Without further ado, let me let me introduce our fabulous people. And thank you so much. Thank you for getting up early for doing this and we're very, very excited to to have you here. I just can't underline how excited I'm like. We know I've got to do the introductions, I'm gonna do those, but it's it's such an important topic area. And when we first talked with Communicor and your focus on it on ADHD And just the thought I I could just picture myself in the doc being asked to remember things of particular dates and just looking like the most terrible witness. And and I just I I know I wouldn't be able to do I'd be like, is it in my calendar? Like, otherwise, I've like literally no idea. And how that and how that would reflect.

And I also thought about how my distraction might affect if I was in the dark looking around. And so it's it's such and we talk about people within ADHD getting into trouble and having issues and the increased numbers in the in prisons. But the court part, I think, is really very rarely being talked about if at all. It's so important. Right introductions, let's do my job properly. We've got William Scrimsher managing director of Communicor Limited. Thank you very much for joining us. Alison Wood, clinical lead for neurodiversity autism ADHD intellectual development disorders, offender health, healthcare NHS foundation trust. And Alison oversees the neurodiversity pathway for eight prisons and has practitioner in each assessment treating.

Michelle White, a PhD student, part time law lecturer currently considering neurodivergence within criminal law and is currently writing an article on the phenomenon of crikey confabulation and its impact on confession witness evidence. It's such an important area. So we've got a number of set questions. So this is a panel session and I if I start to slightly right, Doug, it's a twenty four hour conference. It's been quite long. I did manage to get a few hours sleep. But I I don't know if you're able to hear just now, but the I was happily asleep at 3AM and I got a call going, the feed is down. Working with wonderful Terry and Andrew, get it get it back up again, which we did very, very quickly. They did really very, very quickly.

It allowed us to get to know our numbers, so we got see that we'd had 4,400 people visit us so far in the conference which we're pretty excited about and like always trying to remind people like think of that like a room. You need think of how many people that is in a room and We've got them there talking about ADHD. It's a big deal and it's because of you guys volunteering, like you're giving your time. There's no no pain for you doing it to help make change and thank you so much for it. You are a a part of this. Yeah. So we are pretty excited. I have to say I got a bit of noise when I saw the numbers. I was like, this is really wonderful. We obviously have a lot of people watching now and we hopefully.

Live streaming on currently on Facebook, LinkedIn and YouTube all at the same time. Twitter has not played dice. Right, introduction. So we know there are high numbers of people in the criminal justice system with diagnosed undiagnosed ADHD and actually I think a lot of the research around the difference between diagnosed undiagnosed is very very compelling. Research in 2020 suggests around twenty five percent of adults in the British criminal justice system meet the criteria for ADHD. There is I know a lot of debate about that. We've had someone earlier talk about a number of seventy five percent based on their own anecdotal experience. I've seen research testing forty percent. I've seen research.

I think the overarching thing that is absolutely conclusive is wildly overrepresented and such a significant percentage that they should be a very very focused program. And that's I think that's the bit that we don't need to argue over and therefore could just essentially move the head on. And we talked about in our introduction which when I was talking about how I can make people feel look unreliable when being questioned by the police or appearing as a defendant may give confused evidence interrupts. And actually I do think that the impulsivity on speaking out and shouting out can be can be good. That can be very impactful. And right. Michelle, if I may come to you first. To.

Set the scene a little, how does ADHD contribute to the way people are perceived in the criminal justice system?

I think like you've just said there, essentially, you know, we know it's something that is highly prevalent in the criminal justice system. The research I look at is particularly concerning early stages, so kind of point of first real interaction with authorities moving on to, you know, detention, interview, interrogation, that sort of aspect. I mean as we know already, you know, we've got an increased risk with ADHD of early age criminality, increased risk of re offending, aggressive incidents, psychiatric disorders, suicide, self harm, substance abuse etc.

So we're talking about a population essentially that is much more likely to come into contact with the criminal justice system than kind of the standard person would, the neurotypical person would. It's quite scary to think you know with a huge prevalence of undiagnosed people with ADHD potentially, you know, a lot of the time people are coming into contact with the criminal justice system. It can be their first real experience of getting any sort of support, any sort of official help, any recognition. And when you think about, you know, speculation massively in terms of the amount of undiagnosed population that we've got, particularly within the female population.

