order)
S47, 49
Not
reported
3. LEGISLATIVE AND POLICY FRAMEWORK
3.1 THE MENTAL HEALTH ACT 1983
Part III of the Mental Health Act allows ‘mentally disordered’
defendants to be diverted from the criminal justice system into
compulsory treatment by the healthcare system either before
or after conviction. The Act denes a ‘mental disorder’ as ‘any
disorder or disability of the mind’ and species that a person
with learning disabilities should not be considered mentally
disordered unless the ‘disability is associated with abnormally
aggressive or seriously irresponsible conduct on his part’.Key
disposals under the Mental Health Act 1983 for ‘mentally
disordered’ defendants are shown in Box 3.1.
Some people who have been detained under the Mental Health
Act are entitled to support under section 117 after they leave
hospital; this is sometimes referred to as 'section 117 aftercare'
(MIND, 2017).This can cover health and social care, and
supported accommodation. Aftercare services are intended to
meet needs that arise from or relate to a person’s mental health
problem, and to reduce the risk of mental conditions getting
worse, resulting in the person having to return to hospital.
Clinical Commissioning Groups and the local social services
authority are responsible for providing aftercare services, or for
arranging for them to be provided.
In May 2017, an independent review of mental health
legislation was announced by the Prime Minister19.
In his opening address to our seminar, Lord Bradley welcomed
the review, and highlighted the opportunity to ensure
that people with learning disabilities and/or autism who
display behaviour that challenges were properly included in
forthcoming discussions.
BOX 3.1: KEY DISPOSALS FOR ‘MENTALLY DISORDERED’ DEFENDANTS, MENTAL HEALTH ACT 1983
• A hospital order permits the court to order the defendant’s admission to hospital if the mental disorder makes detention
for medical treatment appropriate, and if suitable treatment is available (section 37). The order can be made by a
magistrates’ court or the crown court following conviction for an imprisonable offence, or by a magistrates’ court
without a conviction if the court is satised that the defendant committed the act/omission with which he was charged.
A hospital order can be for up to six months’ duration in the rst instance, but it can be renewed; thus, unlike most
criminal justice disposals, it is essentially indeterminate.
• Under a guardianship order, the defendant is placed under the responsibility of a local authority or a person approved by the
local authority (s. 37). Like a hospital order, this can be made by a Magistrates’ Court or the Crown Court following conviction,
or by a Magistrates’ Court without a conviction if the court is satised that the defendant committed the act/omission.
• An interim hospital order can be made, by the Crown Court or a Magistrates’ Court, after conviction, when the court needs
more time to decide whether to impose a hospital order or to use an alternative disposal (s.38).
• A restriction order can be imposed by the Crown Court alongside a hospital order, where this is deemed necessary by the
court to protect the public from ‘serious harm’ (s.41). The order places limits on the individual’s discharge from hospital.
(Jacobson with Talbot 2009, p. 23)
3.2 TRANSFORMING CARE
The Transforming Care agenda was initiated as a response to
events at Winterbourne View hospital, where patients suffered
serious systematic abuse by staff (Department of Health,
2012). It aims to deliver a culture change to ensure people
with learning disabilities and/or autism who display behaviours
that challenge receive the necessary care and support.
A signicant part of this work has been to alter traditional
practice of placing people many miles away from home, in
institutional settings for many years, with little or no evidence
of benecial outcomes for the person or their family. This
practice is to be replaced by care and support that is delivered
locally, person centred and responsive to individual’s needs and
wants, thereby reducing the reliance and need for inpatient
services (NHS England, Local Government Association, &
Association of Directors of Adult Social Services, 2015a).
The Transforming Care Service Model for Commissioners
of Health and Social Care Services (NHS England, Local
Government Association, & Association of Directors of Adult
Social Services, 2015b, p. 8) highlights people with learning
disabilities and/or autism whose behaviour places them at risk
of contact with the police as a distinct group whose ‘specic
needs have not always been recognised’.
Two years later this was followed by the service specication
for community-based forensic support (NHS England, 2017a),
which provides a useful guide for commissioners in developing
service specications to meet their local area needs, including
what an ‘active caseload’ of individuals might be.It describes
11
19. The independent review is chaired by Professor Sir Simon Wessely; he will produce an interim report in early 2018 and develop a nal report containing detailed recommendations, by autumn 2018.
20. See also Developing support and services for children and young people with a learning disability, autism or both (NHS England, 2017b), which supplements Building the Right Support (NHS England et al., 2015a)
and the National Service Model (NHS England, 2017a).
21. Individuals with forensic backgrounds are only part of those identied as needing out of county placements and some individuals from other patient groups remain out of area.
BOX 3.2: PEOPLE WITH LEARNING DISABILITIES ON A FORENSIC PATHWAY IN CUMBRIA
Back in 2006 Cumbria Partnership NHS Foundation Trust (CPFT) started an initiative they called ‘Breaking the Cycle’ where
they monitored people who were placed out of county to look at whether they were placed appropriately within services that met
their identied needs and to plan for transition back to Cumbria when appropriate. In autumn 2017 the last of approximately
16 individuals with a primary diagnosis of learning disabilities and forensic backgrounds from South Cumbria, who had been
placed out of area within a specialist forensic (Mersey Care) hospital, moved back into a community-based setting.
Whilst ‘Breaking the Cycle’ meetings no longer occur, CPFT still has monitoring arrangements in place of all individuals placed
out of County21 or who may be at risk of being placed out of county, through local clinical commissioning groups. This now
also includes child cases to try to ensure a smooth transition from child to adult services. The specialist community learning
disability nurse –forensic pathway lead coordinates the therapeutic work for all the individuals with learning disabilities who are
on a forensic pathway. CPFT lead on multi-agency risk evaluations (MARE)22 for individuals with learning disabilities, who are
deemed to present a high risk but who may not have a criminal conviction or meet the criteria for MAPPA. Other individuals
who are eligible, and/or were previously supervised through MAPPA, may transfer into the MARE process and then into a Multi-
Disciplinary Team (MDT). In all these cases the specialist community learning disability nurse works closely with other agencies
involved. This includes the Liaison and Diversion teams, which work within Police Custody and Adult Social Care.
CPFT work closely with the public protection unit within the police, which has identied ofcers who manage MAPPA/MARE
cases. CPFT employs the Development Ofcer for Mentally Disordered Offenders, who leads on all MAPPA/MARE cases and
development work around offenders with learning disabilities and/ or autism23. The specialist nurse has a good relationship
with the police ofcers and may jointly see individuals. The public protection unit ofcers do not wear uniforms; therefore,
they do not draw attention when visiting offenders.
Contact: Kay Lynas, Forensic and Mental Health Lead, South Cumbria kay.lynas@cumbria.nhs.uk
the core functions that need to be delivered locally to provide
effective specialist community-based forensic support to meet
the needs of adults who meet the following criteria20:
• They have a learning disability and/or autism;
• They display behaviours that present an active and high risk
to others or themselves;
• This behaviour has led to contact with the criminal justice
system, or there is risk of this.
Even though the framework, described in box 3.2, predates
these recent policy initiatives, it helps to illustrate what the
community-based forensic support envisaged by Transforming
Care can look like. It also shows that developing such effective
practices takes commitment over time.
Transforming Care promotes preventative and supportive
mechanisms, demonstrated by the principle of ‘no wrong
door’24, which complements duties under the Care Act 2014
(part 1, section 2(1a)) that require local authorities to:
‘provide or arrange for the provision of services, facilities or
resources, or take other steps, which it considers will contribute
towards preventing or delaying the development by adults in its
area of needs for care and support.’
22. For further information, see Cumbria’s MAPPA/MARE Pathway Policy (Cumbria Partnership NHS Foundation Trust, Cumbria Constabulary, Cumbria Probation Trust, & Cumbria County Council Adult Social Care, 2017).
23. Currently the specialist nurse would only work with individuals with Autism if they have a diagnosis of learning disabilities. The MARE process would still cover Autism without involving the specialist nurse.
In addition, the local commissioning group monitor out of county placements for individuals with Autism.
24. The ‘no wrong door’ principle acknowledges that integrated service delivery is challenging and can only be achieved if front line workers are supported with clear guidance and opportunities to build effective
inter-agency relationships to improve outcomes for service users.
12
Some local authorities have developed a ‘whole system
approach’ to working with specic population groups, such
as women, which aims to provide holistic support when a
person comes into contact with criminal justice services.
This is achieved through greater cohesion between policy,
commissioning, and service delivery across and between
justice, health, social care, housing and other community
services. At an operational level this means greater
collaboration between local services to ensure individuals are
offered necessary support at the point of arrest and along the
justice pathway (see box 5.2: Working together for person
centred care in a whole system approach).
3.3 CRIMINAL JUSTICE RESPONSES
Following arrest, and depending on the seriousness of the
alleged offence, the police will decide between possible
courses of action (see Box 3.3); this applies to all people, not
only those with disabilities or accused of a sexual offence.
