Other needs

Other needs

The following needs have a high prevalence amongst adults and young people in contact with the criminal justice system.  These needs can directly and/or indirectly contribute to mental health need and may act as barriers to accessing mental health support.  Some people’s needs may be considered ‘sub-threshold’ in isolation and not meet the criteria for support. However, when multiple needs are present, the level of complexity and need can be high (NACRO (National Association for the Care and Resettlement of Offenders), 2010).

Speech, language and communication needs

Speech, language and communication needs (SCLN) include problems with remembering information, expressing feelings, understanding written and spoken language (Royal College of Speech and Language Therapists, 2015). Although SLCN are not a mental health condition, when this need goes unmet it can have strong implications for mental health.

Reasons include poor educational attainment, difficulties managing emotions, difficulties accessing mental heatlh support and being more likely to become involved in criminal activity.

Figure 30: Reasons why people with SLCN may have poor mental health.

  • Half of all children with unrecognised SLCN go on to become involved in criminal activity (Bryan et al., 2015).
  • People with SLCN are more likely to have difficulties establishing positive peer relationships and to have a lower level of educational attainment, both of which are risk factors for poor mental health (Bryan et al., 2015).
  • Language skills are essential for interacting with others and managing emotions (Morken et al., 2021).
  • People with SLCN may not fully understand their sentence, potentially making them more likely to breach their sentence requirements (Youth Justice Board, 2015).
  • SLCN may act as barriers to accessing support: 40% of offenders are unable, or find it difficult, to access interventions that are verbally mediated, such as anger management and drug rehabilitation courses (Royal College of Speech and Language Therapists, 2015).
How many adults are affected?

80% of adults in prison have SCLN (McNamara, 2012). Comparatively, around 5 to 15% of the general population have SLCN (Bryan et al., 2015).

How many young people are affected?

The prevalence of SLCN in youth offender institutions in Cambridgeshire and Peterborough is thought to be around 75% (Roberts et al., 2020). 1 in 3 children who do not receive support for their SLCN develop mental health problems (Bryan et al., 2015). Their needs often go unrecognised (Bryan et al., 2015), and they are often misdiagnosed with conduct disorders or behavioural problems (Youth Justice Board, 2015).

Neurodiversity

  • The prevalence of neurodiverse conditions amongst people in prison is likely to be substantially higher than in the general population, with estimates ranging from 20 to 50% [(Criminal Justice Joint Inspectorate, 2021b),(Rack, 2005)]. A review of evidence found there was a lack of reliable assessment of levels of neurodiverse conditions, and of the needs of specific sub-populations, at both a local and national level (Criminal Justice Joint Inspectorate, 2021b).
  • Children with neurodevelopmental conditions may not have the language to understand or describe the difficulties they face in dealing with their feelings and symptoms, which can spill out into challenging behaviour. Without support, these behaviours can become more problematic as they grow up (N. Hughes & Williams, 2012).
  • Unmet needs relating to neurodiversity are likely to have a negative impact on factors which are important to mental health:
    • One survey of adult men prison found that those who had ADHD, autism or learning disabilities were over 3 times more likely to have been homeless before entering prison and over twice as likely to have been unemployed, compared to their peers. Over 80% had a previous conviction or had previously spent time in prison (Mccarthy et al., 2016).
    • Due to a lack of understanding around autism, autistic people in prison are at a higher risk of over-medicalisation, bullying, seclusion, and restraint (Durcan, 2020).
    • People leaving prison who take medication to manage their ADHD symptoms are 30% less likely to reoffend (Lichtenstein et al., 2012).
  • Many neurodivergent people in prison are unable to access support, with one survey of people in contact with the criminal justice system finding that (User Voice, 2021):
    • Only 34% of had been screened for neurodiverse conditions.
    • 70% of people who were neurodivergent did not had any adjustments put in place to support their neurological needs.
How many adults are affected?

One survey of adult men in prison estimated that (S. Young et al., 2018): 25% had ADHD, 9% had a learning disability, and 9% were autistic. Other studies estimate 2 to 4% of adults in prison are autistic (Durcan, 2020).

How many young people are affected?

One study found that 43% of young people in prison had ADHD, compared to 3 to 4% of the general population (S. J. Young et al., 2011). Another study estimates that 15% of people in youth custody are autistic, compared to around 1% of the general population (N. Hughes & Williams, 2012)

Low literacy and numeracy skills

Figure 31: Literacy and numeracy skills of people entering prison, and the links to mental health. Data sources: (Prison Reform Trust, 2021),(Ofsted, 2022)

Information about mental health services in prison is often inaccessible to people with low literacy skills (Justice Committee, 2021). People with low literacy skills are also likely to find it difficult to navigate healthcare services after leaving prison, such as registering with a GP (Ofsted, 2022).

How many adults are affected?

One survey of a UK adult prison found that whilst 1 in 3 people had literacy difficulties. The majority did not show signs of specific learning difficulties such as dyslexia; instead these difficulties were thought to result from social and experiential factors (Rack, 2005).

How many young people are affected?

1% of young men entering custody have the literacy skills expected of a 7-year-old (Campbell & Abbott, 2013).

Traumatic brain injury

Traumatic brain injury (TBI) is a physical brain injury that results from an external force, such as a physical assault, fall or car crash (W. H. Williams et al., 2018).  Experiencing a TBI is associated with higher levels of impulsivity and psychological distress (Vaughn et al., 2014); as well as an increased risk of mental health conditions, including depression, post-traumatic stress disorder (PTSD) and panic disorder (W. H. Williams et al., 2018). There is a strong link between TBI and neurodevelopmental conditions such as ADHD. This poses challenges as assessment and support processes are generally designed for single conditions (N. Hughes & Williams, 2012).

How many adults are affected?

One study of adult men in prison found that 60% had experienced any type of TBI; and 15% a moderate to severe TBI (Kent & Williams, 2021). A study of adult women in prison found that 78% had experienced a TBI, most commonly as a result of domestic abuse (Kent & Williams, 2021). Comparatively, it has been estimated that 8 to 12% of people in the general population have experienced a TBI and 2% a moderate to severe TBI (Kent & Williams, 2021).

How many young people are affected?

Between 65 to 76% of people in youth custody have had a TBI (N. Hughes & Williams, 2012). Sustaining a mild TBI in childhood is associated with a 1.6 times increased risk of criminal behaviour by age 17 (W. H. Williams et al., 2018). Young offenders with TBI are more likely to have experienced violence, neglect and trauma (Vaughn et al., 2014).

Additional resources

References 

Full list of references is included at the end of this chapter.

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