So we think about from that sense. It's quite scary essentially that these people are relying upon the first time they're arrested, first time they're detained for any sort of real structured support to be put in place. You know, it's not always that somebody as well would be guilty of a crime that would lead to their detention in the criminal justice system. It's often done a lot of the time now in absence of mental health support. So for example people might be in crisis, they may be you know a risk to themselves, and because of a lack of other areas of support we're generally looking at relying on the police service to detain them for their own sake. Okay so it's really that kind of that lack of other support that feeds into this.

When we look essentially, you know, at this this notion of of perceptions of ADHD in custody, it is really varied. We don't have a standard across the across the country essentially. There was a report done particularly in 2015, by the chief inspector of the constabulary. They said, you know, even within their own research, their own studies, there was this kind of notion of looking at the crime before looking at the person on behalf of their their staff, their authorities, and this was to do with children, so this wasn't even a study of adults and the impact of it. This was just vulnerable children, so I think again we've got this really daunting notice notion.

Of potentially you're looking at a child in a way by which we're just looking at what crime they've done rather than what other factors may be in the background to that. So just to kind of give you an overview, what we're looking at in terms of early stage criminal justice system, you know stop and search processes, arrest, detention, interview, questioning etc, and these can all be highly stressful situations. But you know the neurotypical person You could say essentially by default you know being in custody, being detained in that kind of way puts us all in some sort of vulnerable situation, so it's even worse, even more amplified when we're looking at people with conditions such as ADHD.

What we've seen I think in recent years is this real push towards autism awareness, know, and recognition and protocols being put in place for people with autism, autistic people, but we're lacking in ADHD. There is this real kind of missing dynamic that we haven't caught up to the way that we're looking at autistic awareness particularly. So just to kind of overview really what we're looking at when we consider generalising people with ADHD, When they're looking at stressful situations, we're talking about behaviours that are maladaptive to coping essentially. They can present in escape avoidance, confrontation, lack of planning, you know this can make someone try to escape custody, someone become confrontational.

Someone to appear in kind of a contentious situation with the police or with the authorities. So when we're considering particularly the first encounter someone may have a stop and search or arrest for example, know we're already in a position where they're going to be in conflict with the authorities and that is obviously not the way we want to introduce, it's not the way we want to start the ball rolling for you know being detained in criminal justice. Sometimes we have this unfortunate situation where there may be a mental health triage present, some forces rule this out more regularly than others, some control rooms for example have mental health triages available which can be useful in identifying ADHD related behaviours.

So we know essentially we're telling our police officers what they can anticipate, what they can recognise, but again this is a lack of consistency across the board. Now similarly stopping search procedures, the College of Policing sets out that their officers are required to consider a person's vulnerabilities before conducting a search and exercise their powers accordingly. I'm sure you can think that is such an ambiguous way to put things, know, what is consideration of a person's vulnerabilities if you have, you know, a potential suspect who appears to be violent, appears to be confrontational, how much assessment they're going to do at that point of vulnerability.

So it's really about early recognition for me, it's really about kind of getting the relevant authorities to really understand what they're looking at, what conditions are associated with ADHD, what behaviors are associated so it can be dealt with appropriately rather than in a confrontational way. I mean moving on to the detention process particularly, it can be extremely challenging, I can say even for the neurotypical person, Dependent upon your charge, you know, you could be looking at twenty four hour period of tension without charge, possibly up to ninety six hours once you've been charged depending on circumstance, depending on the severity of the events you've been charged with.

So again we're talking about this really prolonged period of time. We're expecting people who, you know, stereotypically would have problems with sustaining attention, for example, you know, asking them to be detained for that period of time be really difficult, can be really stressful and impactful on them. The right screening in police stations, there is screening offered throughout the system essentially, but again the limits have been found when the research has been done about this. It's not always consistent, it often varies very much on a regional basis, force to force basis. Once that screening is effective, we have this fantastic process where we can divert people through the liaison and diversion service, for example.

To appropriate authorities, to appropriate bodies for them. But again, it comes down to this early detection, and if we fail to detect it or fail to recognise ADHD, you know, we are really hitting a problem in terms of the treatment that person is going to get in custody, particularly when we consider you know the viability of the information they're going to give, the questioning they're going to have. I mean when we look at things like interview and interrogation techniques, The generally accepted behaviours of someone with ADHD, so inattention, hyperactivity, impulsivity essentially just go from the outset in terms of being interviewed and questioned by authorities.

