1
|
Lunsky Y, Matheson FI, Kouyoumdjian F, Whittingham L, Lin E, Durbin A, Calzavara A, Moser A, Dastoori P, Sirotich F, Volpe T. Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:197-207. [PMID: 38264949 DOI: 10.1002/cbm.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. AIMS The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. METHODS This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. RESULTS Adults with IDD were over-represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co-occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. CONCLUSIONS Establishing a population-based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement.
Collapse
Affiliation(s)
- Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Flora I Matheson
- ICES, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Whittingham
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Child and Youth Studies, Brock University, St. Catharines, Ontario, Canada
| | - Elizabeth Lin
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anna Durbin
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | | | - Andrea Moser
- Research Branch, Correctional Service Canada, Ottawa, Ontario, Canada
| | - Parisa Dastoori
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto Branch, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Tiziana Volpe
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Love AMA, Gibbs V, Cooper D, Benevides TW, Mogavero MC, Basketbill IL, Shea LL. Creating the Global Criminal Justice Survey: A Questionnaire Designed to Gather Perspectives from the Autism Community and Criminal Justice Professionals. J Autism Dev Disord 2024; 54:1425-1437. [PMID: 36637593 PMCID: PMC9838505 DOI: 10.1007/s10803-022-05835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/14/2023]
Abstract
Autistic people's perceptions of their interactions with criminal justice professionals are predominantly negative; however, little is known about the state of interactions on a global scale. To further understanding, a comprehensive stakeholder questionnaire was created. Aspects of reliability and validity including evidence for test content and internal structure were gathered using expert reviews, cognitive interviewing, pilot data collection, and a larger data collection effort (N = 1618). Data was gathered from the autism community through perspectives of parents/caregivers as well as from self-reported autistic adults. Criminal justice professionals included law enforcement officers, corrections professionals, probation and parole officers, forensic psychologists and legal professionals. The scale development process was detailed in order to sufficiently document the initial psychometric evidence and share the steps taken to gain diverse stakeholder input. This study is a critical first step in generating further information to facilitate policy and program development with wide applicability.
Collapse
Affiliation(s)
- Abigail M. A. Love
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Chatswood, NSW Australia
| | - Vicki Gibbs
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Chatswood, NSW Australia
| | - Dylan Cooper
- Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Teal W. Benevides
- Institute of Public and Preventive Health, Augusta University, Augusta, GA USA
| | | | | | - Lindsey L. Shea
- Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| |
Collapse
|
3
|
Wigham S, Ingham B, Le Couteur A, Wilson C, Ensum I, Parr JR. A survey of autistic adults, relatives and clinical teams in the United Kingdom: And Delphi process consensus statements on optimal autism diagnostic assessment for adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1959-1972. [PMID: 35168407 PMCID: PMC9597166 DOI: 10.1177/13623613211073020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
LAY ABSTRACT Living with undiagnosed autism can be distressing and may affect mental health. A diagnosis of autism can help self-awareness and self-understanding. However, it can be difficult for adults to access an autism assessment. Clinicians also sometimes find it hard to identify autism in adults. This may mean an autism diagnosis is delayed or missed. In this study, we asked autistic adults, relatives and clinicians how to improve this. The study was in two stages. In the first stage (stage 1), 343 autistic adults and 45 relatives completed a survey. In the survey, we asked questions about people's experiences of UK autism assessment services for adults. Thirty-five clinicians completed a similar survey. Clinicians reported that some autism assessment teams lacked key professionals, for example, psychologists and occupational therapists. We used the information from the three separate surveys to create 13 statements describing best autism assessment services for adults. In stage 2, we asked clinicians for their views on the 13 statements. Clinicians agreed with 11 of the statements. Some autistic adults, relatives and clinicians were positive about autism assessment services, and many also described areas that could be improved. The study findings can be used to improve UK adult autism assessment services and may be helpful for service developments worldwide.
