ADHD: Impact on Prison Rehabilitation and Reoffending

11:00:00

I remind Members that they may only make a speech with prior permission from the Member in charge and the Minister. I understand that there will be interventions, but I exhort Members to keep them very tight. The Minister has kindly and charitably said that he will take 10 minutes, which gives us until 11.20 am for other Members, who should bear that in mind with good faith. As is the convention, there will not be an opportunity for the Member in charge to wind up.

I beg to move, That this House has considered the impact of ADHD on rehabilitation and reoffending in the prison system. It is a pleasure to serve under your chairmanship, Mr Dowd. I think we all accept that our prison system faces significant challenges, including poor rehabilitation, high reoffending rates, overcrowding, limited resources and prisoner numbers that have doubled over the last 30 years and now exceed 87,000. The Minister will know that recent estimates suggest that prisoner numbers could surge to almost 100,000 by the end of next year. In preparing for this debate, I drew on a number of publications with which the Minister will be familiar, but it is noteworthy that many of the studies were undertaken by those with links not only to justice but to the Home Office, the police, health and social care, planning, education, social equality and good government.

I have spoken to people who found out in prison that they have neurodiverse conditions such as attention deficit hyperactivity disorder, which I also have. If they had been supported at school, things would have been different. Does my hon. Friend agree that we need to roll out universal screening for all neurodiverse conditions at primary school level?

I could not agree more; that might help us to understand the interaction between behaviour and authority.

I commend the hon. Lady for securing this debate, and she is right to raise this issue, which is very prevalent in Northern Ireland. There is a lack of specialist staff and training in adult ADHD, which is becoming a bigger part of the conversation. More needs to be done to rehabilitate in a certain way to ensure that prisoners are in a position to learn. Does the hon. Lady agree that, specifically for adult ADHD, the Government need to allocate more to training to ensure that prison staff are equipped to support people in prison settings who have ADHD?

I agree with the hon. Gentleman and will come to that in a moment. The impact of ADHD on rehabilitation and reoffending sits at the junction of many different interests. It seems likely that supporting people with ADHD could be a critical part of delivering the Government’s aim of rebuilding confidence in the criminal justice system. There is a clear link between ADHD and contact with the criminal justice system, and ADHD is significantly over-represented in prisons. While just 3% to 4% of people in the general population are currently identified as living with ADHD, the National Institute for Health and Care Excellence estimates that the proportion is up to 25% in the prison population. Up to a quarter of people in prison are living with ADHD, but studies show that 41% of women in UK prisons meet the criteria for an ADHD diagnosis.

Prisoners often leave the prison system with just one week’s worth of medication, and they then have difficulty getting back into the healthcare system. Does the hon. Member agree that we need a holistic approach to the Probation Service that co-ordinates the health and social care system to act as a bridge between the criminal justice system and wider community services?

Indeed, I do agree. Our interaction with the NHS needs to be far better. I will come to that later. In December 2020, the then Lord Chancellor and Secretary of State for Justice took the important step of commissioning an independent review into neurodiversity in the criminal justice system. The review was led by the chief inspector of prisons, Charlie Taylor; the chief inspector of probation, Justin Russell; and the chief inspector of constabulary and fire and rescue services, Sir Thomas Winsor. The resultant report concluded that when ADHD goes unrecognised or unsupported, the cycle of “crime, arrest, court, prison, probation and reoffending” will repeat itself. That is likely to be because the root cause driving that cycle of constant repetition is not currently being addressed in a structured or uniform way in the criminal justice system. According to the report, the identification, support and management of neurodiverse individuals, including those with ADHD, is “patchy, inconsistent and uncoordinated”. It exposed “serious gaps, failings and missed opportunities at every stage of the system.” To put it simply, the report identified that the system was not adequately supporting neurodiverse individuals. There are many elements of the prison environment that can cause distress to neurodiverse people, including busy and noisy wings, cell-sharing and frequent changes in daily routine. There is no consistent approach to screening for ADHD across prison services, and no single screening tool is used as a standard across the system. The lack of consistent screening means that people who come into the system with ADHD are not identified in a timely manner, or indeed at all.