We know for a fact, we know the research has been done particularly by Good Johnson that there is this really increased risk of false confession with ADHD. It's estimated about three times more likely to falsely confess to an offence if you have ADHD. And when we looked at the reasons behind that essentially, it wasn't so much that people with ADHD were excessively suggestible, they weren't easily influenced in that instance, but they were much more likely to be compliant, they were much more likely to try and, you know, evade lengthy, lengthy questioning processes. There were a number of studies done where they asked participants with ADHD why they had had falsely confessed.

And essentially a lot of them came down to because they wanted to be out of custody, it was as simple as that kind of their stress limit had been reached and they were ready to say whatever they needed to do at that point to get out of custody. They also had a number that tried to falsely confess to prevent other people from being found guilty of the offence, did it as a form of friendship as such, know they did it to help other people. We also had this really interesting of bit of research that was done that looked at the way in which people with ADHD would answer certain questions that were put to them, certain kind of open ended questions, leading questions.

And the general response rate there was for them to answer and say 'I don't know' rather than giving an answer, rather than kind of denying knowledge or making a negative implication. The standard kind of answer for them was to just say well I don't know, and that kind of mobilizes a different reaction from the interviewer. When the studies were looked into particularly on this, it was found that the more they answered don't know, the more evasive police officers interviewing officers thought they were being at the time, which then again propelled a different line of questioning, a different line of interrogation.

Which can lead them to not only falsely confess to a crime, but you're also looking at people with ADHD potentially believing they have committed the crime as well, which is even more dangerous in, you know, the realm of justice essentially. When we talk about this confabulation of recollections, you know, it's been found that people with ADHD also have what's called or can have what's called memory distrust syndrome, where they're not as confident as the neurotypical person in their own recollections of what's happened, which can lead to them being more influenced by what's happening in terms of interrogation.

So for me the real takeaway message from that is we need proper processes to put in place from the outset to make sure that people with ADHD are being treated in a way that is sympathetic to their own behaviors. We don't want people falsely confessing, we want them certainly having this false idea that they have participated in a crime, that they have been guilty, and giving us that information.

That's terrifying. Certainly, the confabulation, like, the the trust of memories. I I definitely like, it's something that resonates with me. Like, I I have learned not to learn not to trust my like, I I've just I suppose it's unreliable enough that I I just can't quite trust them. Like, in terms of yeah. From as simple as things as, like, yes, day to day stuff. That was very eye opening. Thank you and quite something. Our next question is for William. Your organization provides intermediaries to support someone's communication skills in court. How can ADHD affect someone during proceedings?

Well, think firstly, it's important that we understand what communication means because often it's misunderstood. It's it's important that somebody needs to be able to hear and then attend to the information being given to them, which is often through speech, but it could be through different ways as well. And they need to be able to process that information and understand it before they can formulate a response. And that response might be a verbal response, a written response, a note to discuss with a barrister, or or actually no response at all, which is a choice too. And we rely on all we rely on our concentration for all of our thinking processes. So for example, if somebody's having difficulty focusing their attention.

They'll have difficulty responding or remembering the way they've responded or the information that's been given to them. So it sort of falls down at the first hurdle if you like. It's also really dependent on the individual, and there's not a sort of one box fits all approach to communication problems for people with ADHD. Because everybody has a different communication profile and that will be affected by all sorts of things. Lots of the people that we work with, sort of building on what Michelle said, is they don't have a formal diagnosis, so often they are attending court and there's no formal diagnosis for them. They may have other diagnoses or comorbidities which impact on their communication profile.

And they may have additional communication needs that wouldn't usually be associated with ADHD, so there's all these complexities that add to the way somebody communicates. But just as a sort of high level, some factors that might influence somebody's ability to be able to effectively participate. Things like attention skills, I think you drew on this earlier, Henry, about being distracted, somebody who is in court in a dock or sitting on a bench at the back of a family court, often the courts aren't addressing them, so it's hard for them to keep up because they're often speaking to somebody else in the room, whether that be a barrister or a different witness. And often, I mean, often the verbal information is delivered.

At a particular speed or, which is difficult for people with ADHD if they can't process quickly enough, and all of a sudden they get lost in the process. There's physical distraction in court. People think courts are really quiet and and still. They are on the whole, but there is still these people that sort of move around and almost invisible to everybody else, court ushers and things. So there's physical, distractions, things like lights flickering or sounds, buzzing noises, people walking in and out of room and door handles going, all sorts of things going on, people rustling papers. There's auditory distractions.

