Glancing through social media earlier, I saw someone posting about issues for children in police custody and a comment beneath from someone with a particular interest in ADHD for children. The issue concerned why children under arrest are not routinely screened for ADHD and it got me thinking again about all screening in police custody – how well is it done, the missed opportunities to identify someone with additional needs and provide additional support to them is something most of us would welcome, so where are we with it now and what are (at least some of) the issues?
The first thought occurring upon seeing today’s post was “Why ADHD?”
The answer in the particular case is somewhat obvious, the profile person asking the question showed a specific interest in ADHD issues in children, so of course they would be interested in seeing improved screening, detection and support for kids under arrest and why not? What I mean by “Why ADHD?” is something different, which occurs when thinking about custody processes in general. ADHD is just one condition (or group of conditions, depending on who you listen to) which affects children; and children are just one of the groups coming through custody. Vulnerabilities in custody affect adults with bipolar, anyone with autism, women with peri-natal mental health conditions, armed forces veterans and many more besides, some of whom may live with ADHD but many living with a wide variety of other conditions.
So why would a police force screen *specifically* for ADHD in children and not for ADHD in anyone or other conditions than ADHD?
SCREENING TOOLS
There are screening tools which can be administered by non-clinical staff to indicate the need for clinical review and I recall a university research group approaching me about a decade and a half ago, keen to show off their incredible software whilst arguing it could be revolutionary in police custody, to identify people who might be “missed” by normal types of police screening. They came to my office and showed it off, it was genuinely fascinating. I was immediately prepared to admit, if it could be used, it would no doubt help and it was capable of indicating a number of types of vulnerability, including mental health problems, learning difficulties and autism spectrum conditions.
There was one problem: administering the tool to screen one individual took forty-five minutes.
I had to explain that a normal custody office, in those days, was one sergeant and one member of support staff running a cell block with about eighteen cells for adults, plus two or three more for children – some cells blocks were bigger still. A typical throughput in a normal day was well over 30 people and it was often argued such staffing levels were already insufficient for the volume of demand. To administer the screening tool for even half of the people coming through would require considerably more staffing each custody block and as this discussion was occurring just at the point where Chief Constables were wrestling with the coalition government’s austerity agenda – there was little to no chance of it happening even if you could decide which half to screen.
All this reminds me of the debate about condition-specific police training:
THIRTY SEVEN CONDITIONS
Charities have often campaigned for things like “autism awareness” or “learning disabilities” training. At one time, I maintained a list of various conditions which charities or relevant family members had suggested require greater awareness training to ensure incidents gone awry don’t happen again – it was quite incredible, really. It included conditions some healthcare professionals told me they would find difficult to suspect. One family suggested the police need peri-natal mental health training, but wait: this was with reference to how such matters affect fathers who struggle after the birth of their children and / or whilst their wives or partners were affected. I had to point out: the police don’t provide peri-natal mental health awareness training at all, so you might imagine any attempt to introduce that would probably start with emphasis on mothers, something other charities had called for?
Perhaps some think that’s not correct.
The list was extensive and included not just thirty-seven conditions but some of the things in the list were definitely groups of conditions. There is more than one type of dementia, loads of different personality disorders and even once you’ve stopped listing conditions or groups of conditions, you have to get busy looking at how mental health issues affect different groups and like people from black backgrounds, armed forces veterans, children, etc.. The Police Race Action Plan, currently a major initiative in policing calls for police cognisance of the impact of mental health issues affecting black Britons that one might wonder how to start addressing all of these concerns at once.
All of these dilemmas might affect the question of screening.
ADHD affects adults as well as kids – indeed, I’d suggest in the last 5-10yrs we’ve seen an increase in the amount of coverage and discussion which adult ADHD is receiving; and some authors write that ADHD is not just one discreet clinical entity, but a number of different discrete conditions which are distinct from each other. If we’re still busy arguing over the taxonomy of things, how reliable will the screening be and what research evidence backs that up? In the training debate, I remember frequently having to ask my favourite question: the one that eventually saw a reader of this blog get it printed on a mug and sent it to me, something which made me smile –
WHAT PROBLEM ARE YOU TRYING TO FIX?
If you screen someone or screen everyone in police custody and achieve a positive result for ADHD or for another other clinical condition amounting to an vulnerability, what are you then wanting the police to do or do differently, as a consequence of that flag? Probably a number of things but the main two might well be –
- Proper clinical assessment, including assessment under the Mental Health Act 1983 if that’s appropriate to the person and their circumstances?
- Additional safeguards whilst in police custody, like enhanced levels of observations and / or the provision of an appropriate adult for the administration of rights or conduct of suspect interviews?
Is screening the only way to achieve these things? Well, in fairness to the argument, I’ve always believed there are natural barriers to vulnerable people disclosing their backgrounds to the police. Plenty of people will know that if you tell the police you have a history of mental health or neurodivergence, your custody time instantly doubles because of the additional processes and safeguards required around the two bullet points above. That acts as a natural disincentive to disclosure, so the police do need to rely on something.
There’s no obvious and easy answer to this: you can argue there should be better information exchange between services and the police; “alert cards” were popular at one point, especially for autism and I’ve argued there should always be the ability for the police to ask NHS services whether they wish to become involved in supporting someone in detention because that would allow them to do so on the basis of checking medical records which could be flagged with patient wishes and objections around police contact, if community mental health services, for example, were to discuss those things with patients when they were well.
FAST, SAFE AND CHEAP
What I do know is, proposing to screen for just one condition (or group of conditions) when we know there are at least thirty-six other conditions (or groups of conditions) which are no less deserving of consideration or attention.
The Holy Grail remains: screening which is fast, safe and cheap across the majority of predictable vulnerabilities – currently, your screening can only be two of those things and so you must choose.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2025
I am not a police officer.
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 