Medium secure care: forensic aspects of autism and Asperger's syndrome
| Date | 01 January 2013 |
| DOI | https://doi.org/10.1108/JIDOB-02-2013-0005 |
| Pages | 9-16 |
| Published date | 01 January 2013 |
| Author | Elizabeth Barkham,Santhana Gunasekaran,Caroline Lovelock |
| Subject Matter | Education,Health & social care,Sociology |
Medium secure care: forensic aspects of
autism and Asperger’s syndrome
Elizabeth Barkham, Santhana Gunasekaran and and Caroline Lovelock
Elizabeth Barkham is a
Forensic Psychologist at
St Andrew’s Healthcare,
Mansfield, UK.
Santhana Gunasekaran is a
Consultant Forensic
Psychiatrist at St Andrew’s
Healthcare, Mansfield, UK.
Caroline Lovelock is a
Consultant Forensic and
Clinical Psychologist at
St Andrew’s Healthcare,
Mansfield, UK.
Abstract
Purpose – The purpose of this paper is to offer a general review of care for individuals on the autism
spectrum, including Asperger’s syndrome within a medium secure setting.
Design/methodology/approach – The authors undertook a review of the current literature relating to
pathways to care, offending characteristics and treatment interventions. They examined the available
evidence and current practice.
Findings – Available evidence suggests offending characteristics of individuals with autism are different to
those of mental disorders such as schizophrenia. Limited evidence in treatment interventions and in risk
management for those with autism presents a challenge to clinicians. The heterogeneity makes a strong
case for an individualised case formulation approach to treatment and risk management.
Originality/value – This paper offers an overview of the current evidence base relating to the treatment of
individuals with autism spectrum disorders within medium secure settings.
Keywords Intellectual disabilities, Institutional care, Autism, Asperger’s syndrome, Case formulation,
Offending, Medium security, Treatment interventions
Paper type Viewpoint
Introduction
Autism is a heterogeneous developmental disorder and individuals on the autism spectrum
present with varying levels of intellectual ability, communication, social interaction, restricted
or repetitive behaviour and emotional reciprocity. They may also present with a variety of
associated pre-occupations, sensitivities, special abilities or co-morbidities. The vast majority
of individuals with autism do not require secure care. The majority of those on the higher
functioning end of autism spectrum lead fulfilling and meaningful lives.
In this paper we provide an overview of current treatment provisions in medium secure hospital
settings, pathways to care, therapeutic interventions, challenges in treatment and discuss
future directions.
In the UK, mental healthcare and support is usually provided by community mental health
teams. When inpatient treatment is required hospital beds are utilised informally or by detention
under the Mental Health Act (1983). For some who cannot be safely managed in such settings
due to associated violence, secure hospitals are utilised. These are categorised as high-,
medium- and low-secure hospitals based on a number of parameters including physical,
procedural and relational security aspects. Centre for Mental Health (2011) reports that there
were approximately 3,500 individuals in medium secure hospitals during 2011 in the UK.
At the present time there are only a few facilities providing specialist care for those with autism
within the medium secure category in the UK. There is no reliable evidence yet on how many
individuals with autism would need care within a medium secure setting as the expertise,
detection and community treatment facilities are still developing. Clinical experience and
DOI 10.1108/JIDOB-02-2013-0005 VOL. 4 NO. 1/2 2013, pp. 9-16, CEmerald Group Publishing Limited, ISSN 2050-8824
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JOURNAL OF INTELLECTUAL DISABILITIES ANDOFFENDING BEHAVIOUR
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