Like often the the judge will be speaking to a witness, the barrister will be questioning the witness, the solicitor on the other side of the room is whispering to the court clerk about something else that's going on, so there's all these distractions going on at the same time. Internal distractions are quite difficult for people with ADHD because they, they will get lost in a train of thought, so there'll be some evidence about Jane being wearing a blue coat, and the person with ADHD might get lost in a train of thoughts about whether it's green or blue or turquoise and all those things, and then all of a sudden they've missed the next bit of evidence, so they get lost in that train of thought. And sitting still and fiddling.

I'm a fiddler, but it it can be difficult for people with ADHD because it often sort of presents itself as somebody who's disinterested or unreliable because they'll be looking at something else in the room or they'll be shaking their leg, or they'll be looking around, and often, especially to people like juries, that can come across as disinterested or disengaged with the process, which has its own implications. So I think all of these things are linked to their ability to going back to what I said at the start, which is their ability to hear, and attend to and process verbal and written information, and all of those things, then affect their ability to respond not only effectively, but it's also with understanding.

In the way that they want to. When we work in court, it's not about us being on somebody's side, it's about us ensuring that that person is responding in the way that they want to in the courtroom.

Thank you. And, Alison, you've been so patient. You've got like, and like I appreciated you being so. Could you tell us a little bit about what happens to someone when with ADHD when they enter prison? And I suppose and if you do that for sort of with and without diagnosis would be great.

Okay. Yeah.

So I guess I need to be talking about the prisons where I work, which the difficulty with that is that we have identified that neurodiversity and ADHD is something that we want to address in the prisons where I work. So, it's really difficult for me to generalize what that experience would be like in all prisons. So but I do know that in all prisons that when a person comes in, then there is a reception screening process. So there's a very busy reception screening process where everybody is sort of inducted into the prison. And for a person with ADHD, we're aware that that in itself is a really challenging start to the journey. It's normally a pretty busy environment. But but that's the place where you will get to be seen by.

Everybody in the prison, really education, health, and the prison team start to assess your needs, start to, you know, get to know you, introduce you to the system. And from that process, you will go from reception screening into a kind of induction wing type setup where the idea is there that you are prepared for what your prison, experience is going to be like. And that's where lots and lots of opportunities lie because that's where people are supported to understand how to use the prison systems, what making an application looks like, how you're going to get access to health care. So coming into prison is a kind of pretty scary experience, and people are there with more or less knowledge about neurodiversity.

I think I've got such a lot of positive things to say as we go through this discussion because the one good thing in prison system at the moment and and from a ministry justice perspective is that neurodiversity is starting to be taken really seriously. So there is a lot of work going on at the moment, and it is rapidly kind of there is a rapid focus on how we are going to make those adjustments all the way through the prison processes. But at the moment, I would say if you come into prison as a neurodiverse person, whether that be ADHD, autism and any of the neurodiverse conditions, you're going to be struggling with, a busy crowded environment, lots of people who are being.

Remanded for lots of different reasons, who are coming into custody for lots of different reasons, and it is that process where if your needs are known so from a healthcare point of view, I could be really clear that what we do there at reception screening on the day you arrive, if you have ADHD and we have a record of that and you're on medication and we can see that in your medical records, you will be immediately treated. Your treatment will be continued.

You'll be immediately referred to a neurodiversity practitioner.

And as I say, this is not representative of all prisons because I do not think that this is in place in in lots of prisons, but in all of the prisons where I work, you are immediately referred from reception day one to a neurodiversity practitioner. If you're on, if you are recognised to have ADHD, that you will be referred so that that person can review you, find out how you are doing with your treatment, and support you to continue your treatment. Have a look at everything else that you might need in terms of how you're going to cope with prison. If not, we start the screening process, and you're referred for that screening process to to begin.

And is everyone screened, or is it only those that are picked up? Are they it's considered it should be done?

So, I mean, that's a really good question. So I've looked at this loads of different ways. So in terms of these eight prisons, we've had to develop a pathway that will work. Reception screening is a really tricky bit of the prison process because it's physical health health nurses who carry that out. So that's every prisoner who comes through the door gets seen by health care. But that process includes everything from your physical health to your mental health. So what I've tried to do is train all those staff to identify the very, very early signs of ADHD in a person that.

You know, may not be self disclosing that. We may not have a record of it. But what we don't do is a formal screening process at that stage. We're relying on practitioners to be trained to recognise. And so if anything, I'd say that that process was over inclusive, that we refer on Yeah.

