By John Gunn & Pamela Taylor – Co- chairing Crime in Mind
This article appears in our latest newsletter (Summer 2026) which can be downloaded here.
Welcome to our latest newsletter, with its focus on people with intellectual disabilities or neurodevelopmental disorders.
It is timely. For England and Wales, the Mental Health Act 2025 1 is now law.
It should be implemented alongside a substantial research budget. Then, the first call on such a budget should be for people with learning disabilities and/or other neurodevelopmental disorders.
A major element in this legislative reform is that ‘once the government is confident that enough community provision is in place, having a learning disability or autism will no longer be a reason for people to be detained under Section 3 of the 1983/2007 Act unless they have a co-occurring mental disorder.’ This means that, should you need a period in hospital with one or more of these disorders but cannot or will not consent to that, then you must break the criminal law in some fairly serious way to facilitate detention there.
The principles behind the reforms are sound. They include enabling people to have more say in their treatment and care plans, ensuring that they thus receive timely, effective and appropriate treatment whilst safeguarding their dignity and respecting their personal values. The vision is that this will facilitate treatment under the least restrictions compatible with their safety and the safety of others, including shortening any period of detention in hospital whenever this has been deemed necessary. Civil detention if health and safety really are at risk remains an option for people who have one or more mental disorders from most recognised categories (substance use disorders alone have long been an exception), but the new legislation removes this option for people with intellectual or neurodevelopmental disorders and thus marks them as specially different. The hope is that society will step up to the mark and provide better community services in a timelier way; the fear is that it will not and that more people with neurodevelopmental disorders may come into conflict with criminal law and, at best, be forced into more restrictive services.
So, do we have a good enough baseline of service use and good enough resources to monitor the impact on real lives of this substantial change? Current official statistics for people in hospital because of learning disability in England and Wales2 show 3,775 in February 2026, of whom nearly 80% (n=2,965) were then detained under the prior mental health legislation; just one fifth were voluntary inpatients. The majority of the detained patients were under civil orders (1,885, 64%); most of the rest under part 3 (forensic) orders. The civilly detained majority, in future, must be elsewhere. The figures are small, but they are not trivial. We need to be sure that the new legislation delivers the hoped for benefits and neither raises the numbers of people needing specialist forensic mental health services, nor pushes a group of vulnerable people into prison – nor even just pushes them into a slightly different civil law framework that may may not be ready for this shift3.
So, we need research to establish what really follows this legislative change.
For this newsletter, Paula Murphy and Anna Sri, our newsletter editors, have brought together some work from forensic mental health neurodevelopmental disorder teams. All three papers are calling for more community service, more expertise and more recognition of the capacity needed for individual tailoring of treatment plans. The huge concerns about difficulties in accessing the assessments that could help support early interventions and likely prevention of forensic-related needs programmes are noted. Verity Chester and Regi Alexander point out that in 2024 alone, over 200,000 people in England were waiting for an autism assessment. On a happier note they do note that the Royal College of Psychiatrists delivered the National Autism Training Programme for Psychiatrists (NATPP) to over 1,500 psychiatrists; the trained felt satisfied and more confident. Has this translated into improved early intervention?
Once having crossed into offending, all want to see more specialised services available within the community. All three contributing groups want these. Sanjib Ghosh argues that this could reduce need for inpatient care. Jane McCarthy and Iain McInnon report that the shortage of community placements is responsible for delays in detained patients returning safely in a timely way to their home communities. Their survey of Mental Health Trusts/Boards brought a very good response rate, with the positive finding that about half have access to specialist forensic mental health services. Their emphasis, though, is mainly on how to help inpatients move on. We’d also like to highlight the community sentence option – with a mental health treatment requirement (MHTR) whenever that would safeguard the treatment as well as the offender-patient and safety4. Of course the MHTR is for resolving problems rather late in the pathway, but, still, is a mechanism for enabling an offender-patient to stay in the community while resolving their problems and one for which there is good evidence of tertiary prevention5,6,7, albeit not specific to people with learning disabilities.
So, there are many research questions for this field, a few good people working in it and ready to do more, given funding.
Please raise your voices in a call for that!
References:
1 https://www.legislation.gov.uk/ukpga/2025/33
2 Statistics on people with a learning disability and autistic people in mental health hospitals from MHSDS: Data tables – NHS England Digital
3 Tromans S, Bhui K, Sawhney I, Odiyoor M, Courtenay K, Roy A, Boer H, Alexander R, Biswas A, McCarthy J, Gulati G, Laugharne R and Shankar R. (2023) The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism. The British Journal of Psychiatry, 222: 188–190. doi: 10.1192/bjp.2023.10
4 Royal College of Psychiatrists (2021) Position Statement on Mental Health Treatment Requirements (MHTRs) Ps04/21 ps04_21—mental-health-treatment-requirements.pdf
5. Chalam-Judge R and Martin E. (2024) Evaluation report: The impact of being sentenced with a community sentence treatment requirement (CSTR) on proven reoffending. Ministry of Justice Ministry of Justice Analytical Series Evaluation report – The impact of being sentenced with a community sentence treatment requirement (CSTR) on proven reoffending
6. Callender M, Sanna GA and Cahalin K. (2023) Mental health outcomes for those who have offended and have been given a Mental Health Treatment Requirement as part of a Community Order in England and Wales. Criminal Behaviour and Mental Health, 33(5):386-396. DOI: 10.1002/cbm.2312
7. O’Loughlin, A (2025) Mental Health Treatment Requirements. Sentencing Academy: London. Effectiveness bulletin_MHTRs.pdf