The police can exercise a degree of discretion in how they
proceed and a person’s disability may, but does not necessarily,
impact on the decision taken. Where liaison and diversion
services exist, their assessment of the accused will help to
inform criminal justice decision making, alongside referrals into
local services, as needed.
13
The more serious the alleged offence, the more likely the
decision to proceed either to charge or to divert away from
criminal justice into an inpatient setting. Conversely, the less
serious the alleged offence, the more likely the decision to
discontinue in the public interest, to issue a formal caution, or
for the Crown Prosecution Service to issue a conditional caution.
The Equality Act 2010 requires reasonable adjustments to
be anticipated and put in place for people with disabilities, so
enabling them to participate in society on an equal basis with
others without disabilities, including within the criminal justice
system. In police custody, the role of the Appropriate Adult
safeguards the rights and welfare of adults whom the police
consider to be ‘mentally disordered or mentally vulnerable’.
While good progress has been made in enabling effective
participation in justice proceedings for people with disabilities,
the accused are mostly excluded from ‘special measures’
contained in the Youth Justice and Criminal Evidence Act 1999.
BOX 3.3: POLICE OPTIONS FOLLOWING ARREST
The major options available to the police are:
• To discontinue the investigation because of a lack of evidence or because prosecution would not be in the public interest,
• Release on police bail pending further investigation,
• To issue a formal caution25 if the suspect admits the offence and gives informed consent to a caution and the offence is not serious;
• Proceed to charge (as an alternative, the Crown Prosecution Service have the option of issuing a ‘conditional caution’, to
which restorative or rehabilitative conditions are attached);
• Engage with local health and social care services for the purpose of diverting the suspect into treatment or support, in view
of their particular psychological or psychiatric needs
(Jacobson, 2008, p. 23).
25. The use of cautions for ‘mentally disordered’ suspects can be difcult because of the requirement that the offence is admitted, and the suspect agrees to the caution and understands its implications.
If there are doubts about a suspect’s level of understanding or truthfulness of their admissions, a caution is inappropriate.
26. While most of the evidence relates to people with learning disabilities, this would include people with both learning disabilities and autism.
Case law, guidance and training have, however, encouraged
reasonable adjustments in police and court proceedings, and
assessments by liaison and diversion services highlight the
need for such provision.
That said, evidence shows that across the criminal justice
system – police, courts, prison and probation – there remains
much work to be done to ensure people with learning
disabilities and/or autism26 are routinely identied when they
rst come into contact with the police, and are adequately
supported throughout the criminal justice process (HM
Inspectorate of Probation Criminal Justice Joint Inspection,
2014, 2015; Talbot, 2008).
‘The main factor that probation and prison leaders, both
nationally and locally, appear to miss is that they have a
statutory duty to make reasonable adjustments to the services
they provide to make them accessible to all offenders with
disabilities’ (HMI Probation & HMI Prisons, 2015, p. 11).
14
An effective response to people with learning disabilities and/
or autism who sexually offend requires professional health,
social care and justice services to integrate support around the
individual, and a focus on prevention and early intervention,
which can be hard to deliver. Cultural and organisational
factors can mitigate against joined up working and it is
often only at the point of crisis that services intervene. Poor
recognition of individuals with learning disabilities and/or
autism is compounded by limited understanding of how best
their needs can be met, the stigma of sexual offending, and
fear of sexual risk.
Most adults with learning disabilities and/or autism are not
known to services, and those with conditions considered mild
often nd it hard to access support – either from specialist
learning disability services because they are deemed ‘too able’
and do not meet thresholds for support, or because they nd it
hard to access mainstream services because of their disability.
Under-identied and frequently underserved by local
services, people with learning disabilities and/or autism
are over-represented in the criminal justice system. Here,
they are made vulnerable if this system does not recognise
nor support their needs (Talbot, 2008). There is a lack of
reasonable adjustments, including a lack of access to adapted
programmes. According to the Equality Act 2010 this can
constitute unlawful disability discrimination.
For those admitted to hospital there may be no therapeutic
benet from admission, which can lead to people being
trapped for years, with concomitant risks of institutionalisation
and loss of hope. People with learning disabilities and/or autism
often nd it difcult to transfer learning from an articial
hospital environment to the real world.
There are examples where the release of prisoners is generating
a police response to ‘gate detain’ under s136 of the Mental
Health Act. The practice, variously referred to as ‘gate arrest’ or
‘gate detention’, is highly objectionable and should be stopped.
If assessment or transfer to hospital is necessary, this should
be undertaken within the period of detention and not as the
person prepares to leave prison, in the belief that they will soon
be free to return home.
Different responses by local health and justice services can
result in a post code lottery of outcomes, ranging from ‘no
further action’, through to a prison sentence, or detention
under the Mental Health Act 1983, with no opportunity to
defend themselves in a court of law. In many areas there is a
lack of skilled community services that have the condence of
courts; and courts often feel that they have very few options.
The Transforming Care programme, and local Transforming
Care Partnerships, are central to improving outcomes for people
with learning disabilities and/or autism who sexually offend.
Progress, however, can only be made with the full engagement
of a range local services.
Good practice does exist. This brieng paper, and the event
upon which it draws, describes ways of working and treatment
options that can help to reduce risk and improve outcomes for
individuals with learning disabilities and/or autism who display
behaviours that challenge. This, in turn, can help to reduce
numbers of victims, and make our communities safer.
4. THE CASE FOR CHANGE
5. OUR EVENT - ACHIEVING IMPROVED OUTCOMES
15
This section draws together main points from our seminar,
providing additional information to describe the wider context,
and practice examples. Perhaps unsurprisingly, some of the
main points that emerged are generic and well-rehearsed, such as
improved information sharing and collaborative working; some
relate generally to individuals with learning disabilities and/or
autism; and some to individuals with learning disabilities and/or
autism who sexually offend.
Many different views were expressed during our seminar; at
times delegates were in agreement and at other times views
differed. What follows, therefore, is neither representative of all
delegates nor of the authors of this brieng paper.
5.1 PREVENTION
Prevention was a major theme during our seminar - moving
beyond crisis driven responses to sexually offending behaviour
and working to prevent such behaviour from occurring. One of
our seminar delegates, Karina Hepworth, described her work to
support a young man who was displaying sexually inappropriate
behaviour; see Box 5.1.
Sex education for children with learning disabilities and/
or autism, or who are attending schools for children with
additional needs was considered important by delegates.
Sexualised content is readily available and distorted
perceptions of what is ‘normal’ sexual behaviour can bring
BOX 5.1: ILLUSTRATIVE STUDY
Sam [not his real name] came to the attention of the Youth Offending Service (YOS) following a police interview for a series of
‘sexting’ incidences to a female student in the same school. There had been a two-year history of Sam using inappropriate sexual
language to teachers, and incidents of sexual behaviour, such as touching girls’ bottoms. The YOS police ofcer considered a
Youth Conditional Caution (YCC) for Sam but, because he was attending a school for young people with additional needs, it
was decided to approach the school to explore a way forward that took into consideration his level of ability and whether a
YCC was appropriate. The YOS police ofcer and YOS senior nurse specialist in learning disabilities met with the school’s head
teacher and Sam’s head of year, neither of whom were aware of the extent of concern about Sam’s behaviour – Sam having been
transferred from another school only a few weeks before.
Sam has signicant difculties with his level of understanding, and it was agreed that the formality of a YCC was not the best
course of action. It was agreed that the YOS would work with Sam in a supervisory capacity, with the school leading in the
delivery of the work. This approach also helped the school to increase their condence and skills in delivering sex education.
The YOS police ofcer and senior nurse specialist met fortnightly with Sam’s teacher to discuss progress, consider possible
motivations for Sam’s behaviour, and agree next steps. A school risk and safety plan was put in place to reduce the risk
of further incidents and harm to other children. Sam’s social worker contacted his mum to gather information about his
development and health needs, familial factors and behaviour outside school. Plans are now in place to reduce risk, the family
are on board, and there is a clear plan of work. Staff in school feel supported and much more condent to approach a piece
of work that they were unsure of. Sam has said that, while he nds all the following him about difcult, he knows why it is
necessary and wants to learn how to approach things in a different way, so he doesn’t get in trouble.
Contact: Karina Hepworth, Queen’s Nurse, Behaviour Therapist & Senior Nurse Specialist, Learning Disabilities, South West Yorkshire Partnership NHS
Trust & Kirklees Youth Offending Team Karina.Hepworth@kirklees.gov.uk
children into contact with justice services without them
realising that they have done anything wrong.
Creating opportunities for early intervention and support can
be hard to deliver. For example, most adults with learning
disabilities and/or autism are not known to services. Poor
transition arrangements between children and adult services
may in some part account for this. Thresholds to access
community support have risen, and the array of support
services can be hard to navigate (see, for example National
Audit Ofce, 2017).
The combined impact of these factors can make it hard for
more able individuals with learning disabilities and/or autism
to benet from the preventative/ supportive mechanisms of
Transforming Care and the Care Act 2014. Several delegates
spoke of the need for specialist forensic services that work
with local community services to promote and encourage
preventative working, with built in referral routes back into
specialist forensic services when concerns were raised. Integral
to this approach is support based on need, and access to
support for individuals with conditions some may consider mild.
