Supporting vulnerable women with autism

Coping with a prison sentence and the rocky road that follows release from it is a challenging for anyone. But it can be paticularly traumatic for the people affected by conditions such as autism.

Developed in 2014, St Giles Trust’s ASD (Autism Spectrum Disorder) project came about as a result of recommendations from a 2012 evaluation into our female Through the Gates project, WIRE, which supported vulnerable female prison leavers returning to London. The recommendations – and the anecdotal experience of staff working on WIRE - highlighted the significant number of very vulnerable women who had mental health needs around ASD traits and personality disorder.

Funded by the National Offender Management Service (NOMS), St Giles Trust’s ASD project provides support to prison leavers from HMP Holloway with Autistic and Personality Disorder Traits. It is delivered in partnership with The Cambian Group who offer specialist healthcare to people affected by such issues.

The small team comprise London Prisons Manager Shiyamali Tharamakulasingham and experienced Caseworker Molly Hayhurst. A psychologist from The Cambian Group is also attached to the project.

Shiyamali explains that the project aims to “avoid women going down the emergency services route.” There is limited awareness in the sector of issues around ASD and the fact that many women in the criminal justice system may be experiencing them. Women in prison who are seen as disruptive and ‘kicking off’ may have the condition underlying their behaviour.

Autism Spectrum Disorder is a lifelong condition affecting how a person communicates and makes sense of the world around them. Typical traits are wide-ranging but the institutionalised environment of custody and the stark contrast of the world outside when released can worsen someone’s condition. Noisy, artificially light wings, banter from prisoners and staff, sudden changes to routine through lock-downs can all increase someone’s stress and the problematic behaviour which results from it.

“We treat each client as an individual because autism affects people in different ways,” says Molly. “We’ll work with what restricts them day to day and that can be pretty much anything.” Alongside basic needs such as housing and benefits, Molly’s work is more personalised - for example, accompanying a client on public transport to increase their confidence using it.

The ultimate goal is to help reduce the likelihood of re-entering the criminal justice system, assist women to become independent and create a lifestyle where the woman has both support and opportunities.

A key part involves training and supporting other professionals working with the client. “We often have to remind professionals that someone is autistic,” says Shiyamali. Diagnosis can take more than a year so women can be delayed in receiving the support they need. Although awareness of women and ASD has increased, there is still a lack of knowledge. ASD is often seen as a male disorder and the condition is more frequently hidden in women.

Molly helps the women understand their condition and how certain behaviour can lead to being restrained or taken into segregation. One of the key activities of the team is collecting tools and resources to support both clients and the people who work with them

As well as providing support in prison, the project provides through the gates and community-based support as well. A limit is kept on caseloads due to the highly intensive nature of the support needed by the clients and the fact the team are small. In the first year of the project, six women were supported through it against a target of five and this year we are already on track to reach our target of eight.

A NOMS-backed evaluation into the project is now underway. It will look at factors such as improvements in the quality of life for clients, a reduction in emergency contacts with public services, levels of offending and the satisfaction of both clients and partners with the service.

Alongside improving life for the client, the project aims to relieve some of the burden felt by other frontline professionals including those in prisons, probation, specialist agencies and the NHS. Women with the condition can often make frequent and inappropriate use of services and exhibit challenging behaviour when they do. Ensuring the client is supported and that other professionals working with them are aware of their condition and know how to deal with it helps everyone.