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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I am grateful to the hon. Member for Aylesbury (Mr. Lidington) for securing this debate and for discussing a subject that, as he doubtless knows, is very close to my heart. I also thank him for raising the specific case of Mr. Piers Bolduc, who, as he says, has Asperger's syndrome and is currently in Broadmoor hospital. The hon. Gentleman has raised some interesting issues that we will certainly need to explore further if the House introduces new mental health legislation, for example, as is intended. If I fail to address any of the issues that he has asked me about, they will certainly be dealt with in a letter.
The parents of Piers Bolduc have been unstinting in trying to secure a placement for him in a centre that cares specifically for people with Asperger's syndrome, and in which they believe his particular needs can be better addressed. I should say at the outset that it is very sad if they feel excluded from the process in any way. We should learn lessons from that, and it should not happen. That said, Mr. Bolduc has rights as an adult, and I shall talk about them and what they prevent me from saying a little later. It is clear from what the hon. Gentleman said that we need to do more to square the circle and to make sure that parents feel that they have
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an input and are being listened to, even if we cannot always act on their wishes because we have to act on those of another party.
I care greatly about improving the experience of people with Asperger's syndrome and of everyone on the autistic spectrum, the vast majority of whom, of course, do not need such highly specialised help as Mr. Bolduc. I shall talk about Mr. Bolduc's case, which involves a person affected by Asperger's syndrome being detained in a secure mental hospital, in a moment or two. First, I want to say a few words about the recognition of Asperger's syndrome in the criminal justice system, and about high secure hospitals.
I must stress that people affected by autistic spectrum disorders, including Asperger's syndrome, do not normally pose any risk to society at large. I am aware of no evidence of any significant association between autism and criminal offending. In fact, because of the nature of autism and the very rigid way in which many people with autistic spectrum disorders tend to keep to "rules and regulations", they are often more law abiding than the general population. It would be a tragedy, and grossly unfair, if anyone inferred from my comments any suggestion that people on the autistic spectrum are a threat or are routinely dangerous. The hon. Gentleman will doubtless join me in that sentiment. Indeed, people with learning disabilities, including autism, are over-represented among the victims rather than perpetrators of crime. In 1999, Mencap reported that 21 per cent. of the people with learning disabilities that they surveyed had been subject to physical attacks in the previous year. Although research in this field is limited, naivety and a lack of social understanding are likely to increase the vulnerability to crime of people with autistic spectrum disorders.
However, some people with autism—in common with some people from every other group in society—sometimes either break the law or are suspected of or accused of breaking the law. When that happens, fair treatment for them is often dependent on the involvement of people—in the police force, the courts or the prisons—who understand autistic spectrum disorders. Before I became a Minister, I was the chairman of the all-party group on autism, and I have long been keen to see steps taken to improve autism awareness in the criminal justice system. I remain keen and I am pleased to say that some progress is being made.
The Youth Justice Board and the Magistrates Association have arranged a joint conference in July this year to raise awareness of mental health issues and autistic spectrum disorders among magistrates and judges. That conference will also give youth panel chairs and justices' clerks an opportunity to hear about policy developments and learn about the roles and responsibilities of agencies involved in providing services for young people.
Progress is also being made to improve autism awareness among police officers. Probationary police officers receive autism awareness training and are taught to recognise the condition as part of their two-year training programme. In addition, when they receive training in investigative interviewing they are given a detailed briefing on conditions, including autism, that could affect communication or that might mean witnesses being easily intimidated. Throughout their
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training they are reminded that the skills that they have learned may also be needed when dealing not only with witnesses but with criminals and members of the public.
As the hon. Gentleman will know, responsibility for prison health was transferred from the Home Office to the Department of Health from 1 April 2003 and I am the Minister responsible for prison health. I certainly appreciate, and the prison health team also appreciates, that autistic spectrum disorders and learning disabilities may well be under-diagnosed in the prison population.
The Prison Service, Prison Health and the Youth Justice Board share a commitment to the provision of better specialist health and mental health services for offenders. To give practical effect to that, they have jointly appointed a programme manager for juvenile health. Among the benefits expected from the creation of the post is a greater understanding of the nature and prevalence of all conditions, including autism. That should, in turn, lead to an increased emphasis on the diagnosis and assessment of such conditions at establishment level and the commissioning, by primary care trusts, of appropriate services to meet the needs identified.
One of the first projects being undertaken by the new programme manager for juvenile health is the development of a health strategy for juveniles. The extent to which autism may be a significant problem in individual prison establishments would be expected to emerge from the regular health needs assessments undertaken jointly by prisons and their NHS partners.
I fully acknowledge that people on the autistic spectrum, at all ages, are at above-average risk of developing mental health problems. That makes it particularly important to consider what steps should be taken for people with autism to ensure early intervention when mental health problems arise.
