How HMP Feltham Young Offenders Institution became the world’s first autism-accredited prison
Dr Alexandra Lewis, a consultant forensic and child & adolescent psychiatrist, describes how coming into custody can exacerbate already high levels of distress for people with autism and what she and the team have done to help.
“I am a consultant psychiatrist for Barnet, Enfield and Haringey Mental Health NHS Trust and have spent more than a decade working in Feltham Young Offenders Institution (YOI), one of the largest in Europe. I am, therefore, experienced in working with distressed young people who have unexpectedly found themselves in custody.
Prison is a challenging environment for most people. It removes young people from their daily lives and forces them into a new routine and cohabitation with strangers. There is a loss of privacy and choice. Permission needs to be obtained for pretty much everything, even taking a shower or making a telephone call. The many rules that govern daily life in prison can seem confusing to a newcomer.
However, over the years I have become aware that certain prisoners seem to find custody disproportionately distressing and struggle greatly. These are people who have autism.
Autism is a lifelong developmental disability which affects social communication. The clinical expression of autism is not uniform but people typically experience difficulties or misunderstandings in their daily lives and find ordinary life far more stressful than most people.
The majority of studies have found there is an average or lower rate of offending among people on the autistic spectrum. However, it appears that people with autism are over-represented in the prison population. The reasons for this discrepancy are unclear and require further investigation.
Coming into custody can exacerbate already high levels of distress for people with autism. This can result in them exhibiting challenging behaviour and gaining less benefit from attempts at rehabilitation. It also means they can inadvertently end up disrupting the way the prison is run by taking up additional resources as prison staff have to spend more time with them.
I have found that the difficulties experienced by people with autism often result in them attracting attention within prison, although the reasons behind their difficulties may be unrecognised.
That’s why my colleague, Kim Turner, a Speech, Language and Communication Therapist, and I have run an autism diagnostic service at HMYOI Feltham since 2012. If we identify people with autism, we work with education and help staff develop individualised care plans to support them whilst in custody. Links are also made with services in the community to ensure ongoing care after release.
In early 2014 we audited our service and realised that, for us to improve standards of care further, it would be necessary to redesign autism management within the YOI from being primarily a mental health responsibility to an approach involving the whole prison.
With that idea in mind, we approached the National Autistic Society (NAS) and asked them to work with us to develop and implement standards and a framework for good practice to help support prisoners with autism within a custodial environment.
The NAS is the UK’s leading charity for people affected by autism. It has a well-established Autism Accreditation scheme, which provides an autism-specific quality assurance programme for organisations throughout the UK and internationally. Although the charity had previously worked with many different types of organisation, it had never before worked with a prison.
To our delight, the NAS expressed an enthusiasm for the project and this led to a very busy but rewarding 18 months as we worked together to develop and implement standards for good practice in supporting autistic prisoners.
The prison was divided into four interconnected areas for the purposes of the audit: Education, Mental Health, Primary Care and Discipline. It was agreed that each area would be audited separately and all four areas would need to meet the relevant standards in order for the prison to be accredited. Senior representatives from each area oversaw the development and implementation of the new standards. The project has led to the development of closer links between different departments within the prison which has had benefits that extend beyond this project.
Educational sessions and display boards were used to increase the awareness of all staff about autism and 25 staff members received a higher level of training and became ‘Autism Champions’ and now act as a resource for other staff.
Efforts were also made to increase autism awareness among prisoners. Awareness raising events took place in Education and the library. We also introduced autism awareness training for all Listeners (peer support workers) to improve their ability to recognise and support autistic prisoners.
At the end of 2015 the prison underwent an independent Autism Accreditation audit. We were successful and have been awarded Autism Accreditation status by the NAS. We are the first prison worldwide to achieve this!
As knowledge about the project has become widespread, we have been contacted by other prisons interested in learning from our experience. The work has also attracted Ministerial attention and Andrew Selous, the Prisons Minister, issued a statement encouraging all prisons to seek NAS Autism Accreditation (Ministry of Justice, 2015).”
Dr Alexandra Lewis is a consultant forensic and child & adolescent psychiatrist. She has worked at HMYOI Feltham for over a decade and has been responsible for many service developments during this period. She has received several quality awards for this work. She has a particular interest in autism and attention deficit hyperactivity disorder (ADHD) and has undertaken specialist training in these areas.
Dr Lewis completed her medical training in Scotland and undertook postgraduate training in psychiatry in Cambridge and at The Maudsley. She was a Visiting Fellow at McMaster University, Canada and previously worked as a consultant at Broadmoor Hospital. She has a Master’s degree in Mental Health Law, Policy & Practice (LLM) from Northumbria University and an MBA from Warwick Business School.
She is a member of the executive committee of the Adolescent Forensic Psychiatry Special Interest Group at Royal College of Psychiatrists where she leads on issues relating to young people in secure care. She served as a member of the CAMHS Secure Commissioning Reference Group between 2014–2016. She contributed to the development of the Intercollegiate Healthcare Standards for Children and Young Adults in Secure Settings and the Standards for Prison Mental Health Services (which provide the basis for the national Quality Network for Prison Mental Health Services).