5.2 EARLY INTERVENTION
The rst meaningful contact a person has when they are in
crisis is often with the police. This can pose difculties for
the police, who have limited specialist knowledge of learning
16
disabilities and/or autism. However, where liaison and diversion
services exist, contact with the police can provide opportunities
to access support. In addition, many delegates highlighted the
need for better identication (and information sharing) across
the criminal justice process. Transforming Care Partnerships,
and the development of whole system approaches for these
individuals should help to encourage opportunities for learning
disability and autism awareness training, leading to better
recognition and referral routes into necessary support.
At our seminar we heard from Sergeant Paul Jennings
about the Hampshire High Intensity Network, which seeks
to co-ordinate interagency working between emergency and
healthcare teams to better support people struggling with
highly intensive patterns of mental illness and behavioural
disorders. The High Intensity Network uses the Serenity
Integrated Mentoring27 model of care, which combines mental
health nursing and policing to form a specialist support team
that intensively manages the needs and behaviours of high
intensity mental health service users.
Now a national programme, the 55 NHS Mental Health Trusts
that provide crisis care across England and Wales will be able
to train together, share best practice, and develop new national
standards of care for some of our most vulnerable and high-risk
service users.28
Liaison and diversion services operate in police custody and the
criminal courts. They help to identify individuals with specic
needs, including learning disabilities and autism; they make
referrals into local services, as necessary; and inform criminal
justice decision making – including the need for reasonable
BOX 5.2: WORKING TOGETHER FOR PERSON CENTRED CARE IN A WHOLE SYSTEM APPROACH
Essex County Council has recently completed a procurement process to deliver an integrated Criminal Justice Health and
Care service linked to existing offender support provision, which will go live on 1 April 2018. It links street triage, liaison and
diversion, and police custody healthcare provision. The work has brought together seven clinical commissioning groups, NHS
England, The Ofce of the Police, Fire and Crime Commissioner and Essex police, HMP Chelmsford, Community Rehabilitation
Company and National Probation services, the County Council’s own Public Health, learning disability and mental health
commissioners, and local Unitary Councils at a Criminal Justice Commissioning Group; and good links have been made with the
Transforming Care Board. The overall aim is to reduce crime and reoffending, and improve health and well-being by providing
support to historically underserved individuals, their families and carers. The development of this single service and joined
up planning and accountability enables more effective integration of specic local structures and functions to develop a truly
joined-up system at the various points of delivery. Operating within a single framework, and with a common agenda, multiple
partners are better able to collaborate effectively to ensure a client centred system of care and support.
Specic areas being addressed include a greater focus on early intervention and diversion, peer support and mutual aid, and
engagement with service users and their families and carers; and processes are being further developed for identifying and supporting
previously under identied and underserved groups of individuals engaged with criminal justice services, such as those with learning
disabilities and autism.
Contact: Ben Hughes, Head of Commissioning: Public Health and Wellbeing, Essex County Council: ben.hughes@essex.gov.uk
adjustments to support a person through the justice process,
or diversion away from criminal justice into healthcare. An
important feature of liaison and diversion services is their role in
identifying unmet need when a person rst comes into contact
with criminal justice services, and to make referrals accordingly.
Referrals can, however, only be made into services that exist.
According to the Transforming Care Model Service
Specications and highlighted during our seminar – people
with learning disabilities and/or autism who come into contact
with criminal justice services, or are at risk of doing so, are:
‘…often excluded from mainstream mental health or forensic
services because of their learning disability and/or autism,
and excluded from learning disability services because they
are considered too able or too high risk, or because they have
autism but do not have a learning disability’ (NHS England,
2017a, p. 25).
The conundrum for many individuals with learning disabilities
and/or autism is that they can appear too able to access
learning disability services, but are not sufciently able to
access and maintain contact with mainstream mental health or
forensic services.
Differing needs are frequently addressed by different services,
each with their own ‘threshold’ criteria for support. Thus, many
fall through the gaps in service provision, which places them at
greater risk of entry into criminal justice and secure inpatient
systems. In response to this, and other concerns, Essex County
Council has developed a whole system approach. The model
was presented at our seminar by Ben Hughes, and is described
in Box 5.2.
27. For further information, see: http://wessexahsn.org.uk/projects/128/serenity-integrated-mentoring-sim
28. For further information, see: https://www.highintensitynetwork.org/
17
The function of a whole system approach is reliant on
interdependence across local areas, which according to one
of our speakers, can make it hard to maintain a person-
centred approach, especially when the focus is on reducing
risk. Supporting people in the community requires a balance
to be struck between allowing people to take risks (within an
evidence-based risk management structure), while ensuring
that the individual is also protected from harm, alongside
members of the community in which they live.
The stigma of sexual offending, and fear of sexual risk,
heightened by the recent high volume of historic sexual
offence cases and media coverage, can complicate buy-in from
partners, and management of individuals in the community.
Another benet of a whole system approach is that it can help
to remove what one of our delegates described as a ‘takeaway
service’ – meaning that some professionals and practitioners
try hard to nd ways to move a ‘difcult’ client into another
service, and away from theirs.
5.3 CRIMINAL JUSTICE RESPONSES AND DIFFERENT
ROUTES OF INCARCERATION
Local responses to alleged sexual offences by health and social
care services, and police discretion can lead to a ‘postcode
lottery’ of outcomes. For example, delegates spoke about
alleged offences taking place in health settings that were
not reported, low level offences being ‘let off’ with the risk of
escalation when behaviour is left unchecked, and individuals
being ‘randomly’ diverted into healthcare or processed through
the criminal justice system.
One delegate noted that reports that could usefully inform the
decision to prosecute (especially for cases when public interest
might be relevant) are not always available before trial. Several
delegates raised the need for more and better community
sentence treatment requirements which, it was felt, had greater
potential to produce more effective engagement, learning and
outcomes than a prison sentence or hospital admission.
The point was made that a court ordered sentence that
required joint working between health, social care and justice,
and compliance by the offender, could help to ensure improved
working relationships between the respective agencies and
ongoing engagement with the individual concerned.
Clearly a sensitive area, and not wishing to deect or
underestimate the distress felt by victims, questions were
raised during our seminar about the continuum of behaviour
and threshold for criminalising sexually inappropriate behaviour
by individuals who may have reduced mental capacity.
Notwithstanding the principle of inclusion in society of people
with disabilities (see section 2.5), there will be times when
a person with learning disabilities and/or autism is diverted
away from the criminal justice process into an inpatient
setting (i.e. a secure hospital). For example, in his presentation
at our seminar, Joe Rafferty, Chief Executive of Mersey Care
NHS Foundation Trust, noted that on 1st July 201629 between
50% and 75% of people detained under the Mental Health
Act at Calderstones Hospital30 had sexually offended or had
sex offending risks. There were mixed views about the most
appropriate route for a person with learning disabilities and/
or autism when they are accused of a crime – whether they
continue through the criminal justice process (with reasonable
adjustments, as necessary), or are diverted into hospital care –
and these were explored during our seminar.
There is little doubt that the ‘harms of imprisonment’ are
greater for people with learning disabilities than they are
for people without such disabilities (Talbot, 2008). Despite
improvements and pockets of good practice, reasonable
adjustments are often lacking throughout the criminal justice
process (HM Inspectorate of Probation Criminal Justice Joint
Inspection, 2014, 2015).
Those who argue in favour of the criminal justice route
frequently point to a person’s fundamental right to be able
to defend themselves in a court of law, where they may be
found innocent of any crime; or, if found guilty and a custodial
sentence is given, it will generally be for a xed term – neither
of which applies if a person is diverted into healthcare. On the
other hand, it is perhaps reasonable to expect that an inpatient
setting is more conducive to managing challenging and sexually
offending behaviour, and better able to provide the necessary
care and support.
During our seminar, however, concerns were raised about
people with learning disabilities and/or autism becoming
‘stuck’ in hospital settings long after the initial therapeutic
purpose of their admission has been exhausted. Transfer
back into the community, especially for individuals with
sexually offending forensic histories, can be challenging –
see, for example, the foreword to this report by Niles and
Box 5.5a (developing self-protective narratives). This reects
the difculties experienced, more generally, in reducing the
number of people with learning disabilities and/or autism in
secure settings (National Audit Ofce, 2017).
What came to the fore during our seminar is that it often is
not a question of either/or – justice or healthcare – what is
needed is a hybrid, combining the best of each, alongside
social care, within a whole system, person-centred framework.
Properly handled, contact with the police can help individuals
to understand the gravity of their behaviour, and provide a
marker to review levels of support given and/or to encourage
engagement with services (and vice versa). Liaison and
diversion services in police custody are well placed to identify
when a person might need support, and to make referrals
accordingly. The challenge here is for local areas to ensure
community services exist that can respond in a timely way to
the multiple needs individuals frequently present with. The
29. The date Mersey Care NHS Foundation Trust acquired Calderstones Partnership NHS Foundation Trust. Also see: NHS England et al. (2015a, p. 14f).