Collapse
Affiliation(s)
- Sarah Wigham
- Population Health Sciences Institute,
Newcastle University, UK
| | - Barry Ingham
- Population Health Sciences Institute,
Newcastle University, UK
- Cumbria, Northumberland, Tyne and Wear
NHS Foundation Trust, UK
| | - Ann Le Couteur
- Population Health Sciences Institute,
Newcastle University, UK
| | - Colin Wilson
- Population Health Sciences Institute,
Newcastle University, UK
| | - Ian Ensum
- Bristol Autism Spectrum Service, Avon
and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Jeremy R Parr
- Population Health Sciences Institute,
Newcastle University, UK
- Cumbria, Northumberland, Tyne and Wear
NHS Foundation Trust, UK
| |
Collapse
|
4
|
Bayliss LT, Christensen S, Lamont-Mills A, du Plessis C. Suicide capability within the ideation-to-action framework: A systematic scoping review. PLoS One 2022; 17:e0276070. [PMID: 36301944 PMCID: PMC9612581 DOI: 10.1371/journal.pone.0276070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide capability is theorised to facilitate the movement from suicidal ideation to suicide attempt. Three types of contributors are posited to comprise suicide capability: acquired, dispositional, and practical. Despite suicide capability being critical in the movement from ideation-to-attempt, there has been no systematic synthesis of empirical evidence relating to suicide capability that would enable further development and refinement of the concept. This study sought to address this synthesis gap. A scoping review was conducted on suicide capability studies published January 2005 to January 2022. Eleven electronic databases and grey literature sources were searched returning 5,212 potential studies. After exclusion criteria application, 90 studies were included for final analysis. Results synthesis followed a textual narrative approach allocating studies based on contributors of suicide capability. Most studies focused on investigating only one factor within contributors. Painful and provocative events appear to contribute to acquired capability more so than fearlessness about death. Whilst emerging evidence for dispositional and practical contributors is promising, the small number of studies prevents further conclusions from being drawn. An unexpected additional cognitive contributor was identified. The focus of a single factor from most studies and the limited number of studies on contributors other than acquired capability limits the theoretical development and practical application of suicide capability knowledge. Given that suicide is a complex and multifaceted behaviour, future research that incorporates a combination of contributors is more likely to advance our understandings of suicide capability.
Collapse
|
5
|
Chaplin E, Lord Keith Bradley TRH, McCarthy J, Forrester A. Court liaison and diversion services for people with neurodevelopmental conditions: A House of Lords consensus meeting. MEDICINE, SCIENCE, AND THE LAW 2022; 62:252-253. [PMID: 35989653 DOI: 10.1177/00258024221121620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | | | | | - Andrew Forrester
- Cardiff University - Division of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
| |
Collapse
|
6
|
Chaplin E, McCarthy J, Ali S, Marshall-Tate K, Xenitidis K, Harvey D, Childs J, Srivastava S, McKinnon I, Robinson L, Allely CS, Hardy S, Tolchard B, Forrester A. Severe mental illness, common mental disorders, and neurodevelopmental conditions amongst 9088 lower court attendees in London, UK. BMC Psychiatry 2022; 22:551. [PMID: 35962427 PMCID: PMC9373383 DOI: 10.1186/s12888-022-04150-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Court Mental Health Liaison and Diversion Services (CMHLDS) have developed in some countries as a response to the over-representation of mental illness and other vulnerabilities amongst defendants presenting to criminal justice (or correctional) systems. This study examined the characteristics and rates of mental disorder of 9088 defendants referred to CMHLDS. METHOD The study analysed service level data, obtained from the National Health Service's mental health data set, to examine characteristics relating to gender, ethnicity and comorbidity of common mental and neurodevelopmental disorders at five CMHLDS across London between September 2015 and April 2017. RESULTS The sample included 7186 males (79.1%) and 1719 females (18.9%), the gender of 183 (2%) were not recorded. Of those referred, 6616 (72.8%) presented with an identifiable mental disorder and 503 (5.5%) with a neurodevelopmental disorder (NDD). Significantly higher rates of schizophrenia were reported amongst Black defendants (n = 681; 37.2%) and Asian defendants (n = 315; 29%), while higher rates of depression were found amongst White defendants (n = 1007; 22.1%). Substance misuse was reported amongst 2813 defendants (31%), and alcohol misuse amongst 2111 (23.2%), with significantly high rates of substance and alcohol misuse amongst defendants presenting with schizophrenia or personality disorder. CONCLUSIONS This is one of the largest studies to examine mental health needs and vulnerabilities amongst defendants presenting to CMHLDS. It will enable an improved understanding of the required service designs and resources required to manage the healthcare pathways for people attending CMHLDS.