Does the hon. Member agree that there is also a real problem with data collection, which means that the extent of the problem in our prison service is not known? We experience that problem in Northern Ireland, and I am sure it is the same across the United Kingdom.

Indeed, there is no consistent data collection. That is a problem not only in Northern Ireland, but in England and Wales, which the debate is primarily about. If someone is identified and diagnosed, it can be hard for them to access the right care and support due to fragmented care pathways. That is compounded by limited awareness and understanding of ADHD in the prison services.

I think all Members present will have heard from desperate parents whose children cannot get the ADHD medication that they need. Does my hon. Friend agree that the scandalous failure to provide care sets those children up to fail and that, tragically, the consequences are that some end up as the offenders we are discussing, instead of fulfilling their full potential?

I could not agree with my hon. Friend more. His point is similar to the one made by my hon. Friend the Member for Yeovil (Adam Dance): the earlier we screen, the better we will be able to understand how people learn. In the long run, if life is not education, I do not know what it is—I am sure the Minister will have some sympathy with that point, because he and I both served on the Education Committee between 2010 and 2015. We need to make sure we have far better screening so that people can understand how both young and older people learn. We should never finish learning. The report observed that only 24% of prison staff had received some level of training about neurodiversity. I accept that that was back in 2021, but I doubt it is much different now. A basic level of awareness of neurodiversity and the needs of neurodiverse people was lacking among frontline staff. The lack of training, combined with staff shortages in prisons, can impact the management of neurodiverse prisoners. Those working in prisons must be able to recognise that the behaviour of some prisoners may be linked to ADHD, and a lack of training for those in mental health teams can result in misdiagnoses or suboptimal treatment. There is an ongoing need to better embed training for prison officers and extend the establishment of neurodiversity support managers across prisons in England and Wales, as mentioned earlier. The structural changes that are taking place in NHS England, which has commissioning responsibility for offender health services, might provide an important opportunity to consider some of the challenges, and to develop new models for supporting people with health and care needs to access the right care and treatment in the community. That is particularly important where an unmet need has the potential to have a direct impact on an ex-offender’s likelihood of reoffending. Will the Minister outline the measures that are currently in place, and what he plans to offer, in the way of support and continuity of care for neurodiverse prisoners after their release, particularly in healthcare settings? The Ministry of Justice’s cross-Government neurodiversity action plan, published in 2022 in response to the independent review, was a step forward in the official recognition of the unmet need around neurodiversity in the criminal justice system. Some promising steps were taken to advance the commitments in the plan, such as the recruitment of more than 100 neurodiversity support managers in prisons and the roll-out of neurodiversity training in some settings. But data remains insufficient and fragmented, as the hon. Member for Upper Bann (Carla Lockhart) said, and that poses challenges to the effective assessment of the impact of interventions. Will the Minister outline what steps the Government are taking to monitor the number and availability of neurodiversity support managers in prisons across the country, and what measurements are being used to assess the impact of their work? It is important to keep up the momentum behind the neurodiversity action plan. However, the 18-month review and update committed to under the action plan, which was due in early 2024, has not been published. I would be grateful for further details from the Minister on his plans to continue the implementation of the neurodiversity action plan. Will he outline what steps were taken last year and will be taken to implement the plan? When will the 18-month review, which was due in early 2024, be published? The ADHD taskforce was established in 2024 and recently published an interim report on the state of play in ADHD care, with its final report due this summer. The taskforce has taken a cross-Government approach, rightly recognising criminal justice as a key focus. The taskforce interim report highlights a number of important and pressing issues, particularly the need for better data to understand where and how people with ADHD are interacting with public services; the relationship between education, health and wider support in relation to outcomes for people with ADHD, including contact with the criminal justice system; and the value of earlier intervention. What steps have the Government taken and