Making an accurate psychiatric diagnosis of people with Asperger's syndrome is a complex process. Features of the syndrome, such as disturbances of communication, obsessionality and preoccupations, can be mistaken for—or, indeed, merge into—mental ill health. That is exactly what happened with Mr. Bolduc. Secure psychiatric hospitals provide care and treatment for people detained under mental health legislation and who are considered to require such care and treatment in secure conditions. That could, for example, be because they are considered to present a potential threat to themselves or others or might abscond if detained in open conditions. They will include mentally disordered offenders and patients who have proved unmanageable in non-secure conditions. If an individual with Asperger's syndrome is considered sufficiently dangerous, he or she will be admitted to a high security hospital until their condition improves enough for them to be managed in a lower level of security.
I know that many hon. Members are concerned about how many current residents at secure mental hospitals have been assessed as having Asperger's syndrome. It is one of the questions that the hon. Gentleman asked me. A few years ago, the Department of Health funded the National Autistic Society to undertake a specific piece of work in this area. Entitled "A Preliminary Study of Individuals with Autistic Spectrum Disorders in Three Special Hospitals in England", it was published in 1999.
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The report arose from concern among professionals in special—now called high secure—hospitals in England to establish the number of people with an autistic spectrum disorder who were detained in their care under mental health legislation and whether such settings were appropriate. It is available on the National Autistic Society website.
The report identified that there were then 31 individuals with autistic spectrum disorders, of whom 21 were thought to have Asperger's syndrome. Mr. Bolduc would have been a resident in Broadmoor at the time that survey was done. It concluded that
"individuals with autistic spectrum disorders form only a small proportion of all those in the special hospitals".
It is worth noting that the report's conclusions also stated that the
"possibility of the presence of an autistic spectrum disorder should always be considered when assessing offenders in special hospitals."
I am sure we all agree that the relatively small proportion of people affected does not make it any less important to get it right for the people concerned. The important thing is to do all we can to improve services.
The transition from high secure care to conditions of lesser security can be a difficult one for many individuals and needs careful handling. A patient may move out of a high security hospital either on transfer to a less secure hospital or on discharge into the community. The first step would usually be for the patient's responsible medical officer, in consultation with his clinical team, to decide that the patient no longer needs to be detained for care and treatment in conditions of high security.
If the decision is that the patient nevertheless still requires care and treatment in a hospital setting for their mental disorder but that it can safely be provided at a lower level of security, the responsible medical officer or clinical team will seek to identify a suitable alternative placement. The doctor or clinical team at the receiving hospital will need to agree that transfer is appropriate, and the relevant PCT commissioner's agreement to fund the placement will need to be obtained. If the necessary agreements are obtained but a vacancy in the receiving facility is not immediately available, the patient may be placed on a waiting list for admission.
I come to Mr. Piers Bolduc's present situation. I must say at this point that I am limited in what I feel I can say about the specific case. Mr. Bolduc has advised, through his clinicians at Broadmoor hospital, that he does not wish personal details of his case to be discussed publicly. Mr. Bolduc is an adult and has the capacity and right to make such decisions, and there is no reason why that request should not be respected in full. I make no criticism of the hon. Gentleman, because I know that he represents the views of Mr. Bolduc's parents and has their permission to put in the public domain the information that he gave. However, that does not mean to say that I may do so, given that I have Mr. Bolduc's instructions.
I can tell the House, however, that it was following Mr. Bolduc's transfer from Stockton Hall hospital to Broadmoor hospital in 1995 that a diagnosis of Asperger's syndrome was confirmed. A programme of
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therapy and rehabilitation was put in place and has progressed to the point that the clinical team and Mr. Bolduc himself now feel that he is ready for transfer to an alternative, specialist unit. A unit run by an organisation with specialist expertise has been identified, which offers assessment and treatment for people with Asperger's syndrome. In respect of Mr. Bolduc's request for privacy, it is not appropriate to confirm the name of the unit or its location. This unit is well equipped to support Mr. Bolduc with the level of support, safety and security that he both requires and seeks.
All necessary clinical assessments have been undertaken as part of the referral process and Mr. Bolduc has been accepted for transfer to the unit, as soon as a place becomes available. I hope that the hon. Gentleman will be somewhat reassured by that. The necessary transfer agreements are also being pursued by Broadmoor hospital with the Home Office. My understanding is that all involved parties, including Mr. Bolduc's parents, are in agreement that it is in fact the most appropriate placement. Unfortunately it is not possible to say precisely when the transfer can take
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place, as that is dependent on availability of a bed, although it is anticipated that this should be in the coming months. As the hon. Gentleman requested, I am happy to liaise with colleagues at the Home Office to ensure that there are no undue delays. While Mr. Bolduc remains at Broadmoor hospital, his current therapeutic programme will continue with the aim of developing the skills required both for his next placement and beyond.
Finally, I should like to stress again that the vast majority of people with autism or Asperger's syndrome do not present a risk to society because of their condition. We have been discussing very rare cases. However, when people with ASD, such as Mr. Bolduc, do come in contact with the criminal justice system, they are entitled to interact with people who understand their condition and act appropriately. That is what we are trying to put in place across the board, and I hope the hon. Gentleman will accept that progress is being made and that I am committed to keeping up the pace of reform and to improving services for people with Asperger's. I will do all I can to ensure that Mr. Bolduc's transfer takes place as expeditiously as possible and that the matter is dealt with quickly.
Question put and agreed to.
- Adjourned accordingly at Three o'clock.
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