Collapse
Affiliation(s)
- Eddie Chaplin
- Institute of Health and Social Care, London South Bank University, London, UK.
| | - Jane McCarthy
- grid.13097.3c0000 0001 2322 6764University of Auckland, New Zealand & Visiting Senior Lecturer, King’s College London, London, UK
| | - Salma Ali
- grid.4756.00000 0001 2112 2291Institute of Health and Social Care, London South Bank University, London, UK
| | - Karina Marshall-Tate
- grid.4756.00000 0001 2112 2291Institute of Health and Social Care, London South Bank University, London, UK ,South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Denise Harvey
- grid.4756.00000 0001 2112 2291Institute of Health and Social Care, London South Bank University, London, UK
| | - Jessica Childs
- grid.4756.00000 0001 2112 2291Institute of Health and Social Care, London South Bank University, London, UK ,Together for Mental Wellbeing, London, UK
| | | | - Iain McKinnon
- grid.1006.70000 0001 0462 7212Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- grid.5379.80000000121662407Manchester University, Manchester, UK
| | - Clare S. Allely
- grid.8752.80000 0004 0460 5971Reader in Forensic Psychology at the University of Salford, Manchester, UK ,grid.8761.80000 0000 9919 9582Affiliate member of the Gillberg Neuropsychiatry Centre at Gothenburg University, Gothenburg, Sweden ,grid.8756.c0000 0001 2193 314XHonorary Research Fellow in the College of Medical, Veterinary and Life Sciences affiliated to the Institute of Health and Wellbeing at the University of Glasgow, Glasgow, UK
| | - Sally Hardy
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich, UK
| | - Barry Tolchard
- grid.26597.3f0000 0001 2325 1783Teesside University, Middlesbrough, UK
| | - Andrew Forrester
- grid.5600.30000 0001 0807 5670Forensic Psychiatry, Cardiff University, Cardiff, UK
| |
Collapse
|
7
|
Canada K, Barrenger S, Bohrman C, Banks A, Peketi P. Multi-Level Barriers to Prison Mental Health and Physical Health Care for Individuals With Mental Illnesses. Front Psychiatry 2022; 13:777124. [PMID: 35722588 PMCID: PMC9203858 DOI: 10.3389/fpsyt.2022.777124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives People with mental illnesses are overrepresented in the U.S. prison population. It is well established that incarceration for this population poses physical and mental health risks including greater likelihood of victimization and suicide compared to the general prison population. Yet, research is less clear about how staff and services shape these prison experiences. The aim of this study was to examine how people with mental illnesses experience incarceration through interactions with correctional officers and treatment staff and their use of physical and mental health care services. Methods This project utilized a non-experimental design and qualitative research approach to address the research aims. Adults with mental illnesses who were formerly incarcerated were recruited from three different sites in the Midwest and East Coast. Participants completed an in-depth interview and brief survey on health histories. Data were analyzed using descriptive statistics and the framework method for qualitative analysis. Results Participants (n = 43) identified challenges to utilizing health and mental health care including perceived access and quality of mental health, medical, or substance use treatments obtained during prison as well as participant's willingness to engage in services. Access to health care was marked by cumbersome procedures required for service use requests and inadequate staffing. Participants reported mixed experiences with medical and mental health staff ranging from experiencing kindness to feeling staff did not believe them. Participants perceived most correctional officers as exhibiting professionalism while some enacted stigma and created additional stressors. Conclusion Interactions with correctional staff and health care services have the potential to buffer the stressors and risks inherent in prisons for people with mental illnesses. Perceptions from participants suggest both individual- and systems-level opportunities for intervention to better support people with mental illnesses in prison.