will they take to engage with the ADHD taskforce and wider stakeholders to address the barriers and implement the recommendations highlighted in its interim report and forthcoming final report? Many reports show us that people with ADHD are more likely to struggle with impulse control, emotional regulation and memory recall. We understand that those behaviours can lead to early school expulsions, unstable employment and contact with the criminal justice system. Once someone is in the system, ADHD can affect how they interact with the police, legal advisers, the judiciary, court staff and probation officers. That can increase exponentially the risks around unreliable statements, misunderstood behaviours and disproportionate sentences. Responses to their environment can lead neurodiverse people to exhibit challenging behaviour that could result in their being disciplined or sanctioned, and affect their engagement or consideration for rehabilitation programmes. Other reports, such as that published in December 2024 by Takeda, on reforming justice and tackling the unseen challenge of neurodiversity in the criminal justice system, have concluded that there is a need to reassess our approach to managing offenders and consider more innovative ways to interrupt the cycle of reoffending. That includes better approaches to addressing the unmet needs of neurodiverse individuals, where conditions such as ADHD may have a direct impact on offending. Does the Minister agree that, in the light of the challenges, criminal justice services should adjust the way people with ADHD are managed, to improve rehabilitation and reoffending outcomes? Will the Minister address the matter of women who meet the criteria for ADHD in prisons? ADHD in women is often misdiagnosed or missed altogether. Women are more likely to mask symptoms, presenting as anxious, depressed, having eating disorders or as emotionally distressed. That means that for many women and girls their ADHD is often diagnosed late or not at all. More work is needed to understand the experience of women in the criminal justice system who have ADHD. They are likely to experience multiple barriers and may be impacted by co-occurring mental health issues or other disadvantages. For example, one in three women in prison self-harms—the rate is eight times higher than that on the men’s estate—and there is a strong correlation between ADHD in women and self-harming. These issues are directly relevant to the Government’s wider ambition to reform the way female offenders are managed in England and Wales, including the intention to close one women’s prison and increase the management of female offenders in the community. That in part recognises that many women are imprisoned for lower-level offences. For example, in 2023, theft from shops was cited as the most frequent offence committed by female offenders, accounting for 40% of women’s prison sentences shorter than six months. Evidence also demonstrates that the incarceration of women can have a broader impact on families and children. Many women are primary carers, and their imprisonment can result in children being displaced, amplifying cycles of trauma and disadvantage over the generations. The establishment of the Women’s Justice Board presents an opportunity to address these issues, so will the Minister outline whether the board is currently considering neurodiversity and the impact of ADHD on women in prison within its remit? Will the Minister commit to ensuring that ADHD is meaningfully embedded and accounted for in the work of the board in order to ensure that the experiences of women with ADHD in the criminal justice system are a priority? The Government have stated an ambition to address the challenges of prison capacity and to shift the approach taken to women offenders. It is important to recognise that ADHD screening, a coherent care pathway and improved awareness and training in prisons could play a part in achieving that ambition. In summary, my current membership of the Justice Committee and my membership of the Education Committee during my service here between 2010 and 2015, along with my meeting experts in ADHD and criminal justice more recently, has emphasised to me the need to take a different approach to identifying and supporting neurodiverse prisoners to help those individuals to make new lives and thereby to help the Government to make sure that prison is effective and efficient at turning prisoners’ lives around. A new campaign focusing on the unique experience of neurodiverse individuals with ADHD in the criminal justice system explores evidence-based opportunities to improve support and outcomes. Will the Minister meet me and representatives of that campaign to discuss the challenges facing individuals with ADHD in the criminal justice system and the steps that might be taken to meet people’s needs and improve outcomes in relation to rehabilitation and reoffending? I have asked a number of questions, which I provided to the Minister and his team. I recognise that he will not necessarily be able to answer eight questions right now, but would he possibly give me the honour, first, of a meeting and, secondly, of a response to my questions?