Probably good to good to hear because what I worried about and and to other parts of this conversation is that with ADHD being so common within the prison population that for those people screening a lot of ADHD looks normal. Their normal and and we get back to the the scenario that only the most sort of, well, obvious cases getting getting picked up. You're saying that the screening's capturing more? I.

I think you'd have to say that's probably the case because in terms of what resource we have to offer, we're looking at where we consider that ADHD might be impacting on their ability to cope. Now, so people who appear to be coping quite well initially, people who aren't telling us that they've got any of those signs or symptoms or visibly showing any of those signs and symptoms as they walk through the door. They have another chance though to be picked up any time in the process. That it's not a one shot thing. This is about us identifying very early.

What we can do from day one. But after that, if it starts to be that people start to suspect or somebody learns a bit more about ADHD and starts to think that that's something that they identify with, there's there's an opportunity to come back around that process and refer yourself in at any time during your prison journey. But resource wise, it still is focused on people who have the most problems. There is no doubt about that because we've got one practitioner in a prison and up to a hundred, two hundred men who potentially are presenting with ADHD.

So in reality, it it means that we're working with the people who have the most, you know, who who are struggling the most that and it never feels right. We'd love to be offering a much more kind of proactive, positive service.

We could talk about that, you know, as we're going off. And do you do you see that that could there be a place for for screening, like a a more formal screening of everyone coming in?

So we do do formal screening. So once we've done that early identification of who we I feel that this process is.

So that would be that because it with so instead of having a sort of reliance on that practitioner, instead of having a more formalized screening processes.

So the LDD screener has been used by education. So the Ministry of Justice has brought in a formal screening tool for all prisoners for ADHD, and it just it isn't diagnostic. It's a screening tool. So the LDD screener that's been introduced in prisons, and that's been in pilot since is it last January? So what what that's doing is having a look at any learning challenges that a person faces. So not only a health care having a look to see whether or not there's a hint or or, you know, that you have ADHD, but education are carrying out a part one, part two screening tool that is used to feed all of that information back to Ministry of Justice, but also to immediately put in a support plan for anybody within education who requires adjustments.

So there are a number of things going on, and likewise, programs will see you and also screen to see whether or not you have evidence through your OASIS scores and probation scores, whether there is any sign that ADHD is something that we need to think about. In my view, there's a lot of screening going on. What doesn't necessarily happen is that that screening comes together to mean that we all understand what we need to know about that person in the prison at the same time and all make the adjustments from the minute that the person, you know, starts their prison journey. That's the tricky bit. It's lots of screening as opposed to coordinated screening, I think.

Thank you. That's so it's really insightful. Now to just to remind our our audience, obviously, like, please donate. Right? These are this is a charity event. Do you consider donating? Go to globaladhd.com. Click the donate button. It's a it's a big deal to us. We receive no government funds. It's it's the only way we can do stuff. So this is we we have multiple aims here to inform people on ADHD to bring to the forefront where where people are at, to educate and inform and ideally raise some money as well. You have the opportunity to ask questions, so do put any questions you've got into the Q and A chat. If you go to the, again, globaladhd.com.

After you've hit the donate button, you don't need to, then you go to the q and a section and you can add your own questions. You can upvote, downvote other people's, and you can even boost because, like we thought that was a good idea. Apparently, it's like some people have done it so you can boost and put your question to the top for for a donation. Like, we like to think we're quite slick. Let's not talk about the 3AM downvote. And the I missed a question with the fine people of Common Core which was what what.

Support is available to people with ADHD and I could see that he was doing a very good job of following his Christian structure and I was like I bad host, bad bad host and did not. If we come back to him and then we've got obviously some questions for everyone. Back to you.

Yeah so there's there is lots of things available and there's a variety of adaptations available which are outlined in the equal treatment bench book on page it's a very big bench book, but it's on on page three eight four if anyone's interested. But one special measure that people can well, that the court can use in is is the use of an intermediary to assess an individual's communication skills and report those to the court and then make recommendations to the courts about how communication should be used in the court to make sure everybody understands. An intermediate will assess the communication informally assess the communication.

Skills and needs of somebody who has ADHD or all sorts of other things they may have that affect their communication. And then once the report has been written sorry. My light's gone off. Very distracting. We talk about distractions. After a report's been written and served to the court, there'll be a ground rules hearing that takes place, which is where all the professionals in the courtroom and involved in hearing should be in meeting together ultimately to decide the recommendations that might be used and the adaptations that might be used to ensure that person understands everything that's happening in the case and agree those strategies. So some adaptations that as as I said earlier, there's there isn't a one size fits all approach to.