Collapse
Affiliation(s)
- Kelli Canada
- School of Social Work, University of Missouri, Columbia, MO, United States
| | - Stacey Barrenger
- Psychiatry, Northeast Ohio Medical University, Rootstown Township, OH, United States
| | - Casey Bohrman
- School of Social Work, West Chester University, West Chester, PA, United States
| | - Anthony Banks
- School of Social Work, University of Missouri, Columbia, MO, United States
| | - Punita Peketi
- Psychiatry, Northeast Ohio Medical University, Rootstown Township, OH, United States
| |
Collapse
|
8
|
Slavny‐Cross R, Allison C, Griffiths S, Baron‐Cohen S. Autism and the criminal justice system: An analysis of 93 cases. Autism Res 2022; 15:904-914. [PMID: 35289115 PMCID: PMC9314022 DOI: 10.1002/aur.2690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 01/17/2023]
Abstract
We investigate whether autistic people's vulnerability is taken into account at each stage of the criminal justice system (CJS). Defense lawyers from 12 nations were included in the study although the sample was predominantly from the UK. Lawyers completed an online survey regarding one case in which they had defended an autistic client between January 2015 and January 2020; and on one case in which they had defended a nonautistic client charged with a similar offense, to provide a comparison group. Ninety-three lawyers (85% in the UK) reported on one autistic case, and 53 also reported on one nonautistic case. 75% of autistic clients were not given reasonable adjustments during the process. Only 43% were offered an appropriate adult during police investigations, even though they had an existing diagnosis of autism. 59% of prosecution barristers and 46% of judges said or did something during the trial that made the lawyers concerned that they did not have an adequate understanding of autism. Lawyers were 7.58 times more likely to be concerned about their autistic client's effective participation in court and were 3.83 times more likely to be concerned that their autistic clients would engage in self-harm, compared with their nonautistic clients. There is a failure to identify and address autistic peoples' disability within the CJS. There is a need for mandatory autism training for police officers and the judiciary, with a focus on identifying autism and understanding the needs of autistic people so that reasonable adjustments are offered in all cases. LAY SUMMARY: This study sought to investigate if the needs of autistic people are being overlooked by the police and other professionals within the CJS. Results show that autistic people are not always given the support they need during police questioning or in court. The experience of being involved with the police may also have a more negative impact on autistic peoples' mental health than that of nonautistic people.
Collapse
Affiliation(s)
- Rachel Slavny‐Cross
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Carrie Allison
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Sarah Griffiths
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
- Psychology and Language SciencesUniversity College LondonLondonUK
| | - Simon Baron‐Cohen
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| |
Collapse
|
9
|
Cooper DS, Uppal D, Railey KS, Blank Wilson A, Maras K, Zimmerman E, Bornman J, Shea LL. Policy gaps and opportunities: A systematic review of autism spectrum disorder and criminal justice intersections. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1014-1031. [DOI: 10.1177/13623613211070341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autism spectrum disorder prevalence is rising, and as this population enters adulthood, preliminary research has identified high rates of contact with the criminal justice system. Policy and programmatic reform are crucial given reported negative and violent outcomes for autistic individuals when encountering the criminal justice system. Given the size and scope of the entire criminal justice system, identifying priorities and opportunities for change is critical, and must be rooted in evidence-based findings to maximize impact and scalability. This article provides a systematic review of the literature on autism spectrum disorder and criminal justice system intersections, analyzed through a convergent qualitative synthesis. As the extant literature is diverse and employs a variety of study methods, this review allows for an analysis across study types. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis structure was utilized and captured 89 total articles from six databases. Studies are grouped by the Sequential Intercept Model, which offers a framework for analyzing criminal justice system dimensions, and informs where research at the intersection of autism spectrum disorder and the criminal justice system is most prevalent. Themes were identified at each intercept and described through key study findings to articulate implications and guidance for policy, practice, and future research to promote equitable justice for autistic individuals. Lay abstract The number of people with autism spectrum disorder has increased, and as this population ages, research is showing high rates of contact with the criminal justice system among this group. Social and communication differences that autistic individuals experience can act as a risk factor during these interactions, as shown by public reports of negative and violent encounters between autistic individuals and the law enforcement. There is a clear need for evidence-based strategies to reduce high rates of contact and to improve outcomes when an interaction occurs. This article provides a systematic review of research on autism spectrum disorder and criminal justice system to compile this evidence base. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis structure was used to identify 89 articles after searching six databases. The Sequential Intercept Model describes the criminal justice system as different stages, or intercepts, that are connected, and the Sequential Intercept Model serves as an overall framework to organize the included articles. Articles were analyzed to identify research themes at each intercept, which offer guidance for policy and program changes that support equitable justice for autistic individuals.