30. This site at Whalley in Lancashire is now called Mersey Care’s specialist learning disability division. Earlier in 2017 NHS England announced that they will cease commissioning learning disability services
at this site and Mersey Care are currently consulting with commissioners on a new clinical model, see: http://www.merseycare.nhs.uk/about-us/news/statement-on-specialist-learning-disability-site-in-whalley/
18
Essex model (Box 5.2: Working together for person-centred
care in a whole system approach) is an example of where
efforts are being made to secure community services for people
who have historically been under identied and underserved.
See also NHS England (2017a, pp. 24-39).
5.4 COMMUNITY SUPPORT AND TREATMENT
There were mixed views at our seminar about the availability of
interventions and treatment options to meet the specic needs
of people with learning disabilities and/or autism who sexually
offend, which may reect differences in local practice. Little
information, however, appeared to be available to sentencers
about what interventions for offenders were available locally
and what might, in theory, be possible. Delegates who work
with young people spoke highly of the AIM project, which
has developed a range of tools and training for assessment
and intervention with children and young people who display
sexually harmful behaviour31, including young people with
learning disabilities. Delegates working with adults spoke highly
of the Good Lives Model of Offender Rehabilitation (GLM),
which is used in a number of jurisdictions, including the UK,
and has been used as a framework for sex offender treatment
programmes. Ward and Stewart (2003, p. 356) describe this
as ‘essentially a capabilities or strength-based approach’.
‘According to the GLM, individuals commit criminal offences
because they lack the opportunities and/or the capabilities to
realise valued outcomes in socially acceptable ways’ (Lindsay,
Ward, Morgan, & Wilson, 2007, p. 48).
SOTSEC-ID32 have demonstrated the effectiveness of cognitive-
behavioural treatment groups for men with learning disabilities
who have sexually offended (Heaton & Murphy, 2013;
SOTSEC-ID, 2010). More recently, and in response to little in
the way of provision for young people with intellectual learning
disabilities who display sexually harmful behaviours, they have
developed a sub-group, ySOTSEC-ID, to share knowledge and
experience of working with children and young people with
learning disabilities, and to develop a similar intervention
protocol for evaluation (Malovic, Rossiter, & Murphy, 2018)33.
Delegates wondered whether it would be helpful to have
standardised programmes across health and justice settings
and, while some were supportive of this approach, others felt
that personalised responses would be lost. One experienced
learning disability nurse described how she ‘mixes and
matches’ from a range of resources to ensure the particular
needs of each client are met. This approach helps to adapt
trauma informed working where it is required. This is
recommended as high numbers of individuals who commit
sexual offences have themselves been victims of abuse.
Individuals with learning disabilities and/or autism who sexually
offend are a minority group, within which there are smaller
minority groups of individuals. During our seminar, delegates
highlighted the need to better understand the specic needs of
women, individuals from black and minority ethnic groups, and
those with autism.
The need for improved data about interventions and treatment
options was highlighted. It is important to be able to say, with
condence and underpinned by robust evidence that, ‘this is
what getting it right’ looks like.
Similar concerns were raised for individuals upon release from
prison, as were raised during our discussions on prevention and
early intervention – namely, difculties in accessing community
support. A recent study by Murphy et al. (2017), which
followed up 38 men with learning disabilities who were leaving
prison in England, found they received little support in the
community, despite high rates of clinically signicant anxiety
and depression, and many had been re-interviewed by police.
This lack of support is also reected in a recent inspection
report on ‘Through the Gate Resettlement Services for Prisoners
Serving 12 Months or More’. This said:
‘There were great hopes for Through the Gate, but none of these
have been realised. Staff working for Through the Gate services
in prisons are keen and committed, but they are making little
real difference to people’s life chances as they leave prison’ (HM
Inspectorate of Probation and HM Inspectorate of Prisons, 2017).
In the study by Murphy et al. (2017), more than half the men
had a probation ofcer, who they tended to see once a week
or once a fortnight, and half had a care manager/social worker.
Twenty-two had contacts with specialist health professionals,
including learning disability services.
Although the sample size was small, it is noteworthy that
contact with specialist health professionals was associated with
a signicantly reduced likelihood of contact with the police
– which makes it all the more disappointing that it was not
unusual for probation ofcers involved in the study to:
‘…complain that they had referred the men to the community
[learning disability] teams but had been told they were not
eligible for support’ (Murphy et al., 2017, p. 965).
5.5 SETTLING INTO A COMMUNITY HOME
AFTER PRISON OR HOSPITAL
Deprivation of Liberty and Deprivation of Liberty Safeguards34
(DoLS) were discussed by some delegates in two different
contexts: to support discharge planning from secure inpatient
settings, and as a way of providing structured support and
risk management for individuals in the community who are in
contact with criminal justice services, such as those released
on bail and sentenced to a community order.
31. Established in 1999 by ten Youth Offending Teams and Social Service Departments, NSPCC, the police, education, health and G-map (G-map provides services for young people who have sexually abused, and their
families), AIM has developed a range of tools and training for assessment and intervention with children and young people who display sexually harmful behaviour. For more information, see http://aimproject.org.uk/
32. Sex Offender Treatment Services Collaborative – Intellectual Disabilities.
33. For more information, see: https://www.kent.ac.uk/tizard/sotsec/ySOTSEC/About%20ySOTSEC.html
19
Depriving a person of their liberty is a serious undertaking.
The issue in question focused on the extent to which depriving
or restricting a person’s liberty in the community was a
preferred option to their being detained in prison or a secure
in-patient setting.
The Mental Capacity Act allows restrictions and restraint to
be used in a person’s support, but only if they are in the best
interests of a person who lacks capacity to make the decision
themselves. DoLS apply when a person lacks capacity to
make the decision about their care and accommodation when
the person is in hospital or a care home. In other settings,
including in supported living or their own home, the person
who lacks capacity to make the decision about their care and
accommodation may be deprived of their liberty in their best
interests via an application to the Court of Protection (Social
Care Institute for Excellence, 2017).
There was a view that more creative working between health,
social care and justice agencies could help to ensure a better
understanding of risk and how it could be mitigated, leading
to more effective support and risk management strategies for
individuals with learning disabilities and/or autism who sexually
offend. Concerns about DoLS have resulted in proposed
amendments to the Mental Capacity Act (Law Commission,
2017). Amongst other things, the amendments strengthen
people’s rights in areas such as best interest decisions, and
incorporates a new scheme, the Liberty Protection Safeguards,
which would replace DoLS.35
One delegate recommended that digital technology should be
explored, specically whether an ‘app’ can be developed that
individuals can themselves use to manage their own risk, and that
professionals and practitioners can access to provide support.
It was recognised during our seminar that within society
generally, and in particular within local communities, there
is a ‘powerful fear of sexual risk, which can complicate
its management’. In the context of our seminar, and of
this brieng paper, ‘risk’ is often compounded by poor
understanding of learning disabilities and autism and the
prejudice frequently shown towards individuals with such
disabilities. This demands specic and often creative
responses by professionals and practitioners, personalised to
suit the individual and their circumstances.
Keeping communities safe is important; so too is support for
individuals with learning disabilities and/or autism, enabling them
to live productive lives, free from harm within a risk management
framework. One example shared at our seminar was about
developing self-protective narratives as an integral part of preparing
for release from a secure inpatient setting; see Box 5.5A.
Whether leaving prison or an in-patient setting, delegates said
that nding suitable accommodation was difcult.
Guidance for commissioners of health and social care says
that people with learning disabilities and/or autism who display
behaviour that challenges:
‘should have choice about where they live and who they
live with’, and goes onto say that ‘Inappropriate housing
arrangements increase the likelihood of people displaying
behaviours that challenge, which can lead to placement
breakdown and an avoidable admission or readmission to
hospital’ (NHS England, Local Government Association, &
Association of Directors of Adult Social Services, 2016, p. 4).
Transforming Care Partnerships36 are encouraged to develop a
housing strategy, and to engage with housing providers,
to accommodate the estimated 2,400 people who will
require new living arrangements upon discharge from
inpatient care by March 2019.
BOX 5.5A: DEVELOPING SELF-PROTECTIVE NARRATIVES
Jonathan [not his real name] is managed through MAPPA. He pleaded guilty to indecent assault of pubescent boys. He has
spent over twenty years in hospital on section 37/41 of the Mental Health Act and is currently being prepared for community
discharge. During one of his outings to his new community he went to the barber’s. His forensic support worker reects:
‘People talk while they’re having their hair cut, and barbers are very good at eliciting information from people: ‘I haven’t seen
you before. Who are you? Where have you come from?’ Because Jonathan had been in an institution, that gave him a dilemma.
He couldn’t exactly say: ‘I spent the last twenty-odd years there because I sexually offended against young boys.’ With it being a
small community, it would have completely ostracised him. So, we did lots of role-play for him to work out what kind of replies
he would need to give to some of these questions and he developed a narrative around having recovered from illness.’