Somebody's communication needs in court because there's all sorts of things impacting on that. And the I suppose the beauty of an intermediary assessment is that we can have a bespoke approach to the way that communication is used. But some adaptations that an intermediary might recommend might include things like evidence being given from behind a screen or from video link. Often our intermediaries are in sort of a private room with a video link to the courtroom to remove distractions for somebody with ADHD. Restricting movements around the court, so maybe that people aren't allowed to enter or leave the court until there's a break time.

Minimizing background noise. So is there is there a way that the judge or the courts can minimize noises from outside or pick a different courtroom, for example, where there's less outside noise or road noise or something that's happening in there. Regular breaks for the service users, so making sure that they've got time to recover from really working hard with communication for a period of, I don't know, forty five minutes, an hour, or whatever that is. Signposting topics throughout evidence to ensure that, it's easy to follow. So and especially in cross examination. So we're now gonna talk about the time in the park. We're now gonna talk about the time at John's house. We're now gonna talk about when you went to the shops afterwards.

So rather than jumping around, which barristers often do, signposting those topics to keep it chunked up if that helps. Approving the use of fidget objects. I'm not gonna call them toys, but fidget objects for people to use in court to sort of try and and keep them engaged with the communications going on in the court. The intermediary would often or usually sit in the dock with the person for the communication needs. So they sit in the in the glass box in the back of the court or in a family court, they'll sit with the respondent at the benches, and therefore they can explain things in real time and support their communication, but also that ongoing assessment of their attention.

And whether that's fading and then can request a break from the court. Use of visual aids, so things like timetables and maps, all sorts of things. We've had Lego in court, all sorts of things to explain to sort of demonstrate where things happened or what time things happened and support that attention. Real time explanation, like I said, about sitting next to people in court. So how can you explain things? The intermediate will often be assessing.

The evidence. Is there something I need to explain right now? And is there something that can wait until or maybe it's a bit more complex, and I can't explain it real time. Either I ask for a break, and then we go and explain it in a conference, or can it wait for ten minutes until we've got a break scheduled. Explanation time is really important because often the courts will have a ten minute break or a fifteen minute break, and everybody in the courtroom gets rest. The person with ADHD has been working really, really, really hard.

And then they've got to go into a conference room, and they've got to go through it all again to make sure they've understood, and the intermediary will be working with them to do that. And then just as they've finished and and they've got to the point where they've understood everything that has been said or the evidence has been gone through back in court, everybody goes back into court and that person with ADHD hasn't had a break. So it's ensuring that the court recognize that there is they need time for explanation, which is separate to time for a break, and that probably means that everyone else is going to get a longer break, but it's important that that person with the communication need has that break time as well to recover. So.

Like I say, these are typical recommendations, but the importance of that intermediate assessment is that it's specific to the communication profile of the individual who has the communication need, and this could be influenced by all sorts of factors like we've said, comorbidities or no formal diagnosis or things going on, mental mental mental health problems or other neurodiversity that's there. It's really important that that sort of bespoke approach is taken to somebody's communication and not just they've got ADHD, so I'll give them this tick box in court because that doesn't support anybody.

Wow. Like, that's damn mute button. You actually made you made me just have a sort of a bit of a moment where where you talked about the court processes and then going out and the fact that they've been working so much harder, but then they're going through, it was itself work and and I I Explanation time. Yeah. Yeah. That's really good phrasing into making sure people know it's still work. But I even I have to even for myself, like, doing meetings and stuff where where, like, these these sort of one, you know, with lots of people and and I everyone has this ten minute break and I'm like, what do we do? Like, I'm exhausted and I'm like Yeah. And then they focus and do something for a while. Like, how are you even doing this? Like, and.

I'm just needing more time. I'd I'd always you know when you know you're different but you don't quite know, put your finger on, like, that really helped me see something myself. So but I think it's interesting how these reflections here reflect into everyone's individual life as well, and that being just a a small example. It's and I have to, like, into sorry. Sorry. Well, Michelle, like, when you talked about people being distracted by the the coat, the green coat, and then thinking about a red coat and missing what was going on. I was like, gosh, that's my like.

