Dr Mitzi Waltz Expert witness, disability consultant, and Lecturer in Autism Studies

1. What health and social care workers need to know about autism and the criminal justice system Dr Mitzi Waltz Expert witness, disability consultant, and Lecturer in Autism Studies The Autism Centre, Sheffield Hallam University Disability Studies in Nederland

2. A key role in justice • Health and social care staff have a crucial role to play when people with autism are involved with the criminal justice system (CJS). • People with autism can be witnesses, victims, suspects, defendants, convicted perpetrators in custody, or former prisoners who have been released into the community. • No matter how they have become involved with the CJS, input and cooperation may be needed from staff in health and social care. • In this presentation I will talk about what health and social care professionals need to know and do to ensure that people with autism are treated fairly within the CJS.

3. Education and information The role of health and social care staff role can include educating CJS staff about autism. This may range from helping services work better for individuals with autism generally, to providing training around the needs of a specific individual with complex needs. Training may be needed in a number of areas, including: • Basic autism awareness • How sensory-perceptual differences may require adjustment to manual handling procedures, secure unit design etc. • How autism may affect learning and social understanding • Supporting communication for people with autism • Medical needs associated with autism

4. Diagnosis and assessment There are undiagnosed people with autism spectrum conditions in the youth offending, prison and forensic unit systems (Siponmaa et al., 2001; Scragg and Shah, 1994), and it stands to reason that this applies to individuals who come into contact with the CJS in other ways. Courts, facilities and legal teams need professionals who can: • Locate and interpret information about individuals who already have a diagnosis • Diagnose autism spectrum conditions, often under difficult circumstances, e.g. when a person has committed a crime and it is possible that they may have an autism spectrum condition • Assess level or lack of criminal responsibility • Assess what kind of support or service is needed by an individual to participate in CJS processes (defendants, witnesses, victims), including rehabilitation and reintegration (Woodbury-Smith, et al., 2006) • Inform safeguarding processes

5. Direct support for individuals • There are few experiences in life more stressful than being the victim of or witness to a crime • Being accused of a crime—whether guilty or innocent—is also a frightening experience • Many people with autism face these life-changing events without professional support. It would be extraordinarily helpful if health or social care professionals could be more involved, via counselling or therapy, medical support when needed, and other forms of direct support • There is also an important, and often overlooked, role in crime prevention—listening and responding to people with autism who are at risk of victimisation, helping individuals and families when there is a risk of offending, and assisting with successful community reintegration after offending. • Further, non-custodial sentences should include ASD-specific alternatives, delivered by expert staff from health and social care, to reduce the likelihood of repeat offenses (Beardon, 2008).

6. Supporting parents, carers, partners and children • If a person with autism normally relies on family members for support, these individuals may lack information about CJS procedures, and lack access if they are in custody. • Health and social care professionals may be needed to provide counselling or therapy, and other forms of direct support. • They can also form an important link between the family and the CJS, especially for individuals who are incarcerated, providing information, referral and advice, and ensuring that the needs of parents, carers, partners and children are considered and heard within processes.

7. Supporting parents, carers, partners and children • This role is particularly important if the parent or carer has an autism spectrum condition themselves. • Many adults on the autism spectrum have partners or children. • Their families may need support to manage a difficult situation, and guidance about how to handle what will happen during a trial or (if the individual with autism has been accused of a crime) what to do if they are convicted.

8. What information is needed? Both health and social care staff and CJS staff need to know about autism: • The “triad of impairments” and what these mean for everyday function • Sensory-perceptual issues • General information about how people with autism typically learn • General information about issues children and adults with autism face in their families and communities • Most importantly, that autism is a highly variable spectrum condition and that it can co-occur with other challenges: They need to know how to learn about and understand each specific person with autism they work with.

9. A big learning curve for health and social care staff Health and social care staff need to know about the CJS: • How it usually works (the real, not the ideal or the TV versions) • The rights of individuals accused of crime, of victims, of witnesses, and of their families • Potential risks for clients on the autism spectrum • Programmes and processes that may address risks: for example, use of an appropriate adult in interviews, adaptations to trials, alternative sentences • Communicating effectively with care and treatment professionals within in the CJS

10. A big learning curvefor criminal justice system staff CJS staff need to know about health and social care for people with autism: • How the health and social care systemusually works for people with an ASD—like many others in the community, CJS staff often assume that people with disabilities receive a great deal of support on a regular basis, and may be shocked to learn that this is rarely the case. • How to successfully access health and social care support for clients/prisoners when this is needed. • How to navigate common bottlenecks and barriers in health and social care system for clients/prisoners with an autism spectrum condition. • Communicating effectively with NHS health and local authority or contracted social care staff.