Sexual offences are never forgotten, and they stay with both the victim and the offender, for life. The strong prejudices
and emotions that people have towards those who are labelled as sex offenders make those whose histories become known
vulnerable. This role play intervention was pivotal in enabling Jonathan to settle into the community. It helped him ‘to build
his resilience and his practical skills in protecting the things about his past that he needs to protect’.
Contact: Pam Mount, clinical nurse specialist, Mersey Care, pamela.mount@merseycare.nhs.uk
34. Footnote deleted
35. For further information, see: https://www.lawcom.gov.uk/project/mental-capacity-and-deprivation-of-liberty/
36. In England there are 48 Transforming Care Partnerships made up of clinical commissioning groups, NHS England’s specialised commissioners and local authorities.
They work with people with a learning disability and/or autism, and their families and carers; https://www.england.nhs.uk/learning-disabilities/tcp/
20
BOX 5.5B: CREATIVE RISK MANAGEMENT PLANNING
Gary (not his real name) was 17 when he raped a female child. Initially found unt to stand trial, he was later convicted and
given a custodial sentence of two years. During his trial he was found to have an IQ of 59. In prison, there was little planning
to identify and respond to his needs, and Gary described being bullied and assaulted when the nature of his offending became
known. He wasn’t considered for an adapted Sex Offender Treatment Programme because of his ‘short’ sentence.
Gary’s release from prison was planned under MAPPA37 due to his status as a registered sex offender. He was not keen to return
home (his home was later assessed as unsuitable), and he was released to a Probation Hostel. Gary was unable to understand
the conditions of his licence, and quickly breached rules. He was assessed as being unsuitable for support from adult social care
and, due to continued breach of his licence, was recalled to custody. Driven by an inability to determine a suitable community risk
management plan, Gary was escalated to MAPPA level 3. It was agreed that Gary’s social functioning should again be assessed,
which conrmed he was eligible for nancial support, and supported housing was recommended. It was further agreed that the
local learning disability service would work with Gary to help him prepare for re-release, and to adapt the written instructions of his
licence conditions to help him understand what was expected of him. Despite a robust search, a suitable address for Gary could
not be found. A manager from the learning disability service suggested a Shared Lives38 placement, which involves placing adults
with special needs into households with ‘foster carers’. A suitable placement was found with a couple who had many years of
experience of working with learning disabled men and managing inappropriate sexual behaviour.
To prepare for Gary’s arrival, they received training from probation staff, MAPPA and SOPO39 briengs, and their home was
visited by police, probation and learning disability services. Finally, Gary was released by the Parole Board to the Shared
Lives address. He engaged well in his new environment and began to ourish. He developed self-care skills and, for the rst
time, was able to undertake basic cooking and cleaning tasks without instruction. He developed positive relationships with a
forensic psychologist and a speech and language therapist, and their joint work helped to improve his condence and behaviour
management. Gary successfully completed his licence.
REFLECTION AND COLLABORATION:
Following Gary’s situation, all the agencies involved met to reect on their learning, and two main factors were identied:
there was no process to enable probation practitioners to seek timely guidance and support from learning disability services,
and agencies knew little about each other’s roles and responsibilities. As a result, the following was put in place:
• A package of training was developed and delivered jointly to all probation staff;
• A pathway for referral into learning disability services for probation clients was established at all stages of the criminal
justice process;
• A Criminal Justice Learning Disability Champions Group was established, which comprises justice, health and social care
agencies, including learning disability and social care services, police, probation (NPS and CRC)40, youth offending service, HMCTS41,
and G4S42. The Group meets quarterly, participate in shared training sessions, and feedback learning to their respective organisations.
• A learning disability nurse provides a dedicated one day per week for the assessment of probation clients, and several adult
offenders have been diagnosed with learning disabilities and/or autism since June 2016, when the role commenced.
Contact: Danielle Kenny, Senior Probation Ofcer, National Probation Service: Danielle.Kenny@probation.gsi.gov.uk
These arrangements, however, are unlikely to include individuals
leaving prison and those at risk of contact with the criminal
justice system. Many delegates said that support for independent
living for people with learning disabilities and/or autism was
increasingly hard to get, and some individuals were losing support
as thresholds were raised; and this, in turn, led to an increased
risk of contact with the police. When thinking about what a
‘home’ in the community may look like, we need to consider the
37. Multi-agency Public Protection Arrangements.
38. The Shared Lives scheme offers accommodation and support within approved family homes for people aged 18 and over who rely on the help and support of others to maximise their potential and maintain a sense of
independence; Derbyshire County Council website, accessed 18/12/17: https://www.derbyshire.gov.uk/social_health/adult_care_and_wellbeing/disability_support/learning_disabilities/support_living/default.asp
39. Sexual Offences Prevention Order.
40. Community Rehabilitation Company
41. Her Majesty’s Courts & Tribunals Service
42. G4S is a secure outsourcing company.
social care and support needs of the individual, as well how
best to manage risks. At our seminar, Senior Probation Ofcer
Danielle Kenny described how necessity led to a creative
approach to risk management planning for a man with learning
disabilities convicted of a sex offence, which in turn led to the
development of a pathway for referral into learning disability
services by probation staff, and a multiagency network of
Learning Disability Champions; see Box 5.5B.
21
Even if a person is settled in their physical home environment
and has no further social care needs, they may nd it difcult
to become ‘at home’ in the community, in other words to nd
meaningful things to do and make social contacts. To remind
the reader, the Good Lives Model assumes that assisting
individuals to achieve positive life goals via non-offending
methods ‘may function to eliminate or reduce the need for
offending’ (Ward & Maruna, 2007, p. 108).
As a follow up to our seminar, Dr Tania Tancred (Senior
Forensic Psychologist, National Probation Service)
circulated information about Adapted Circles of Support and
Accountability, run by Circles South East.43
The standard Circles model was originally designed for high-risk
sex offenders on their release from prison (Wilson, McWhinnie,
Picheca, Prinzo, & Cortoni, 2007). More recently (since 2013),
an Adapted Circles model has been developed specically to
support individuals with learning disabilities and/or autism. An
illustrative study showing how the adapted Circles model worked
for one man is shown in Box 5.5C.
5.6 WORKFORCE DEVELOPMENT
The need for better information sharing is well rehearsed and
isn’t repeated in detail here – other than to say that inadequate
information sharing makes effective outcomes harder to
achieve and improvements are long overdue. One solution we
discussed was the idea of a key worker ‘Holding the story’.
BOX 5.5C: ADAPTED CIRCLES OF SUPPORT AND ACCOUNTABILITY
D was referred to Circles South East’s Adapted Pilot through the local Health Trust. He completed the adapted sexual offender
treatment programme when resident at a secure hospital. At the end of his treatment he left hospital quite quickly and with
little support, as he was no longer able to get support under Section 117 of the Mental Health Act. Circles South East
assessed D at the end of his treatment and accepted him. He was found a bedsit on release and had limited contact with
Social Services. Circles South East provided D with a counsellor to address childhood trauma and behaviours emerging from
this. He had no additional support at this time and was very low. He attempted to overdose twice before he was moved to a
more structured and supportive environment.
After three months in the community a Circle of volunteers was set up to support him and to help him to use the counselling
support in a more formal and structured way. D has now been in a Circle for nearly a year. Sometimes his diagnosis of Borderline
Personality Disorder and learning disabilities has meant that he has been misunderstood by agencies. The Circle has advocated on
his behalf regarding engagement with Social Services, support in gaining Mental Health support and linking with the Police.
He has now lost 5 stone of excess weight, is engaged actively in his local community with appropriate pursuits, is completing
courses with a local charity and has re-established contact with family members. His depressive episodes are now irregular,
and he seeks help before they overwhelm him. The Circle still has a further year to run and is now focusing on helping him to
practice his social skills in a less formal environment. The risk he presents is linked to development of intimate relationships
and therefore it is important for him to engage with appropriate contacts in the community and practice his safety plans
before making more permanent connections in the community.
For further information, email info@circlessoutheast.org.uk
This means that a single (or small number) of staff should
understand a person’s situation, history and aspirations for
the future so that they, and/or their family member are not
constantly having to repeat themselves.
Many delegates felt strongly that positive outcomes largely
depended on local availability of ‘good’ professionals and
practitioners (the ‘post code lottery’). As in many events such
as ours, the question of workforce development, or rather lack
of it, including opportunities for sharing practice, was raised.
At a local level, a ‘champions network’ comprising health,
social care and justice agencies, including members of the
judiciary, can support shared work-based learning and a better
understanding of the respective roles and responsibilities of
each agency, alongside opportunities to explore collaborative
working and common agendas; and the ‘reection and
collaboration’ example in Box 5.5B is a good example of
this. The different terminology used by different sectors, and
understanding of ‘risk’ can be problematic, and is perhaps best
explored within local areas.
