Prevalence of Neurodiversity in a UK High Secure Psychiatric Hospital Cohort: A Records Study

Background: The term neurodiversity is an umbrella term for any atypical pattern of cognitive ability, including but not confined to neurodevelopmental disorders. Research suggests that several neurodivergent conditions are overrepresented in offender populations, with a recent survey suggesting that over half of those coming into contact with the criminal justice system may have a neurodivergent condition. Considerable effort has been invested in trying to divert people with such conditions out of long-stay hospitals, but nevertheless, a few studies in secure hospitals suggest that while prevalence in hospitals may be lower than in prisons, it is high relative to the general population.

Aims: To determine the prevalence of recorded neurodivergent conditions in one high secure hospital.

Methods: We conducted a records survey of a resident cohort of men in one high secure hospital in England during December 2022.

Results: Records were accessed for all 197 resident men. According to these records, over one-half (115, 58%) of the men had at least one neurodivergent condition; nearly a third (56, 29%) had more than one form of neurodivergent condition. The most frequently recorded form of neurodivergent condition was general cognitive dysfunction (24%), followed by general language difficulties (16%), ADHD (15%) and autism (14%) and those with a history of seizures (14%) and atypical brain scans (12%). Dyslexia was reported within 6.5% of patient notes, acquired brain injury 5% and chromosomal disorders 2%. The survey also suggests some differences in the prevalence of neurodivergent disorders across clinical groups, with higher rates among people with mental illness than with personality disorder. Prevalence was also unevenly distributed across nature of ward type.

Conclusions: With the survey suggesting that the majority of patients in one high secure psychiatric hospital have at least one form of neurodivergent condition, it raises questions around how useful the term is and what the term neurodivergence means in this population. With each form of neurodiversity having different needs, the diversity of conditions present also raises questions around what a 'neurodiverse informed model of care' would look like in forensic mental health services.