Collapse
Affiliation(s)
| | - Disha Uppal
- A.J. Drexel Autism Institute, Drexel University, USA
| | | | | | | | | | | | | |
Collapse
|
10
|
Chaplin E, McCarthy J, Marshall-Tate K, Ali S, Xenitidis K, Childs J, Harvey D, McKinnon I, Robinson L, Hardy S, Srivastava S, Allely CS, Tolchard B, Forrester A. Evaluation of a liaison and diversion Court Mental Health Service for defendants with neurodevelopmental disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104103. [PMID: 34628339 DOI: 10.1016/j.ridd.2021.104103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
AIM Neurodevelopmental disorders (NDD) may present as neuropsychiatric problems as well as impairments of motor, cognitive, social and communication functioning. This study describes the introduction of a specialist service with expertise in NDD into an existing court mental health liaison and diversion service to determine if the service would impact on the health needs or disposal outcomes of defendants. METHODS We examined referrals of defendants with NDD disorders over 30-months at a London Magistrates' Court. The pre-existing Court Mental Health (CMH) service was enhanced to provide additional expertise and hereafter referred to as the CMH + NDD Service. Baseline data including gender, ethnicity, remands and the rates of mental disorders was collected from the CMH Service using the existing minimum mental health service dataset. This was compared with data collected from the CMH + NDD Service. RESULTS We found the following rates of NDD 9.5 % (n = 43) for the CMH service, and 9.5 % (n = 79) for the CMH + NDD service. Although overall the rates were the same the number of defendants with a single NDD diagnosis was increased in the CMH + NDD service with ADHD 10 %, ASD and ID 4% higher, the rates of comorbid NDD decreased in the CMH + NDD service compared to baseline. Specific disorders such as depression were recorded at higher rates for NDD defendants in both phases, however, this did not reach significance. In contrast, schizophrenia and delusional disorders, alcohol and substance use were observed at much higher in the non-NDD defendants during both phases of the study. The rates of diagnosis of schizophrenia and delusional disorders increased for the NDD group within the CMH + NDD service. Following the first court appearance, there was a 10 % reduction in custodial remands for defendants with NDD who were seen by the CMH + NDD service (34.2 %, n = 25 in the CMH + NDD service vs 43.8 %, n = 14 in the CMH service). CONCLUSION The study found it is possible to successfully integrate practitioners with expertise of NDD into existing liaison and diversion services. This service enhancement demonstrated modest evidence of service effectiveness, including an increase in the detection of comorbid mental illness and a reduction in custodial remands for defendants with NDD. Further work needs to be completed to examine how this model can be rolled out across multiple courts and in particular, a cost-benefit analysis is required to understand whether an approach involving a cluster of Courts, as opposed to a single site is the most effective approach for this group of defendants.
