Learning Disability Today
Supporting professionals working in learning disability and autism services

Institutions without exits: prison and learning disability

Much of the work on people with learning disabilities and the criminal justice system focuses on keeping them out of prison; on ensuring that their needs are met and they are equipped with appropriate adults in police custody and in court, and so on. But inevitably, a number do end up (rightly or wrongly) in prison. And indeed, they often come back to prison again.

At every stage, it’s all too probable that they do not get the support they should have – or indeed that their learning disability is not recognised at all.

The prisons and probations inspectorates are completing an independent evidence review  into neurodiversity (including learning disability) in the criminal justice system, which is due to publish its final report later this year. There is certainly a lot to tackle.

Beneath the radar

To start with, some of the basic information isn’t available. The actual prevalence of learning disability in UK prisons is not clear – and it also depends on the way it’s defined. The Ministry of Justice estimates it as five to 10% of the prison population; others suspect it is a third or more, if the definition includes people with a cognitive impairment (which may include acquired brain injury) that impacts on their ability to understand and communicate.

An additional issue is that these are people whose learning disability is relatively mild – it may not be identified without specific screening. In fact some may never been diagnosed at all, while others may not wish to disclose it because they do not want the stigma. Most have been living without support. “Social services teams would say that they can wash, dress, cook and shop, and just about budget. But actually these are also people who get themselves into terrible tangles,” explains Glynis Murphy, who is the Professor of Clinical Psychology and Disability at the University of Kent.

“The people we work with are very rarely the instigator for an offence; they’re the ones that get caught, or duped into being the lookout while a place gets burgled, and then without the insight to get themselves out of the interview,” says Tony Bowman of the Association for Real Change (ARC) Scotland, which leads the Supporting Offenders with Learning Disabilities (SOLD) Network in partnership with People First Scotland

“If they have behaviours that put them at risk of going to prison, whether they do go or not is incredibly arbitrary. It depends a lot on who the victims were,” Murphy adds.

If they are in with the mainstream prison population, without support, it is often a struggle. “For many people with a learning disability, prison is even harder for them than for the other prisoners,” says Jenny Talbot of the Prison Reform Trust. Prisons are full of rules, regimes and systems; and anything from a phone call to a visit to a medical appointment requires filling in forms. As a result, a lot of go without visits or medical care. They will also break prison rules that they didn’t even know existed.

Hardly surprisingly, Talbot points out, they find the whole experience frightening. “We know, for example, that prisoners with learning disabilities are more likely than other prisoners to be clinically significantly more anxious in prison.” 

Specialist services in prisons

Some people’s learning disabilities are identified – sometimes for the first time; and, if they’re lucky, get support. Sometimes this is as simple as staff who understand and offer help with the confusing things that prison brings up; at other times they receive specialist support. A small number of prisons have ‘therapeutic communities’ specifically for people with learning disabilities, where they can address ‘offence related risk and associated personality and psychological problems’; a few, like HMP Dovegate, have dedicated learning disability nurses. Some have specific dedicated areas (which may also include people with autism and/or other vulnerabilities).

HM Prison and Young Offenders’ Institution Parc in Bridgend, Wales (which is managed by G4S Health Services) screens prisoners on arrival. The prison has a dedicated unit for people who have learning disabilities, autism spectrum conditions and acquired brain injuries, complete with education programmes and activities as well as a sensory room, and the team working on the Cynnwys unit has also worked with other prison staff to educate them about this cohort.

Since it opened, the rates of violent incidents in the prison have dropped by a third and self-harm by three-quarters; and equally importantly, the number of adjudication hearings in the prison for people who have broken rules (which may affect their parole) have decreased by a quarter.

“In fairness, when someone is diagnosed things are put in place,” says Bowman. “But there’s a large cohort who are not identified.” There is also very little provision for what happens after a prisoner’s sentence finishes.

The outside world

Again, there is some good practice in this area. Some prisons with provision for learning disability have good links with the services outside, both statutory and voluntary. But there is not much known about how life after prison works out in practice. Murphy and colleagues have produced some of the studies that do exist, finding that the former prisoners they interviewed were often ‘under-occupied, with limited social networks’, and very prone to anxiety and/or depression. They felt they were not getting support and many had been reinterviewed by police. 

“There’s also a problem with institutionalisation, with people becoming dependent on the routine and reoffending to get back into what they perceive as a safe place,” Bowman points out. “I think what often happens is people are given phone numbers to ring, but if you have a learning disability that doesn’t really work. You need someone practically alongside you.” He adds: “A steady relationship and a paid job are key factors in not reoffending, but there’s huge levels of exclusion for people with learning disabilities. We shouldn’t be surprised when people transgress.”

Supporting prisoners with learning disabilities

The people working in this area advocate not just more support for former or potential prisoners, but also more community support overall. Murphy has been instrumental in establishing NHS England’s community learning disability forensic support services, which now operate in a number of different areas. These work with people with a learning disability and/or autism who display challenging behaviours that have either led them already into contact with the criminal justice system, or could potentially do so.

At the same time, she feels that community learning disability teams should widen their criteria, pointing out that in teams that do this people are generally very grateful for the opportunity to seek help if they run into difficulties. “I think the most important thing is that people with mild learning disabilities are very often not considered eligible for support from social services or health teams.”

“If people are living in the community they have the same rights and freedoms and also responsibilities as everyone else,” Talbot concludes. “However, if they don’t fully understand them they are at greater risk of coming into contact with the criminal justice system. When they do, everyone should get a referral to the community learning disability team, and that early intervention can prevent escalation. And while people shouldn’t be kept out of prison on the grounds of disability alone, there’s a lot that could be done to provide robust and effective community sentencing instead –and that applies to the whole prison population too. We’d be much better off if we looked at every prisoner’s individual’s needs, and try to provide the support they require.”    


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