The need for a formal process, at a national level, for sharing
practice, transferring skills and learning from the experiences
of others was considered important. Being able to capture the
knowledge and experience of staff working in specialist inpatient
settings, as these reduce in number and community models of
care and support are established, was especially highlighted.
A proposal was made to develop a national standard that would
collate the statutory functions of respective agencies as they
relate to people with learning disabilities and/or autism who
43. This model is not exclusive to Circles South East. Adapted circles are also offered by the Safer Living Foundation Circles project in the Midlands and also by the circles project in Manchester.
Circles UK are currently working to make sure this model is available in all areas.
22
display challenging behaviour, including inappropriate sexual
and sexually offending behaviour. This would be used to create
minimum standards, while a national network for shared learning
would encourage creativity and best practice.
It was further suggested that by incorporating specicity for
people with learning disabilities and/or autism into health
and justice commissioning frameworks, rather than a blanket
requirement to meet duties under the Equality Act, greater
attention would be given to ensuring necessary reasonable
adjustments for these individuals, and training for members of
staff working with them. A number of delegates said there was
a need for awareness training for health and justice personnel,
including Appropriate Adults, that addressed sexually offending
behaviour through the lens of learning disability and autism.
Ensuring a skilled workforce is in place was highlighted as
important, and concerns were expressed at apparent falling
numbers of learning disability nurses, but it was also felt that
in addition to nurses we need a wider range of appropriately
qualied individuals experienced in working with people with
learning disabilities and/ or autism. It is essential that these
individuals receive appropriate support.
People with learning disabilities and/or autism who have
sexually offended often have high levels of emotional demand
and many have histories of exposure to child sexual abuse.
The needs of staff working with them need to be attended
to by the support of a good occupational health structure,
regular clinical supervision and timely access to psychological
treatment for counselling or other therapies required when faced
with working with the abused and the abusers on a daily basis.
While training was seen as important by most delegates,
others were more sceptical and said that training was often
hailed as a solution, when what was needed was a culture
shift and more effective ‘policing’ to ensure what should
happen, such as reasonable adjustments for people with
disabilities, actually did happen.
Whatever changes may arise in terms of workforce
development, but also the issues outlined in previous sections,
delegates highlighted the importance of ensuring that
people with learning disabilities and/or autism are involved
in designing their own care and support and in helping local
services to develop new and improved responses. Working with
individuals with direct experience to design and deliver services
that meet their needs, and builds upon their strengths, is
likely to be more effective and efcient than services designed
without their unique insight and experiences.
Many delegates said how valuable they had found our event
and hoped there would be opportunities for follow up.
6. RECOMMENDATIONS
23
PREVENTION AND EARLY INTERVENTION
This report has attempted to tackle a signicant and challenging topic, encompassing legislation, and national and local policy
and practice. After our event, on 10 May 2017, Lord Bradley said:
‘Some of the main points to come out of the day were that services must be planned and commissioned in an integrated
way, involving a wide range of partners. Integration must include robust information sharing protocols backed up by effective
enhancement of technology. Crucially, all partner organisations should commit to joint training to bring expertise together, and to
break down cultural and organisational barriers.’
These points – along with others made by delegates at our event – are reected in the recommendations that follow. While our
recommendations seek to address individuals with learning disabilities and/or autism who sexually offend, some of what we say
refers also to all individuals with learning disabilities and/or autism who nd themselves in contact with, or on the edges of, the
criminal justice system.
1. Education and learning about sex and relationships for children with learning disabilities and/or autism should be included
in the curriculum from a young age, and reinforced throughout their statutory education. Education and learning should
address relationships, sexually (in)appropriate behaviours, how to stay safe, how to prevent unwelcome sexual behaviour, and
what to do if you are a victim of unwelcome sexual behaviour.
a. A recent government consultation on changes to the teaching of sex and relationship education, and PSHE44 closed on 12
February 2018. Delegates from our event responded, highlighting the importance of sex education for children with learning
disabilities and/or autism attending mainstream schools and schools for children with additional needs. Sexualised content is
freely accessible on social media, and distorted perceptions of what is ‘normal’ sexual behaviour can bring children into contact
with justice services without them realising they have done anything wrong.
2. Local Transforming Care Partnerships and community-based forensic support: We agree with the Transforming Care Model
Service Specications that effective specialist community-based forensic support should be delivered to meet the needs of people:
a. With a learning disability and/or autism;
b. Who display behaviours that can be described as challenging;
c. Where this behaviour has led to contact with the criminal justice system, or where there is risk of this
[happening in the future]’ (NHS England, 2017a, p. 24).
The cited specications found in reccomendation 2 are aimed at adults and we welcome the additional guidance on working with
children and young people (NHS England, 2017b). We further agree with the threshold criteria proposed by Transforming
Care, as shown in Box 6. To ensure timely referrals from criminal justice agencies, local Transforming Care Partnerships
should establish positive working relationships and referral routes with liaison and diversion services, and vice versa; see
recommendation 9.
3. Involvement of family members: Family members frequently provide much needed support for relatives with learning
disabilities and/or autism. The difculties they can face in securing the additional support they feel is needed is well
rehearsed. Family members may also have concerns about sexually inappropriate behaviour displayed by their relative, but may
be reluctant to raise these for fear of a punitive response for their relative and/or being blamed themselves for not preventing
or even ‘creating’ that behaviour. The involvement of family members should, where appropriate and with the consent of the
individual concerned, be supported. This should include, for example, information about topics that family members may feel
reluctant to raise, such as sexual relationships, sexual behaviour, and sexually inappropriate behaviour.
Transforming Care Partnerships, Adult Autism Strategy arrangements and Education Authorities are well placed to support this
work, and to take a lead role where services do not exist. NICE45 (2015) guideline [NG11] considers environmental
interventions in section 1.7, such as parent-training programmes for parents or carers of children who are at risk of developing,
behaviour that challenges and these could offer a safe space for discussion.
44. https://www.gov.uk/government/consultations/changes-to-teaching-of-sex-and-relationship-education-and-pshe
45. National Institute for Health and Care Excellence
24
4. A ‘whole system approach’ is one that recognises the contribution that all partners, including service users, make to the delivery
of care and support. Whole system working does not have restrictive service boundaries – it puts the individual at the centre of
service provision and responds to their particular needs. A system-wide strategy should sit with the Health and Wellbeing
Board, which should assure itself that the overall strategy and operational activity involves appropriate partners. This could
be done by allocating the task to existing relevant partnerships, such as the Adult Autism Strategy46 and Transforming Care
Partnership.47 Activities undertaken within the overall strategy could include:
a. A shared, multi-agency directory of services, including voluntary sector support;
b. Multi-agency awareness training, involving individuals with learning disability and/or autism;
c. Opportunities for shared learning across the ‘whole system’, which is important for front line practitioners unused
to dealing with individuals with learning disabilities and/ or autism, especially those who display sexually inappropriate
behaviour. Opportunities should include: recognising and responding to sexually inappropriate behaviour, sharing good
practice and concerns, and effective joint working across the whole system.
5. Equal partners: Working with people with learning disabilities and/or autism to design and deliver services that meet their
needs and builds upon their strengths is likely to be more effective and efcient than services designed without their unique
insight and experiences. Opportunities for involvement include:
a. Awareness training;
b. Designing their own care and support packages;
c. Informing the design and ongoing development and review of services;
d. Research.
6. Recent years have seen improved interventions, treatment options and outcome data for individuals with learning disabilities
and/or autism who sexually offend. Health and justice agencies should collaborate to agree a suite of shared, evidence-based
interventions and treatment options for use in the community, and in secure and custodial settings. Data should be shared
to inform ongoing development. It is important to be able to say, ‘this is what getting it right looks like’, taking into consideration
the need to balance supporting the individual to take risks within a supportive, evidence-based risk management structure, while
ensuring they are protected from potential harm and the community is kept safe.
a. A national digitally driven network should be developed to help ensure shared learning and dissemination of best and
evolving practice across health, social care and justice.
BOX 6: EXCLUSION CRITERIA AND THRESHOLDS FOR COMMUNITY-BASED FORENSIC SUPPORT
(NHS ENGLAND, 2017A, PP. 36-37)
Support should be provided for adults with:
• A conrmed diagnosis of learning disability; and/or
• A conrmed diagnosis of autism; or
• in the absence of a conrmed diagnosis of either a learning disability or autism, evidence that on the balance of probability
such a condition may be present.
AND who either:
• Have a conviction for an offence;
• Have had an allegation of offending made against them;
• Are considered to be at signicant risk of offending, and/or present a risk of serious harm to the public.
NB. “At risk of offending” means that an individual has exhibited behaviours which could be construed as an offence (such as assault) or have
carried out activities which may be viewed as pre-cursors to more serious offending behaviours. The provider should take referrals from a wide range
of sources, including housing, criminal justice system agencies and health and social care services. It should also establish mechanisms for self-
referral and from families and carers. The service should accept referrals on the basis of need, rather than being restricted purely to diagnosis.