11. Three case studies • I often act as an expert witness in cases where an autism spectrum condition may impact the behaviour or support needs of someone involved in the case. • These include civil (personal injury, family law) and criminal cases. • Today I will talk about three real cases involving people on the autism spectrum—two trials and one everyday experience of crime—and discuss the kind of information and input from health and social care professionals I used, or that was needed. • In one case the person with an autism spectrum condition was accused of a crime, in one the person on the spectrum was the crime victim. • I will end with an example of good local practice in a case where someone with autism was a crime victim but there was no trial.

12. Things to think about… • As I discuss these cases, think about how you in your role as a health or social care professional, or as a CJS professional in need of advice or support for a client, might contribute to processes like the ones I describe.

13. Case A: Defendant on the autism spectrum • This was a high-profile, high-stakes case: a defendant with Asperger syndrome faced significant time in prison due to events that occurred in a politically charged situation. I was hired by the defense team—but my duty as an expert witness is always to the Court. • I provided unbiased information in a report and in Court testimony about autism and its possible impact on the defendant’s understanding of what had happened, his behaviour during the contested event and during arrest and custody, and his level of understanding. I also provided guidance on adapting procedures to the Court and his counsel, elements of which were passed on to opposing counsel, about how best to work with the defendant. • I used the defendant’s records from education and health, interviewed the defendant, and received additional information from his family. • Significant adjustments were made to procedures to ensure a fair trial. These included a pre-trial visit to court, explanation of procedures, support for and from family, and adjustment of questions/language.

14. Case A: Defendant on the autism spectrum • However – process during arrest and detention was not autism-friendly: communication was confusing, and the defendant was hit several times by police while standing and on the ground, suffering a concussion • It was fortunate that the defendant, as an NUS representative, had training on what to do if arrested. This is important for all people with autism. He did not have an appropriate adult with him when first questioned, despite informing police about his ASD, but because he had training he did not respond. • The outcome was acquittal for the (innocent) defendant.

15. Case B: Crime victim on the autism spectrum • In this case, I worked for the perpetrator’s defense counsel—but my duty as an expert witness is always to the Court. • The defendant (non-autistic) was accused of multiple counts of sexual abuse and rape of a young woman on the autism spectrum. She had been well under the age of consent during the years in which he was accused of “grooming” and then sexually abusing her. • I was hired because defense counsel hoped they could establish that the testimony of a person with autism was unreliable. • Note: this is sometimes the case (as with any individual)—but not this time.

16. Case B: Crime victim on the spectrum • I used reports from health and social care professionals about the victim, interviews, and viewing recorded testimony by the victim. • I also relied on research about the reliability of people with autism in understanding and reporting about events, some of which had involved input from health and social care professionals. • As a result of my report, defense counsel were unable to use AS to call the victim’s testimony into question. • The result was justice for the (guilty) perpetrator, and for the victim.

17. Health and social care input – it starts long before a CJS issue occurs • In both of these cases, I relied on information provided about the individual with autism by health, social care and/or education professionals. • Some was very helpful indeed! • However, some was poorly written, inaccurate, contradictory or incomplete. • So if you write reports, try to do it well—it may make a massive difference to someone many years from now, when they are no longer your client. • This is true for CJS professionals as well: ensure that reports you write about clients or prisoners are complete and accurate. Someone else, many years from now, may rely on this information to determine crucial issues like whether the individual presents a risk to others.

18. Health and social care input: What else would be helpful • It would have been very helpful to me in these and other cases to be able to make direct contact with health and social care professionals who knew the person well. They may hold information that can fill in gaps in the record, or reconcile discrepancies. • This may be crucial in some situations: for example, when the case involves a child in foster care or an adult who lives in residential care or does not have contact with family members. It can be difficult to get the information CJS professionals need about how to communicate and work effectively with individuals without family input, and health and social care staff may hold the key.

19. Something else to consider… • One issue often not thought of is that CJS proceedings may produce a public record, and that record may include information about diagnosis. • Also, some trials are open to the public, or newsworthy in some way (see previous slides), and may be an occasion for comment and discussion in the community, the news media or on the Internet. • This could have some serious consequences for people with autism in terms of privacy about their diagnosis and how it affects them – information that people in their community, future employers, bullies and so on may be able to find and use. • This is something that I would like health, social care and CJS professionals to think about. Are there steps we can do to protect people (especially victims and witnesses), and/or to prepare them and their families to handle these consequences?