For ADHD, don't we? People think we're not interested but things we are often too interested with thinking about it and we continue to think about it and then we're like oh I missed oh what just happened and now if I put my hand up I'm going to look like a Wally like a with much more significant impact in a criminal justice system. Right, we have a return to come to the end times. We've got some wrap up questions for you all. So, there's a final question. It's the same variance. Michelle, what what do you think needs to change in the justice process during those initial stages of arrest and detention? What do you think will make a make a difference for people?

I think for me, it's kind of taking a more approach. It's more personalized. It's not we've got the system in place at the moment that recognizes vulnerability. Okay? But what does it mean by vulnerability? Well, in essence, we're treating, you know, a wider concept there. You know, you're asking a wide spectrum of neurodivergence to be pigeonholed within this notion of vulnerability. What we should be doing, I think, for the most part is making sure that, you know, the authorities that are dealing with people have a real understanding of the individual conditions so they can acknowledge it from not always relying on, you know, detainees to self identify as having ADHD or any other condition. So it's really about person.

Supporting the individual, not just kind of looking at them from a vulnerable perspective overall. It's really understanding what they need for support.

Thank you. Moving a question over to Alison. What do you think needs to change in the area you you see?

So I think so my post came about in 2020. Knox Healthcare decided that we needed a neurodiversity clinical lead in prisons, and I'm aware that when I've just been talking, and I did say so, that other prisons will not be, you know, having a full pathway in place where they are screening, where we are making sure that there's continuity of care. So where that's working and we are able to identify somebody's needs, recognizing that there's still a whole load of people who have unidentified needs. But I'm also concerned that we work with people where there are identified needs because it's not even necessarily going be the case that if we know you have ADHD or if you had it as a child, that you are going to be supported.

In a criminal justice setting. So where we're getting that right and we're able to offer treatment, we're offering psychoeducation, recovery college where somebody could be a student in their own, you know, learn about themselves, not just ADHD, exactly like Michelle was saying about what that might mean for you. So we will do sensory assessments, sensory plans, and we can make adjustments in the prison to mean that you have different levels of gym access. And so there is absolutely loads of things that we can do to provide you with a very individualized approach. What that requires though is a level of resourcing to identify need. It requires what the prisons are doing at the moment is employing neurodiversity support.

Managers who are band six prison officer, non uniform grade people. And there's gonna be one in every prison within the next two years. And that job is so crucial. I've got one in one of the prisons where I work. And that then means that what we're doing in health education or psychology can be supported by somebody who's on the wing and working with all the offices every day. So what needs to happen is exactly what Michelle said in in the prison setting is that we need to have the resource to be able to identify need, coordinate then the approach that we take once we understand what somebody needs, and ensure that we have a prison system wide criminal justice system wide approach.

For me, the bits that have worked the best about setting up a pathway has been making sure that we haven't seen a person who comes into prison in isolation from their lives before they came to prison, and most importantly, when they leave prison. So we spend an awful lot of time planning release and making sure that we're looking at where that's gonna need to be, where their treatment's going to need to be secured. It's not a straightforward thing. It's a controlled medication that you leave prison with. We needed to make sure that that continues for you. But even if that has happened, we're also looking at whether you're housed, whether you're supported, whether people understand that your ongoing needs are a risk for re offending. So.

Yeah, getting that right is going to take a lot more resource, a lot more work, but I'm really, really optimistic because the fact that we're employing support managers in every single prison to look at ADHD and the wider neurodiversity issues, think, is is really, really, really positive.

Is no. That is positive. I've not heard of that. No. Actually, it it is it is exciting. And I obviously, I desperately hope it happens. Right? Like, we're there seems to be quite a lot of well, it's the volatility around budgets that appears to be happening within government right now that's obviously, I think, very concerning for for everyone, particularly for know for a long time they've not been considered a core. And so yes, think we're all waiting on that one. William, it's for you to close us out.

Oh, wow. Quite a responsibility.

What.

Do what do you think needs needs to change? I think from from our aspect, I think I'd sort of draw on what Alison was saying earlier, that there's lots it's it's encouraging there's lots going on around neurodiversity in the criminal justice system, as well as wider, I think. But and this year, I mean, Community Court's operated as an intermediate provider for the last, over ten years now, and it's been totally unregulated. We welcome the creation of the HMCTS appointed intermediary service this year, which is a framework which allows for that bar to be set about what an intermediary should look like, something we've been asking for for a long time. And.

