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You and Yours - Transcript 成人论坛 Radio 4 |
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TX: 13.09.07 - Caught in the criminal system (Aspergers) PRESENTER: LIZ BARCLAY |
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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 成人论坛 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. BARCLAY Now Piers Bolduc is a 31-year-old man with Aspergers Syndrome. He's spent the past 13 years at Broadmoor - one of England's three high security special hospitals. We've discovered that despite national publicity and a high profile move to a special unit for people with Aspergers Syndrome he's now back in Broadmoor. Piers' case illustrates the problem of looking after people with complex Aspergers - there is a shortage of suitable accommodation for adults and misdiagnosis or non-diagnosis is still widespread. Carolyn Atkinson is here. Carolyn what is Aspergers Syndrome. ATKINSON Well it's on what is known as the autistic spectrum. At one end you have people with autism who have communication and speech problems, they have social interaction problems - for example they don't read body language - and they have varying degrees of learning disability. At the other end of the spectrum you have Aspergers Syndrome. Now these people have some of the same problems - social skills, problems interacting with people - they have a love of routine and of repetition but their speech is not affected and there are no learning difficulties, in fact they very often have very high IQs. But one trait is to take language very literally, so an extreme example of that could be the problems caused by a phrase like, for example, it's raining cats and dogs. BARCLAY How many people then are there in special hospitals who have Aspergers? ATKINSON Well the last count was way back in 1993 and the figure then was 31 but that was only men, so no one actually knows what the true figure is and as for women we've no idea. But as we'll hear in a minute many adults go undiagnosed or misdiagnosed so that no one really knows what the full picture is. But it is safe to say that the case of Piers Bolduc is probably not an isolated one. Now the National Autistic Society has told me that the problem of inappropriate accommodation is now so severe and the waiting list for their current facilities is so long that it's going to build a second secure unit for people with Aspergers which may give hope to Chris Bolduc. Her son Piers has lived in Broadmoor for the past 13 years and she hasn't seen him for eight years. BOLDUC We're just outside the main entrance to Broadmoor. It's a bit surreal really, it's very emotional for us because we're actually going to the hospital where our son is but we don't actually see him and that is very - that is very hard, we're not absolutely sure of the exact location of his ward but it must be pretty close. And coming back to Broadmoor you sort of think to yourself here we go again, you just hope that at this meeting we're going to have something positive on the table to where we go from here because it's been 13 years and here we are - we're still trying to get our son moved on and out. ATKINSON Chris Bolduc and her husband Eugene last saw their son Piers almost eight years ago, his younger brother Jago saw him exactly 10 years ago. The route to Broadmoor began when 16-year-old Piers had problems revising for his O Levels. A child psychologist diagnosed obsessive compulsive disorder, Piers was given drugs. A year later he was diagnosed, wrongly as it turned out, with schizophrenia and given more drugs. BOLDUC He went from being a very quiet placid young man to one of lots of twitching and movements, involuntary movements, very agitated, a completely changed personality. He was on the neuroleptics and SSRIs which my husband and I fiercely fought against because we felt that this was totally wrong. ATKINSON Because the SSRIs are antidepressants and the neuroleptics are tranquillisers. BOLDUC Yes in total they're just mind altering drugs which are given to people on the schizophrenic diagnosis, they're not at all suitable for somebody who has Aspergers Syndrome on the autistic spectrum. ATKINSON Piers' family maintain if you give anti-psychotic drugs to a person who isn't they soon will be and according to Chris Bolduc things went from bad to worse. BOLDUC When he was about 19 he went out one evening on his bike and he went into our local town and he saw some youths around a phone box and he approached the phone box and for no apparent reason he approached a youth from behind with a penknife and the young lad was hospitalised overnight and had a few stitches in his back. But the whole incident should never ever have occurred and had Piers have had the correct diagnosis at the time and not put on this strong medication we firmly believe that - well I wouldn't be sitting here now talking to you about it. ATKINSON He went to court and as his mother puts it his options were to plead mad or bad. Because he was already under a psychiatrist he decided to go down the psychiatric route. After a remand centre he then went to a private psychiatric hospital and then 13 years ago the referral to Broadmoor. BOLDUC Everyone was saying go down the psychiatric route and we thought well that will be a little bit of a cushion then surely everything would then become clear and things would get correctly diagnosed and perhaps Piers would then be able to move on in some way, after having the relevant help that would be needed. ATKINSON And that is exactly the opposite of what happened. BOLDUC Yes. ATKINSON The aim was for Piers Bolduc