46: Statutory guidance for Local Authorities and NHS organisations to support the implementation of the Adult Autism Strategy states that the responsible authorities (local authorities, police, probation, Clinical
Commissioning Groups, and the re and rescue authority) are under a statutory duty to work together to reduce reoffending, tackle crime and disorder, tackle anti-social behaviour, tackle alcohol and substance misuse,
and any other behaviour which has a negative effect on the local environment.
47: The Transforming Care programme is scheduled to end in March 2019, and a whole system approach for this group should be developed and extend beyond this time period.
CONTACT WITH CRIMINAL JUSTICE SERVICES
7. Principle of inclusion in society of persons with disabilities: We agree with the report on the Law Commission’s review into
Untness to Plead, which looked at how defendants who lack sufcient ability to participate meaningfully in trial should be dealt
with in the criminal courts. Following a lengthy and comprehensive consultation, the Law Commission based its recommendations
on the belief that:
‘…the normal criminal trial is the optimum process where a defendant faces an allegation in our criminal justice system.
We consider that full trial is best not just for the defendant, but also for those affected by an offence and society more
generally. This is because the full criminal process engages fair trial guarantees for all involved… [and] offers the broadest
range of outcomes… Removing any defendant from the full trial process should, we consider, only be undertaken as a last
resort’ (Law Commission, 2016, p. 4).
This reects the principle of inclusion in society of persons with disabilities, legislated for in the Equality Act 2010, and
promoted by the United Nations Convention on the Rights of People with Disabilities (UNCRPD) 2006, which was ratied by
the UK government in 2009.
8. Mental Health Act independent review: People with learning disabilities and/or autism who commit offences should not be
treated less favourably by the combined criminal justice, health and social care systems. There are currently people detained
in hospital for longer periods than they would have spent in prison, with no discernible clinical purpose or therapeutic benet.
Specic sentencing options should be developed for offenders with learning disabilities and/or autism. See recommendation 12.
9. Identication of support needs: The planned roll out of liaison and diversion services to all police custody suites and youth
justice and criminal courts by 2020/21 is welcomed. Commissioners of liaison and diversion services, working together with
the police, should ensure that all suspects are screened for learning disability and autism. Assessment reports by liaison
and diversion services should provide information on the need for reasonable adjustments to ensure a person’s effective
participation in criminal justice proceedings, and provide guidance on ways in which adjustments can be made (see also
Talbot, 2012).
a. Liaison and diversion services should develop positive working relationships with community-based forensic support within
local Transforming Care Partnerships to ensure timely referrals, and vice versa. See recommendation 2.
10. Appropriate Adults48: We agree with the National Appropriate Adult Network that a statutory entitlement to assistance
from an appropriate adult should be accorded to the adult suspects, where necessary. There should be a national framework for
funding and quality assurance of appropriate adults. Accountability should ensure independent provision for all adults in need
of support.
11. Intermediaries: We agree with the Law Commission that a statutory entitlement to assistance from an intermediary
should be accorded to the accused, where necessary (Law Commission, 2016, p.9). We agree with Justice (2017) that
intermediaries should be accessible at the police station and in court through a duty scheme (see also Talbot, 2012). The
Ministry of Justice should review arrangements for intermediaries to ensure that suspects and defendants are able to access
support from an intermediary during the investigation stage, pre-trial and in court.
12. Community sentences: The Community Sentence Treatment Requirement (CSTR) trial sites are welcomed. Specic CSTRs
should be developed for offenders with learning disabilities and/or autism, including for those convicted of sexual offences.
Health, social care and justice agencies should collaborate to agree a suite of shared, evidence-based interventions and
treatment options for use in the community settings; see recommendation 6.
25
48. Personal correspondence with Chris Bath, chief executive, National Appropriate Adult Network: 14 February 2018.
FURTHER RESEARCH
13. The last 20 years has witnessed great progress in research into sex offenders with learning disabilities (Craig, 2017). Most
advances were made in explaining why offending happens (see section 2.2) and in discussing specic practice issues in
treatment, such as the debate about victim empathy work (compare to box 2.4B and footnote 12).
a. Less attention has thus far been paid to exploring the social context in which treatment takes place and the impact this
has on treatment outcomes. Further research is needed in this area.
b. Murphy et al.’s (2017) study on offenders with learning disabilities leaving prison (see section 5.4) provided fascinating
insights and more research of this kind is needed to expose what happens, and needs to happen, when a person is released
after their prison sentence or detention has nished.
c. Further research is needed to better understand the vulnerability and criminogenic factors of:
i. Individuals with autism who display inappropriate sexual behaviour and sexually offending behaviour, including
sensory needs, levels of anxiety, and general autism prole;
ii. Minority groups within learning disability and autism communities, such as women and individuals from black
and minority ethnic groups.
26
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LEGISLATION
Autism Act 2009
Care Act 2014
Criminal Procedure (Insanity and Untness to Plead)
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29
APPENDIX 1: SEMINAR DAY PROGRAMME
Behaviour that challenges: planning services for people with learning disabilities and/or autism who sexually offend
MORNING THEME: THE BIGGER PICTURE
09:30 Registration, tea/ coffee
10:00 Welcome
Andrea Hollomotz (lecturer, University of Leeds)
Jenny Talbot (Director, Care not Custody, Prison Reform Trust)
10:05 Opening plenary
Lord Bradley
10:20 Keynote panel:
health and justice pathways for individuals with learning disabilities and/or autism
Lord Bradley (chair)
Police response
Janette McCormick (Disability Lead for the National Police Chief’s Council)
Health and justice response: liaison and diversion services
Kate Davies OBE, Director of Health & Justice, Armed Forces and Sexual Assault Services
Commissioning, NHS England
Community forensic services response
Joe Rafferty, Chief Executive Mersey Care NHS Trust
Adult social care response
Janice Grant, ADASS care and justice network and social care health and wellbeing
directorate, Kent County Council
11:25 Table discussions: 3Bs
Jenny Talbot (chair)
11:55 The NHS Learning Disability policy context: beyond the magic ingredient
David Harling (NHS improvement)
Ellie Gordon (Independent clinical advisor)
12:15 Lunch
APPENDICES
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AFTERNOON THEME: DISCUSSING PRACTICE EXAMPLES AND FINDING SOLUTIONS
13:00 Towards best outcomes: practice examples
Jenny Talbot (chair)
Through the gate example
XXX (XXX)
Niles (Service user, XXX)
A community placement in adult foster care
Danielle Kenney (Senior Probation Ofcer, National Probation Service)
Overview of the ESRC project and inter-agency working in a Swiss adapted sex offender
treatment programme
Andrea Hollomotz (lecturer, University of Leeds)
Monika Egli-Alge (forensic psychologist & psychotherapist, Forio, Switzerland)
Crisis driven behaviour – meeting ‘their’ needs (not our own)
Paul Jennings (Mental Health Police Sergeant, Hampshire police)
14:05 Pooling budgets for person-centred, rather than service-specic delivery
Ben Hughes (Head of Commissioning: Public Health and Wellbeing, Essex County Council)
14:30 Table discussions: Achieving best outcomes
Jenny Talbot (chair)
Table chairs:
Clare Hughes (Criminal Justice Manager, National Autistic Society)
with Sheila Nagy (Practice Manager, National Probation Service)
Prof Glynis Murphy (co-chair, SOTSEC-ID)
Kerensa Hocken (Cluster Lead Psychologist for Sexual Offending Strategy, NOMS)
Alison Giraud Saunders (independent consultant)
Annie Norman (RCN Professional Nurse Adviser for Learning Disability and Nursing in
Criminal Justice Services)
15:45 Final comments/ next steps
Andrea Hollomotz & Jenny Talbot
16:00 Drinks reception
16:30 Close
APPENDIX 2: LIST OF SEMINAR DAY DELEGATES
Behaviour that challenges: planning services for people with learning disabilities and/or autism who sexually offend
Surname Name Job title/ organisation
Niles Service user
Alexander Dr Regi Consultant Psychiatrist, PiC LD Services, St John’s House, Diss, Norfolk
Ali Salma Specialist Liaison & Diversion Practitioner - Intellectual Disabilities
Allnutt Caroline PRT volunteer
Anwyl Michelle Clinical nurse specialist, Mersey Care
Anderson Julia Clinical Nurse Manager, Mersey Care
Barnes DJ Barbara District Judge (Magistrates’ Court)
Boer Dr Harm Consultant Forensic Psychiatrist for People with Learning Disability, Forensic
Service, Brooklands, Coventry and Warwickshire Partnership NHS trust
Lord Bradley Keith
Brufal Tabitha Deputy Director, Early Interventions, Women and Vulnerable Offender Policy
Burns Mick Head of Mental Health (Interim)/ Co-Commissioner
PD Offender Pathway (North), NHS England
Burton Zoe Ofce Manager, PRT
Byrne-Watts Irene Director of community services, Mersey Care
Curen Dr Richard Consultant Forensic Psychotherapist, Respond
Davies OBE Kate Director of Health & Justice, Armed Forces and Sexual Assault Services