11:18:00

It is a complete joy to serve when you chair, Mr Dowd, and a pleasure to respond to the contribution made by the hon. Member for Wells and Mendip Hills (Tessa Munt) to set out this very important matter. I will do my best to answer her eight questions. I thank all Members, on both sides of the Chamber, for their considered contributions to today’s debate. This has been a measured and helpful discussion underscoring the importance of recognising and responding to the needs of neurodivergent offenders, including those with attention deficit hyperactivity disorder. There is a huge prevalence of neurodiversity in our prisons: studies have estimated that at least half of the offenders in our jails have some kind of neurodivergent need, though the figure is likely to be even higher, with about a quarter of prisoners thought to meet the ADHD diagnostic criteria. As the hon. Member for Wells and Mendip Hills said, NICE calculates that figure as up to 25%, including 41% of women. As the inspectorates have highlighted, for these offenders prison can be particularly difficult and distressing, leading to challenging behaviour that could result in their being unnecessarily sanctioned or disciplined. Prison is rightly first and foremost a punishment, but it must also reduce reoffending. Offenders deserve the opportunity to turn their lives around so that they can play their full part in society on release. We need to make better citizens, not better criminals. Above all, we want to ensure that every offender gets the rehabilitation they need to protect the public. That relies on ADHD and other neurodivergent needs being picked up quickly, and on offenders getting the support that they need so that they can engage with support, treatment and education. There is a great deal of good work already under way. I will answer the questions asked by the hon. Member for Wells and Mendip Hills. On what measures are currently in place and what we plan to offer in way of support and continuity of care to neurodiverse prisoners on their release, my hon. Friend the Member for Wolverhampton West (Warinder Juss) rightly identified the key role of probation. There is guidance and training for probation staff to help them to understand ADHD, how needs can look different for different individuals, and that some needs are not visible. Probation staff are skilled at taking a strength-based approach in assessments for pre-sentence reports and sentence plans. Together, that can help our practitioners to adapt the work they do with offenders, whether that is in a one-to-one context, such as supervision appointments, in group settings in a behaviour programme, or in unpaid work placements. In addition, the Probation Service has commissioned neurodiversity specialists in five probation regions: Yorkshire and the Humber, the north-west, the west midlands, the south-west, and Wales. Those services offer direct support to people who are diagnosed with or suspected to have a neurodivergent condition; supporting engagement with their orders or licences, they provide briefings to probation staff designed to help them to identify factors that may be related to neurodivergent conditions, and give guidance on how best to support the rehabilitation of these individuals. The hon. Member for Wells and Mendip Hills asked about neurodiversity support managers. We have neurodiversity support managers in all our public prisons, and they have a whole-prison approach to neurodiversity. That includes: improving processes to identify and support prisoners with neurodivergent needs; providing training and guidance for prison staff; and ensuring that neurodivergent prisoners can access education, skills and work opportunities within the prison. Neurodiversity support managers also ensure that reasonable adjustments are made to prison environments to make them more supportive of neurodivergent needs. They are frequently recognised in His Majesty’s Inspectorate of Prisons reports for their positive impact in prisons, with recent reports from HMP Kirklevington Grange and HMP Warren Hill highlighting their support for prisoners as an example of good practice. The 2021 joint inspectorate neurodiversity review of evidence, which the hon. Member for Wells and Mendip Hills cited in detail, suggested that at least 50% of prisoners have a neurodivergent need, although many will not be diagnosed. In response to the review, the previous Government published a cross-Government neurodiversity action plan in July 2022, with updates in the January and September of 2023. I am pleased to tell hon. Members that we will publish a final update to the action plan later this year, which will respond directly to the joint inspectorate’s report and set out a cross-system strategy to further improve outcomes for neurodivergent people, building on the vital work of the ADHD taskforce. I welcome the publication of the ADHD taskforce’s interim report. It is a timely and important piece of work that outlines the systemic challenges in ADHD services across the country and sets out both short and long-term recommendations to improve support for people with ADHD. Many contributions made by Members highlighted the issues in other services, which is why the report is important. I am grateful to colleagues across Departments who have worked collaboratively to shape the recommendations. The report rightly makes clear that no single Department can resolve the challenges alone. ADHD, when left unsupported, can lead to a cascade of negative outcomes: school exclusion, unemployment, substance misuse, involvement in crime, and, tragically, sometimes suicide. We will continue to work with the taskforce and together across Government to achieve the report’s aims. In youth justice, youth offending teams are increasingly tailoring interventions to children’s specific needs, including those with neurodiverse conditions, with 95% of practitioners reporting that assessments and planning now take into account individual vulnerabilities. Where children are detained in youth custody, all children receive a comprehensive health assessment that screens for a range of needs, including mental health and neurodiversity when they first arrive. All education providers across the three public young offender institutions also have a special educational needs co-ordinator who, in collaboration with NHS England, conducts assessments for children who may have undiagnosed needs, including ADHD. We are having a roundtable later today with education providers to look at alternative education providers outside of the youth justice estate to look at ways of bringing their expertise into the youth custody system so that we can learn from others and improve the way we do business in the youth custody service. The hon. Member for Wokingham (Clive Jones) drew attention to focusing on and analysing needs. His Majesty’s Prison and Probation Service takes a needs-led approach to supporting people in prison, including those with ADHD. This ensures that needs are identified as early as possible so that appropriate reasonable adjustments and support are provided throughout custody. To improve current screening processes, HMPPS is procuring a new needs assessment tool. I am pleased to confirm that Do-IT Solutions has been awarded the contract for this tool, which will be introduced as part of the new prisoner education service. The tool will identify individual strengths and additional learning needs, including those associated with autism spectrum conditions and ADHD.