That then ensures that people have access to a service when they need it because the service is regulated. So that's that's really encouraging for people with ADHD and all sorts of communication problems. I think for us, our concern is that our research suggests that there's a massive justice gap, particularly in the North of the country, where access to our service and probably to other services, but I I can only speak about our service, but our research is suggesting that the Northeast and Northwest are three and four years behind London and the Southeast in with intermediary referral when you normalize that number against number of cases. And it gets even worse in Wales, where I think it's six years behind. So I think it's for us.

We're sort of really concerned about this access to justice gap, which seems to not only is it three or four years currently, but when you when you sort of project what the numbers may look like based on the past data, it suggests that the the gap is getting wider. So not so that the North and the Northeast and Northwest are not catching up with London and and and the Southeast, but they're actually getting further behind. And that's that's sort of worrying for us, and it's something that really concerns us. So we're in the process of sort of publishing.

Our findings, but also doing as much as we can to get the word out and raise awareness. But I think just going back to what Alison said earlier, I think it's encouraging that there is an awareness happening in the criminal justice system. Some would say find it, but I think it's but I think that's that's an it's an encouraging move, which, you know, having, you know, community court's been in this space for ten years, it seems to be accelerating somewhat now, which is which is good.

Fantastic. I had one question. It's just when you say a gap, what does that what does that mean? How does how do you measure the gap? So we've looked at.

We've referral intermediary referral rates per 10,000 cases in the criminal and family courts and across various regions. So there's nationally published data about how many cases there are in all regions. We do, I believe, between 7080% of all the intermediary work across country now, which means that our dataset's quite substantial. When you look at when you look at the number of intermediary referrals per 10,000 cases over the last few years in London's well, every region, you find this gap of, when it's about three or four times in the referral rate in in the Southern well, London and the Southeast compared to the Northwest and Northeast. So that means that Joe Bloggs, who walks into a solicitor's firm in Newcastle.

Is three or four times less likely for his solicitor to recognize that there's a need and make a referral for intermediate services than he would be if he walked into his solicitors in London. And that's that's the concern for us. I think, Henry, is that is that that it goes back to some of, you know, the earliest point of contact, which is, you know, where's that where's that informal assessment taking place that somebody's recognizing there's a need and therefore therefore signposting to the services or accessing the services that they may need. And this is a this is a centrally funded service. So it doesn't come out of local.

Legal aid budget or council budget or anything, local authority budget. It comes out of the central cost of money. So there should be equality or equity of of referral rate. I think what what our data's what we've done then with the data is looked at, well, where's the speech referrals speech condition referrals in the country? Where's the mental health referrals in the country? Where's the social care referrals in the country, and you almost get you get an increase in the areas where our referral rate is lower in those conditions and those referral rates, and the intermediary referral rate drops off. So there's a bigger need and there is a lower referral rate.

Hopefully that explains it. No, thank you. I think that was important to understand what the gap means. And I think it's been talked about there's differences across the country I think everyone's touched on and it's very important.

That's it. Just to add to that Henry, we're going to publish the data in the next couple of weeks so Oh wonderful. So it'll be on our website in the next couple of weeks in a format, is always helpful, I think. Okay. Well, we'll we'd love to help, obviously, promote that. It's it's important. It's a big deal. Guys, thank you so much.

Thank you for being part of this. You've all volunteered your time. No one no one's getting paid. Everyone's here just to make a difference for people with ADHD, for neurodiversity. You've got up early to do it and obviously prepared and brought your knowledge and expertise to share. It's a wonderful thing. Truly, genuinely appreciate it and thank you. So thank you on behalf of the audience. Yes, that's it. I'll say goodbye and move on to the next one. Thank you, Henry. Thank you, guys. Bye bye. Have a great rest of your days. Bye bye. Bye. That was an incredible session, very very interesting. Obviously ADHD in the prison service and the criminal justice system is incredibly important. We know that people with ADHD are overrepresented.

There and that discussion that just so important in what we want to do is obviously change that so people with ADHD, you know, with a with a health issue and not ending up in the criminal justice system. They need to be getting the health support that they should. We are lobbying for that. We're trying to make that change. Do donate if you can. Go to globaladhd.com and click donate and we receive no government funding. Donations there will be are split between the different between the charities across that are participating in this, all of us changing ADHD globally. We're coming together to learn together, to raise the bar, like, for everyone, and it's a it's a big deal that we're doing. So thank you so much. Thank you for.

Attending and watching this, and thank you to our participants.