Commissioning, NHS England
Easton Jo Director of Policy and Research, Magistrates' Association
Edgar Kimmett Head of Research, PRT
Egli-Alge Monika Director, Forio (Switzerland)
Flavelle Eileen Clinical Director, Michael Batt Foundation (Plymouth)
Fletcher Mick Specialist Behavioural Nurse, Hull and East Riding for
Humber NHS Foundation Trust
Gayler Paul Strategic Housing Manager, Maldon District Council
Giraud-Saunders Alison independent consultant
Gordon Ellie Independent clinical advisor
Graham Anne Director, Resolve Care
Grant Janice ADASS care and justice network and social care
health and wellbeing directorate, Kent County Council
Hagem Birgitte Specialist Prosecutor, DLA Team, Crown Prosecution Service
Hammond Tracy Operations Director, Learning Disability England
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32
Surname Name Job title/ organisation
Harling David Head of Learning Disability, Mental Health Team - Nursing Directorate, NHS
Improvement
Hepworth Jonathan Senior Mental Health Supplier Manager
Hepworth Karina
Queen’s Nurse, Behaviour Therapist & Senior Nurse Specialist, Learning
Disabilities, South West Yorkshire Partnership NHS Trust & Kirklees Youth
Offending Team
Higgins Laura Board Certied Behaviour Analyst/ Service Manager, BILD
Hocken Dr Kerensa Cluster Lead Psychologist for Sexual Offending Strategy - Midlands, NOMS
Hollomotz Dr Andrea Lecturer, University of Leeds
Hughes Ben Head of Commissioning, Public Health and Wellbeing, Essex County Council
Hughes Clare Criminal Justice Manager, National Autistic Society
Hutchinson John Director, New Focus Preston
Inett Andy Consultant Forensic Psychologist, Psychology lead for low secure services (LD
and mental health), Kent and Medway NHS and Social Care Partnership Trust
Jennings Paul Mental Health Police Sergeant, Hampshire police
Kenny Danielle Senior Probation Ofcer, North Offender Management Unit, National Probation
Service
King David Director, Resolve Care
Lockett Karen Regional Head of Transforming Care (Midlands & East)
McConnell Elaine Chief Executive, Lucy Faithful Foundation
McCormick DCC Janette Cheshire Deputy Chief Constable
Mount Pam Clinical nurse specialist, Mersey Care
Murphy Prof Glynis Professor of Clinical Psychology & Disability, University of Kent; co-chair, SOTSEC-ID
Nagy Sheila Practice Manager, Lancs/Cumbria Sex Offender Resource Team,
National Probation Service NW Division
Nicholls Shelley Association of YOT Managers, (Nottingham YOT)
Norman Ann RCN Professional Nurse Adviser for Learning Disability and Nursing in Criminal
Justice Services
Rafferty Joe Chief Executive, Mersey Care NHS Foundation Trust
Sinclair Dr Neil Clinical Psychologist, Co-chair, SOTSEC-ID.
Smith Les PRT volunteer
Stewart Zandrea Director,SOLVE Social Care and Health, and ADASS associate
Talbot OBE Jenny Director, Care not Custody, Prison Reform Trust
Tancred Tania Senior Forensic Psychologist, NPS OPD Lead Kent, Surrey & Sussex
Walker Chris Editor, Learning Disability Practice, RCNi
Williams Matt Senior Project Worker, New Focus Preston
APPENDIX 3: A BRIEF OVERVIEW OF THE AUTISM ACT 2009
Written by Clare Hughes, Criminal Justice Manager, National
Autistic Society
The Autism Act 2009 was the rst disability-specic law in England,
and it did two things:
• It placed a duty on the Government to produce a strategy
for autistic people;
• It placed a duty on the Government to underpin the strategy
with statutory guidance for councils and the NHS
Both must be kept under review.
• 2010 – Fullling & Rewarding Lives (1st strategy and
statutory guidance was produced)
• 2014 – Think Autism 2nd (strategy was produced)
• 2015 - Updated statutory guidance
• 2016 – Progress Report on Think Autism
CJS ACTIONS WITHIN THINK AUTISM STRATEGY
• Ministry of Justice:
Establish a Cross-Government Group to consider and take
forward issues to do with autism and the criminal justice
system and report on progress to the Autism Programme
Board, including issues such as training and awareness,
screening, reasonable adjustments, and the use of IT
systems to better support people with autism. Consider
whether autism awareness training can be built into
the work of the new Institute of Probation, and, where
appropriate look to place relevant information in to the
Transforming Rehabilitation data room.
The group has been meeting since 2014 and has a good
representation from the different Government departments.
The Institute of Probation held several regional training
events, delivered in partnership with Key-Ring. In addition,
the Institute held an equality and diversity conference in
Bristol in 2015, which featured a workshop on addressing
the needs of autistic people.
• Home Ofce:
Work with the College of Policing to update and add to
their mental health e-learning training which includes
autism training for new police ofcers, look at evidence-
based advice for managing autism within justice settings,
and whether the markers on local police force systems used
for offenders with mental health or learning difculties can
be extended for those with autism.
The College of Policing launched their Mental Health
Approved Professional Practice (APP) in 2016, which
includes information about autism and learning disabilities.
Discussions are still taking place about the use of a marker,
33
which will cover a range of vulnerabilities, including autism.
The disability lead for the National Police Chief’s Council
has set up and oversees the ongoing work of the autism
Community of Practice. In February 2017, a joint DH, MoJ
and National Autistic Society (NAS) event was held to share
best practice in relation to autism and policing. In May 2017,
the NAS launched an autism guide for police ofcers and
staff funded by DH and supported by MoJ.
• National Offender Management Service (now Her Majesty’s
Prison and Probation Service) -
Examine and share good practice in prisons towards
prisoners with autism. Report back to the Autism
Programme Board on the impact that the mandatory
assessment of functional skills for all prisoners from August
2014 has had on identifying prisoners with autism.
The NAS have been working with a number of criminal
justice agencies to develop Autism Accreditation standards.
HMYOI Feltham became the rst prison to achieve
accredited status in 2015. The former Minister for Prisons,
Probation, Rehabilitation and Sentencing, Andrew Selous,
visited Feltham in March 2015 and subsequently wrote
to all prison governors and directors to encourage them to
consider working towards Autism Accreditation. A number
of prisons are now working towards Autism Accreditation
and pilots exist in probation, police forces and forensic
support services. Autism and learning difculties are
covered under the refreshed Young Offender Institution
training on working with young people in custody.
• Crown Prosecution Service
Develop an aide-memoire and support material for prosecutors,
highlighting key issues, implications for the prosecution process
and sources of support for people with autism.
The CPS launched their ‘autism checklist for prosecutors’
in 2015. The Checklist provides basic information and
signposting in relation to issues arising from a victim’s,
witness’s or defendant’s perspective. (Publicly available on
their website)
CJS ACTIONS WITHIN THINK AUTISM STATUTORY GUIDANCE
Local Authorities must:
• Under the Care Act, from April 2015, assess the care and
support needs of adults (including those with autism) who
may have such needs in prisons or other forms of detention
in their local area, and meet those needs which are eligible;
• Work with prisons and other local authorities to ensure that
individuals in custody with care and support needs have
continuity of care when moving to another custodial setting
or where they are being released from prison and back into
the community.
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It would be good practice for local authorities, in partnership with NHS
bodies and NHS Foundation Trusts:
• As the Liaison and Diversion approach is rolled out, to
connect with the local authority autism lead, relevant
community care assessment team(s), and local preventative
services with local Liaison and Diversion services.
NHS bodies and NHS Foundation Trusts should:
• Ensure that Liaison and Diversion services have a clear
process in place to communicate the needs of an offender
with autism to the relevant prison or probation provider;
• Ensure that in commissioning health services for persons
in prison and other forms of detention, prisoners are able to
access autism diagnosis in a timely way;
• and healthcare, including mental health support,
that takes account of the needs of people with autism.
Local Authorities, NHS bodies and NHS Foundation Trusts should:
• Seek to engage with local police forces, criminal justice
agencies and prisons to the training on autism that is
available in the local area; and
• Consider undertaking some joint training with police forces and
criminal justice services working with people with autism.
Local authorities also have to complete an autism self-
assessment framework (SAF) every 18 months and rate
themselves red, amber or green. The SAF covers a range of
issues including criminal justice.
The questions relating to their links and work with criminal justice
agencies are:
• Do staff in the local police/court/probation services engage
in autism awareness training?
• Are the Criminal Justice Services (police, probation and, if
relevant, court services) engaged with you as key partners
in planning for adults with autism?
• Is access to an appropriate adult service available for
people on the Autistic Spectrum in custody suites and
nominated 'places of safety?
This is still a challenge for many Local Authorities. Only 11%
of councils reported good joint working with CJS agencies
(almost two thirds had some discussions and had CJS agencies
attending their autism partnership board). Only 22% said that
appropriate adults were available and trained in autism.
NOTES
35
University of Leeds
Leeds, United Kingdom
LS2 9JT