to spend a short time there and the general consensus appeared to be that Broadmoor was not the best place for him. BOLDUC Although I don't want to minimise what happened, because it was serious and very traumatic, when you actually pick up your local newspaper every week incidents like that occur in most major towns, very, very sadly, almost every weekend. And what happens to those people? They do not end up in Broadmoor. ATKINSON With their teenage son seemingly stuck in Broadmoor they headed off to the House of Commons to raise Piers' case with their MP David Liddington. LIDDINGTON I have been shocked, I mean deeply shocked, the more that I have got to know some of the details of this case the more this revealed to me both the serious shortcomings in the treatment that Piers Bolduc has had over the years and also the gaps in the system of provision we have in this country for the treatment of people with autistic spectrum disorders who are detained in secure mental hospitals. ATKINSON So how can a person be wrong diagnosed with the knock on effects it carries? One of the world's leading experts on autism - Professor Pat Howling - from the Institute of Psychiatry in London, says there's still a lack of knowledge when it comes to diagnosing adults with Aspergers Syndrome. HOWLING If the psychiatrist were to say do you ever hear voices when there's no one in the room - which is a sort of fairly typical sign of somebody having hallucinations - somebody with Aspergers Syndrome is quite likely to say yes because they've taken the question very literally and of course one hears voices of people upstairs, in the corridor, that sort of thing. So they interpret questions in the wrong way, give their answers in a way that's easily misinterpreted. And so they may be diagnosed as having delusions or hallucinations and because of their odd emotional affect as well this can lead to their being given a diagnosis of schizophrenia and of course then treated for a schizophrenic type illness which is often totally inappropriate. ATKINSON In fact, according to Piers Bolduc's mother, her son was finally diagnosed with Aspergers after two nurses chatting during their tea break commented that Piers' behaviour was similar to a person on another ward at Broadmoor who was formally diagnosed with Aspergers. So two years after arriving at the special hospital he got the correct diagnosis. But like many people with Aspergers finding the right place to live is a problem. For a few people places like Broadmoor are appropriate but for many others they're not. However, there are few alternatives and transferring from secure hospitals to medium secure units are fraught with problems - there are not enough of them. The National Autistic Society - the NAS - runs the Hays Unit near Bristol. It's the country's only medium secure unit for people with Aspergers detained under the Mental Health Act. There are just 12 places. The NAS's Carol Povey says the waiting list is currently at 20 and rising. And she's exclusively revealed to You and Yours that the society has decided the demand is now so high that it's going to build a second secure hospital and a team is now actively searching the country for a suitable site. POVEY We're looking at facilities that will be able to meet the needs of people with very complex needs, some of whom will be detained under the Mental Health Act, some of whom won't and we have in the past helped people to move through from those hospitals into community settings but where they do have programmes that are based very specifically around their individual needs. ATKINSON And would the level of security there be high enough to deal with some of the people who are in special hospitals at the moment? POVEY We wouldn't be looking at replicating the special hospitals. What we would be doing is still having a level of security but we don't want to replicate the special hospitals, we would be developing something that is different and is very appropriate for large numbers but not everyone. ATKINSON This obviously will give hope to people, perhaps families who feel their relations aren't in the best situation possible, although you're very keen to make it clear that you don't want to raise expectations too high too quickly. POVEY That's right. As a national charity we recognise the horrific situations that many individuals are in and they desperately need more services, they need better facilities and we're trying to meet those needs without giving people false hopes. ATKINSON The Bolduc's had always hoped that their son would be able to move on to somewhere like the Hays Unit and in fact three years ago he was transferred there, causing a flurry of national publicity. But what's not been reported up until now is that it didn't work out and he came back after seven weeks. Broadmoor Hospital, which is run by the West Middlesex Mental Health Trust, won't comment on individuals but it has told us: STATEMENT Patients are often assessed for their readiness to move to a different level of security through a period of trial leave at a medium secure unit or other appropriate facility. If the trial breaks down in any way the patient will return to Broadmoor to continue treatment and his case will be kept under review until such a time as clinical staff feel he's ready to try again. ACTUALITY Hello Chris come in, good to see you, how are you doing? Good to see you again. You haven't met Lord Howe before have you? ATKINSON For Chris Bolduc the battle to move her son goes on and while she welcomes the news that the NAS is planning another unit that is some years away, so for her it's back to her MP David Liddington and