One in four prisoners in Britain are believed to have attention deficit hyperactivity disorder (ADHD), according to a new report. The figure, which has surprised experts, is five to 10 times higher than its prevalence of 2% to 4% in the general population.
Patient groups and doctors are now calling for offenders to be screened for ADHD when they arrive in prison. Routine examination of every new prisoner could reduce violent incidents behind bars and help sufferers avoid committing further crimes by helping them to manage the disorder, they say.
The extraordinary figure is highlighted in a new report drawn up by the ADHD Foundation, a panel of experts in the disorder and the drug company Takeda, which analyses the evidence about ADHD and the criminal justice system.
The report warns that the failure to spot prisoners with ADHD when they arrive to start their sentence contributes to difficulties managing jails, because those with it are up to eight times more likely to be involved in incidents involving aggression as a result of their condition.
“Someone with ADHD can be very impulsive and unable to sit still, and quite a lot of them become quite fractious and hyperactive, so for them being locked up in a small, confined space makes them more and more wound up. They have a low tolerance of frustration, so they kick off and kick the doors or thump the wall or self-harm or damage property, like trashing their cell,” said Dr Joe Johnson, a consultant psychiatrist with the Mersey Care NHS trust, who worked as a visiting psychiatrist running mental health clinics in Risley men’s prison in Warrington for six years.
“Although ADHD is very common in the prison population, it’s not screened for,” he said. Automatic screening on arrival would confer “far-reaching” advantages, he added.
“Screening could significantly improve outcomes because ADHD is a very treatable disorder. It could reduce the risk of reoffending, reduce rates of substance misuse, as some people could be self-medicating with illicit drugs, improve their mental health and [make them] more likely to engage in education and employment,” Johnson added.
The prison authorities could easily identify those with ADHD by starting to include that in the screening process newly arrived prisoners already went through for mental health problems, he said.
The report also found that treating ADHD using either psychological management techniques or medication had been shown to reduce criminal behaviour in men by 32% and women by 41%. However, an estimated 80% of prisoners with it had not been diagnosed, it added.
“People with ADHD don’t have a criminal gene. They aren’t more likely to become criminals,” said Dr Tony Lloyd, the chief executive of the ADHD Foundation. The unusually high proportion of people with the condition being jailed was down to their inability to get diagnosed when they were children, he said, because of long waiting times for NHS child and adolescent mental health services, schools’ poor management of pupils with it and the fact that some sufferers then struggled to hold down jobs, and some ended up taking drugs, especially cannabis, which could lead to them committing crimes.
However, Johnson aded that in his experience some convicts who were already on medication for ADHD when they arrived then found themselves unable to keep taking it because the prison authorities said that the drugs were not on the list of therapies they issued.
The unnamed 14-year-old boy convicted at Liverpool crown court last month of stabbing 12-year-old Ava White to death in the city last November had ADHD.
Research published in the journal BMC Psychiatry in 2018 found that diagnosis and treatment of ADHD in inmates could prove “a critical intervention” that “is likely to have a positive impact on the offender and society”. Despite that, “in the criminal justice system ADHD remains both mis- and underdiagnosed and consequently inadequately treated.”
The academics listed a series of “barriers” in jails to ADHD being identified and treated. They included too little awareness among staff and inmates of its symptoms and treatments, a lack of “use of appropriate screening and diagnostic tools” and a shortage of mental health staff.
The Department of Health and Social Care declined to comment. But a Whitehall source said that the Ministry of Justice is trialling and looking at using several different screening tools that would indicate that a prisoner has neurodivergent traits, including those associated with ADHD, and which will help staff help such inmates. The source insisted that all adults and under-18s who are detained are already screened for ADHD during the first week of their stay as part of an assessment of whether they have mental health, learning disability or neurodivergent needs.
