At Change Grow Live’s south west prisons service, we see first-hand the impact that neurodivergent conditions can have on engagement with substance support. People in prison are disproportionately affected by neurodivergence, and many of them struggle to engage with or be reached by existing pathways. That’s why our team has been at the forefront of developing an innovative pathway for neurodivergent people to access support in prison settings. By making our services in prisons more accessible to neurodivergent people, they will feel more able to engage and to progress with their recovery.
As we enter a new phase of this project, we wanted to share the learnings we’ve gathered so far, and explore how these can create a roadmap for breaking down barriers and encouraging more people into life-changing support.
A 2021 evidence review into neurodiversity in the criminal justice system, led by HM Inspectorate of Prisons, suggested that more than 50 per cent of people in adult prisons had a neurodivergent condition. Since then, anecdotal estimates among professionals supporting neurodivergent prisoners believe this is more likely to be 70-80 per cent. This is compared to the 15-20 per cent of neurodivergent people living in the community.
Typically, neurodivergent service users have at some point interacted with the police and many get caught in a cycle of addiction, imprisonment and reoffending. In the south west this has led to a suite of innovative NHS commissioned initiatives aimed at improving health and justice outcomes for neurodivergent people.
In partnership with NHS England South West Region and Oxleas NHS Trust, Change Grow Live’s south west prisons team are proud to be leading a 12-month neurodiversity service redesign project to improve drug and alcohol access and support for neurodivergent people in ten prisons across the region. The project prioritises the needs of neurodivergent people, but also embraces principles of universal design that will help us to improve service accessibility on a wider scale.
The project builds on Change Grow Live’s organisation-wide commitment and celebration of neurodivergent service users, staff and volunteers. Recent investments include the development and implementation of a specialist ADHD diagnostic assessment pathway in Nottinghamshire for adults using substances within the criminal justice system.
At an organisational level, Change Grow Live has invested in building workforce capability to better understand and support neurodivergent people. This includes staff training, skill-share workshops and a dedicated neurodiversity staff/volunteer intranet page to share resources, personal stories and celebrate diversity.
Core commitment
At our south west prisons service, we’re now making sure this commitment is a core part of our approach. We’re being supported in this project by our partner Genius Within, a neurodiversity-led organisation with experience of working across the criminal justice system. The first phase of the project involved a comprehensive audit of key service delivery elements to identify barriers to access. This included assessments, recovery/clinical interventions, and Through the Gate processes and support for people leaving prison.
Through focus groups facilitated across four prisons, service users and staff spoke about the challenges they experience in accessing and delivering services. Service users told us they experienced stigma because of their substance use, and staff wanted more training and development opportunities to understand and support neurodivergent people.
Both groups told us about the impact of not having a diagnostic pathway in the prison system, particularly for ADHD. This included service users who had screened positively for ADHD but were unable to receive a more targeted clinical intervention (ie ADHD medication) without a diagnosis. Some service users told us this impacted their decision to use substances illicitly – they suggested this may be different if they took ADHD medication which could help them manage typical ADHD traits such as anger or difficulty relaxing.
At a national level, the scale of this problem is well evidenced, and untreated ADHD accounts for at least an estimated £11.7m annually in the criminal justice system. Some service users with ADHD and autism told us they didn’t feel comfortable accessing group programmes because they didn’t like being around lots of people. They said groups delivered in a classroom setting reminded them of difficult, and in some cases traumatic, experiences at school.
We also heard that some of the resources staff used to deliver targeted interventions, such as workbooks, could be ‘too wordy and confusing’ and there was too much jargon used to explain concepts like the stages of change. We collected our findings in a final report that identifies key learnings useful for project stakeholders and wider criminal justice and community drug and alcohol partners. Learnings include improved continuity of care pathways and community drug and alcohol support for neurodivergent people.
The report also includes a set of recommendations guiding phase 2 of the project – ‘design, test and learn’. This has guided us as we have developed a series of resources to help break down these barriers to support.
With the input of project representatives and lived experience experts, we are currently redesigning a suite of resources to support interventions and engagement with neurodivergent people. This includes a harm minimisation booklet that fits into a wallet, to support people with a poor working memory as they prepare for their release.
Our partners Genius Within are redesigning a set of ‘in cell’ workbooks usually completed by service users on their own or in a 1:1 with their allocated recovery worker. The redesigned resource will support harm minimisation education while also providing engaging and interactive distraction-based activities and tools. This targets service users who are unable to access groups, and responds to the many service users who told us how much they enjoy distraction packs. Each resource is tested with service users to check how effective it is before its inclusion within the finalised and improved pathway – and we will continue to explore new ways to engage with the people.
We will also be rolling out bespoke, face-to-face training to staff within each of the ten prisons, to ensure the redesigned pathway can be properly embedded into the way prisons support people. The training will equip staff with a better understanding of neurodivergent conditions, as well as build practical skills to engage and deliver interventions to neurodivergent service users.
Next steps
The third and final phase of the project will evaluate the outcomes and impact of the new pathway. We will then share our learnings via a regional roadshow, showcasing redesigned resources and best practice ‘top tips.’ We believe that sharing our learnings and contributing to system-wide change are a key part of our commitment to ensuring life-changing support is available to anyone who needs it.
If you’d like to find out more about our work creating a new neurodiversity pathway, our roadshow dates, or any other project updates, we would be glad to hear from you. Please email: elaine.wilcock@cgl.org.uk
Many neurodivergent people in prison have never been educated about their condition or how it impacts their emotions, feelings and the way they communicate. They struggle their whole lives to fit into a society that has been built for neurotypical people. Without any reasonable adjustments in place to help them navigate this neurotypical world, many people start using drugs and alcohol early in life to try and numb the impact of their unsupported neurodivergent condition.
(picture Mark Harvey / Alamy)