Incompatibilities and seclusion of patients with an autism spectrum disorder detained in high-secure psychiatric care
| Date | 11 December 2017 |
| DOI | https://doi.org/10.1108/JIDOB-05-2017-0007 |
| Published date | 11 December 2017 |
| Pages | 188-200 |
| Author | David Murphy,Emma-Louise Bush,Ignazio Puzzo |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders |
Incompatibilities and seclusion of patients
with an autism spectrum disorder
detained in high-secure psychiatric care
David Murphy, Emma-Louise Bush and Ignazio Puzzo
Abstract
Purpose –Whilst individuals with an autism spectrum disorder (ASD) represent a relatively small proportion
of patients detained in high-secure psychiatric care (HSPC), previous research suggests that such individuals
present with difficulties and needs significantly different from non-ASD patient groups. However, to date,
there has not been any formal examination of how individuals with an ASD are represented in records of key
risk management actions (i.e. seclusions and incompatibilities with other patients). The paper aims to discuss
these issues.
Design/methodology/approach –An observation of hospital data examining two key risk management
actions for a group of individuals with an ASD is detained in one HSPC hospital. These include the number of
formal incompatibilities with other patients and the number of, and hours in, seclusion. Both actions require
extra staff and security provisions and can decelerate the rehabilitation and recovery process.
Findings –In addition to suggesting an overall increase in the general prevalence of ASD within the hospital
compared to previous estimates, individuals with an ASD appear to have a disproportionately higher number
of incompatibilities with other patients compared to those patients without an ASD and experience more and
longer periods of seclusions.
Originality/value –Although the methodological limitations of the study are acknowledged,explanations for
the findings are discussed along with future research and recommendations as to how ASD patients might
be best managed in the hospital. It is argued that the findings add further support for a specialist ASD service
within HSPC.
Keywords Forensic, Psychiatry, ASD, Secure care, Incompatibilities, Seclusion
Paper type Research paper
Introduction
Autism spectrum disorders (ASD) are considered life-long neurodevelopmental disorders and
include Asperger’s syndrome, high functioning autism, classic autism and atypical autism. There
is some heterogeneity in the difficulties associated with each of these disorders; however, the
triad of impairments is homogenous among all individuals on the autism spectrum (Wing, 2002).
The triad of impairments includes significant difficulties with reciprocal social communication,
social interaction and different dimensions of imagination (e.g. having a restricted range of
interests or preoccupations, a preference to predictability and routine, perspective taking
difficulties). In addition to the triad of impairments, individuals with an ASD typically present with a
characteristic cognitive style of literal thinking, multi over serial processing difficulties, a need for
clarity and unambiguous information, and specific social cognition difficulties (Attwood, 2006).
Sensory hypersensitivities (to noise, lights, textures, personal space, etc.) are also extremely
common (Bogdashina, 2016), as are emotion regulation difficulties (Mazefsky et al., 2013).
Although having ASD is not a risk factor for offending, for some individuals the difficulties
associated with having ASD can make them vulnerable to law breaking or social misdemeanour
which may result in detention in a secure environment. Despite uncertainty as to the prevalence
Received 19 May 2017
Revised 26 July 2017
Accepted 26 July 2017
David Murphy is a Clinical
Neuropsychologist at
Department of
Neuropsychology, Broadmoor
Hospital, Crowthorne, UK.
Emma-Louise Bush is a
Research Assistant at the
Department of Psychology,
Cardiff University, Cardiff, UK
and Department of Forensic
Research and Development,
Broadmoor Hospital,
Crowthorne, UK.
Ignazio Puzzo is a Senior
Clinical Scientist at Department
of Forensic Research and
Development, Broadmoor
Hospital, Crowthorne, UK.
PAGE188
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JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
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VOL. 8 NO. 4 2017, pp.188-200, © Emerald Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-05-2017-0007
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