20. Positive steps for the CJS We know from Baines and Christie (2013) that only a small minority of local authorities have gone past the discussion stage when it comes to making plans for adults with autism who come into contact with the CJS as part of their strategy for adults with autism. Some of the things this minority of LAs have done include: • Having a CJS rep on their Autism Strategy or Safeguarding board (35.3%) • Using some form of Autism Alert scheme (19.3%) • Training police officers (18.7%) • Training in the CJS beyond police (magistrates, probation officers, etc.) (14%) • Safe Area / Safer Places scheme (8%) • Using CJS liaison nurses or volunteers to identify people with ASD within the CJS (8%) • Using a specialist nurse to identify and assist people with an ASD in custody, court or prison (6%) • Using a Liaison and Diversion scheme (3.3%, plus some of the 6% above)

21. It’s clear that health and social care need to reach out to the CJS… • These statistics tell us that the vast majority are not (yet) doing any of these things. • Most of the local authorities that are trying, are still doing very little. • Some local authorities are waiting for health and social care teams to approach them with a clear statement that change is needed or, better yet, a well-formulated plan. • Some local authorities haven’t thought much about this issue. • Some, worryingly, don’t realise that there is a problem at all… • However, steps taken by proactive LAs show that progress and improvement are possible, and provide a blueprint for others. • I hope that everyone in attendance today pushes for similar actions within their own LA or service.

22. Working in and with CJS facilities • My experience as an SEN lecturer indicates that many staff working in secure units and specialist forensic units would benefit greatly from training similar to that received by autism specialist teachers. • I have trained nursing and care staff working at two such facilities, including specialist unit managers. • Improving manual handling and motivational procedures appears to be especially important for improving practice: these are two areas where staff reported major problems, and significant improvement when autism-specific strategies were adopted

23. Working in and with CJS facilities Reported benefits of training include: • Improved understanding of how sensory issues may impact individuals, and knowledge of helpful strategies to use or to teach. • Improved understanding of how autistic people typically learn, allowing task directions and taught curriculum (for example, anger management programmes) to be adapted. • Improved understanding of how life experiences such as bullying and abuse may impact the life trajectories of autistic adults. • Improved understanding of how to successfully support individuals.

24. A final example of good practice • People with autism are far more likely to be victims of crime than perpetrators, and police practice needs to be adjusted to respond to their communication needs. • The West Midlands is one local authority where, in partnership with Autism West Midlands, the local CJS has taken a variety of steps to better support people with autism. • A person with autism well-known to me was robbed in Birmingham, so I’ve had personal experience of the difference this makes. • And then he was attacked and robbed in Leeds, and the lesson was strengthened.

25. A key part to play in improving practice • Paradoxically, sometimes contact with the CJS as an alleged offender can be the trigger for support and care needed by an individual finally being put into place (Barry-Walsh and Mullen, 2004). • We should always take pre-emptive steps to avoid such traumatic outcomes, but when they have already occurred, health, social care and CJS staff should seize the opportunity together to improve life outcomes and protect both people with autism and others. • At all times health and social care staff are likely to hold information needed by the CJS: diagnostic reports, general information about autism, assessment data about individuals, and key knowledge about productive ways to work with, teach, care for and communicate with people with autism. • Partnership working will always improve the situation.

26. Contact information Dr Mitzi Waltz Email: mitziwaltz@yahoo.com Phone: +31 (0)630053134 www.mitziwaltz.com

27. References • Baines, S. and Christie, A. (2013) “What do the Autism Self-Assessment Frameworks (2011 and 2013) tell us about the Criminal Justice System?” London: Public Health England. • Barry-Walsh, J.B. and Mullen, P.E. (2004) “Forensic aspects of Asperger syndrome,” Journal of Forensic Psychology and Psychiatry, 15(1): pp. 96-107. • Beardon, L. (2008) Asperger Syndrome and Perceived Offending Behaviour [doctoral thesis]. Sheffield: Sheffield Hallam University. • Scragg, P. and Shah, A. (1994) “Prevalence of Asperger’s syndrome in a secure hospital,” British Journal of Psychiatry, 165: pp. 679-682. • Siponmaa, L. et al (2001) “Juvenile and adult mentally disordered offenders: The role of child neuropsychiatric disorders,” Journal of the American Academy of Psychiatry and the Law, 29: pp. 420-426. • Woodbury-Smith et al. (2006) “High-functioning autistic spectrum disorders, offending and other law-breaking: Findings from a community sample,” Journal of Forensic Psychiatry and Psychology, 17(1): pp. 108-120.

28. Resources for health and social care professionals • Action for Prisoners Families: http://www.prisonersfamilies.org.uk/ Organisation that advocates for and informs parents, carers, children, and partners of prisoners in the UK. • On the Inside: http://www.ontheinside.org.uk/ Web site for children who have a parent or carer in prison in the UK. Includes good information for family members as well—including for parents who are facing a custodial sentence. • UK Health, Justice and LD/Autism Network: http://www.jan-net.co.uk/ Discussion and information group for professionals, includes access to a wide range of reports and research documents. • Also on the NAS’s Network Autism service: http://network.autism.org.uk/group/autism-and-offenders-partnership