Collapse
Affiliation(s)
- Eddie Chaplin
- London South Bank University Institute of Health and Social Care, United Kingdom.
| | - Jane McCarthy
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karina Marshall-Tate
- London South Bank University Institute of Health and Social Care, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Salma Ali
- Newcastle University, United Kingdom
| | | | - Jessica Childs
- London South Bank University Institute of Health and Social Care, United Kingdom
| | - Denise Harvey
- London South Bank University Institute of Health and Social Care, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
11
|
McCarthy J, Chaplin E, Hayes S, Søndenaa E, Chester V, Morrissey C, Allely CS, Forrester A. Defendants with intellectual disability and autism spectrum conditions: the perspective of clinicians working across three jurisdictions. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2021; 29:698-717. [PMID: 36148388 PMCID: PMC9487969 DOI: 10.1080/13218719.2021.1976297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The treatment of vulnerable defendants by criminal justice systems or correctional systems varies within and between countries. The purpose of this paper is to examine three legal jurisdictions - New South Wales in Australia; Norway; England and Wales - to understand the extent of variation in practice within the court systems for defendants with intellectual disabilities (ID) and/or autism spectrum conditions (ASC). Two of the jurisdictions had a process for screening in place, either in police custody or at court, but this was not universally implemented across each jurisdiction. All three jurisdictions had a process for supporting vulnerable defendants through the legal system. Across the three jurisdictions, there was variation in disposal options from a mandatory care setting to hospital treatment to a custodial sentence for serious offences. This variation requires further international exploration to ensure the rights of defendants with ID or ASC are understood and safeguarded.
Collapse
Affiliation(s)
- Jane McCarthy
- Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eddie Chaplin
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Susan Hayes
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Erik Søndenaa
- Faculty of Medicine, Institute of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Forensic Department, St.Olavs Hospital, Trondheim, Norway
| | - Verity Chester
- Hertfordshire Partnership University NHS Foundation Trust, Little Plumstead Hospital, Hospital Road, Norwich, UK
| | - Catrin Morrissey
- Lincolnshire Partnership NHS Foundation Trust and University of Nottingham, Nottingham, UK
| | - Clare S. Allely
- School of Health and Society, Salford University, Salford, UK and affiliate member of the Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrew Forrester
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| |
Collapse
|
12
|
Chaplin E, McCarthy J, Allely CS, Forrester A, Underwood L, Hayward H, Sabet J, Young S, Mills R, Asherson P, Murphy D. Self-harm and Mental Health Characteristics of Prisoners with elevated rates of autistic traits. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 114:103987. [PMID: 34004498 DOI: 10.1016/j.ridd.2021.103987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/09/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prevalence studies among prisoners have found rates of 1-4% for autism spectrum disorder (ASD) or autistic traits. However, little is known about those prisoners with high levels of autistic traits. AIM This aim of this study was to compare the mental health characteristics of prisoners with autistic traits with neurotypical prisoners not screening positive for neurodevelopmental disorders. METHOD The study recruited 240 male prisoners from a London prison and screened for autism spectrum disorder using the Autism Quotient (AQ) 20 and 10, and Autism Diagnostic Observation Schedule (ADOS). The Mini International Neuropsychiatric Interview was used to assess for depression, anxiety, self-harm behavior and suicide. RESULTS Screening using the AQ identified 46 prisoners with significant autistic traits, with 12 meeting the diagnostic threshold for ASD using the ADOS. Those screening positive with autistic traits were significantly more likely to have thought about self-harm and suicide in the past month than neurotypical prisoners and have a comorbid mental disorder. They were also significantly more likely to report having attempted suicide during their lifetime compared to neurotypical peers at a rate of 64.9 % compared to 11.6 % for the neurotypical prisoners. CONCLUSION Prisoners with elevated levels of autistic traits were more likely to report self-harm, suicidal thoughts and were more vulnerable to a range of mental disorders than neurotypical prisoners. There is a need for more evidence on the experience of autistic prisoners to inform how pathways should work to improve health outcomes through increased awareness and access to screening and subsequent diagnosis which currently prisons are currently not set up for.
Collapse
Affiliation(s)
- Eddie Chaplin
- London South Bank University Institute of Health and Social Care, United Kingdom.
| | - Jane McCarthy
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | - Lisa Underwood
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | | | | | | | | |
Collapse
|
13
|
Corrigendum. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2020; 30:281. [PMID: 33044784 DOI: 10.1002/cbm.2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|