Will the tool be used for every entrant to the prison estate or is it for those who might be suspected of having some sort of neurodiversity?

My understanding is that it will be, but I will write to the hon. Lady to confirm the details. To pick up on the point made by the hon. Member for Upper Bann (Carla Lockhart), data on prisoners with ADHD may be held locally by prison healthcare providers, but is not held centrally by NHS England. Where it is known, 55% of prisoners who took an initial assessment via the prison education service and then enrolled on a course had a learning difficulty or disability. We continue to work to improve our data collection and information sharing. This includes plans to integrate screening results and any information relating to additional need into digital learning and work plans to support prisoners’ education, skills and work progress through custody. But this area needs more work. On the issue of women, the Prisons Minister in the other place, Lord Timpson, leads on the Women’s Justice Board—indeed, he chairs it. It is a passionate area of interest for him and the Lord Chancellor. I will write to Lord Timpson to flag the issue of ADHD, but I am sure it is already on his radar and in his work plan. If it is not, it will be soon. There is a neurodiversity support manager in every female prison and they have all had specific training on women with ADHD. Mr Speaker, I am grateful once again to the right hon. and hon. Members who have contributed to the debate, particularly the hon. Member for Wells and Mendip Hills, who led it. I am very happy to meet her at a later date to further explore the matter. As the ADHD taskforce has rightly pointed out in its interim report, “ADHD, when unsupported, is a potent route into educational failure, long-term unemployment, crime, substance misuse, suicide, mental and physical illness.” We have made significant progress to support neurodiverse people in the criminal justice system, including those with ADHD, but there is still much more to do, which is why this debate and the interest and commitment of the hon. Lady and other hon. Members is so valuable and helpful to all of us. I look forward to continuing to work with the taskforce and colleagues across Government to ensure that neurodiverse offenders are given the support they need to turn their backs on crime for good.

I thank the Minister for his largesse and for promoting me to Speaker. Question put and agreed to.

11:29:00