a meeting with the Tory health spokesman in the Lords Lord Howe, to see what else can be done. HOWE I've for a long time taken an interest in autism and conditions on the autistic spectrum. I'm very shocked by the details of this case. We have considered some new avenues this morning, I'd rather not tell you what they are, and I think those avenues have not yet been explored, I think that the authorities at Broadmoor will wish to explore them with us. And that is the approach that I think is right. BOLDUC I think it went very well indeed. The situation with our son is now with our member of parliament again. They know what it's done to the family, they're also taking on board the wider picture, which is also very, very important. The other young people who are also in similar circumstances, may be they have not thought as we have done for various reasons, but they are out there and they do need help and they do need support and change has to happen. ATKINSON Experts warn that the diagnosis and treatment of people with Aspergers is not only lacking in the special hospital system but in the wider criminal justice system as well, not least in prisons. Dr Lindsey Thompson from Edinburgh University has been working with the charity Research Autism and has come up with a new diagnostic tool which can spot people with Aspergers who slip through the system. She hopes it can be fully tested, subject to final ethical approval, across the Scottish prison system. THOMPSON The beauty of this instrument is its brevity - it takes about one and a half minutes to apply. We're asking questions about an individual's interactions with those around them, whether they seem odd or a loner, how they talk to others, whether they focus on a narrow range of topics, whether they appear to follow instructions or rules, whether they're a stickler for rules and how they get on with other people. That's the type of question that is asked. The strength of this instrument is that it gives us a potential route to identify these individuals and thereby to direct services. And this may include the development of some new services. ATKINSON And Richard Mills from Research Autistm who's spent years studying autism in prisoners and people in the special hospital system says it holds enormous potential for the whole criminal justice system, a system which at the moment fails to fully understand the effects the Aspergers. MILLS We know that many people who have been through the court system, when we look at their individual histories, we find that when, for example, they got into the dock their behaviour, due to a mixture of anxiety and the sort of interactional problems that people with Aspergers Syndrome have, they're not terribly good at following court procedure. And so knowing how to behave appropriately in court may be a problem and may actually attract an even more severe response from the court itself. If a judge, for example, is speaking to a defendant and the defendant doesn't appear to be paying attention or the defendant may be interrupting the judge or talking over the judge or the defendant is interpreting the judge's language or other court personnel - interpreting their language literally he may see this behaviour as being defiant or wilful. ATKINSON As for Chris Bolduc, after her latest meeting with her son's psychiatrist at Broadmoor Hospital, she's exploring other possible transfers for him but says there are no obvious answers. BOLDUC For somebody on the autistic spectrum with no personality disorder, no learning disability, no mental illness where can he go? It's a constant bereavement - there's a family member missing. And we're getting older, my husband and I are getting older, his brother's getting older and we just cannot see on the horizon where this nightmare is going to end. ATKINSON Do you think you are going to see him again? BOLDUC We have to believe that we will because if we go down the route of saying no we won't I don't think we would survive. BARCLAY Chris Bolduc. So Carolyn it looks as if there are possible changes coming that will give hope to people with Aspergers caught up in the criminal justice system. ATKINSON Yes and that ethical approval that they're hoping for in Scotland, that I referred to there, for the roll out across the Scottish prisons, that would involve the prison officers asking all those questions about inmates, that's expected to be decided one way or the other over the next few days. Just a line on visiting rules in special hospitals: in general the onus is on the patient to arrange visits, someone with Aspergers may not be adept at following the procedures, so the staff are always there to help and it's part of the care plan to do visits if they can. But equally they are adults and they may just not want to see people. Now the Department of Health weren't able to put up a minister to talk to us about any of these issues but they have given us a statement. They say to do with diagnosis and misdiagnosis they accept that it can be very difficult but they say that all psychiatrists should be able to distinguish between, for example, schizophrenia and Aspergers Syndrome. And in terms of accommodation and how long people should stay somewhere they say that a care plan should be in place and it should indicate a timescale, if at all possible, for the length of stay. But overall it basically comes down to individuals - they say each person is very different and their needs should be assessed on a one-to-one basis. BARCLAY Carolyn, thank you. Back to the You and Yours homepage The 成人论坛 is not responsible for external websites |
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