Attention deficit hyperactivity disorder (ADHD) screening in custody

The aim of screening is to: 

• help individuals in custody identify traits of ADHD
• signpost individuals to seek professional help and support
• provide a custody environment that is suitable for individuals who are neurodivergent

The intended outcomes of the screening are to:

• improve custody staff understanding of ADHD and how to support neurodivergent individuals
• increase the number of referrals to local services
• reduce offending and reoffending for neurodivergent individuals
• improve multi-agency partnership approaches to neurodiversity

The ADHD Liberty charity are encouraging ADHD screening across all areas of the criminal justice system. After hearing about a pilot conducted by City of London Police on ADHD screening in custody, Cumbria Police wanted to develop this for Cumbria and implement the process across the force. 

The response inspector conducted several input sessions inviting users and volunteers to explore a proof-of-concept model for ADHD screenings in custody. The purpose of the sessions was to resolve any user or process errors prior to the launch. The following teams and organisations were involved in the consultation:

• health care practitioners (HCPs)
• Cumbria Constabulary’s learning and development team
• Cumbria Constabulary’s custody staff
• Cumbria Constabulary’s chief officers
• Cumbria Constabulary’s occupational health unit
• Cumbria Constabulary’s marketing and media team
• Cumbria Constabulary’s custody governance
• Cumbria Constabulary’s staff associations
• Cumbria Constabulary’s valuing individuals group
• Police Federation
• Unison
• office of police, fire and crime commissioner 

The response inspector set up an email account for the screening pilot along with a workflow process for the volunteers and the custody sergeant. Initially, a separate email account was created for the HCP, however during the pilot phase this was streamlined to ensure that they could access Cumbria Constabulary’s inbox.

The response inspector developed a Microsoft form to capture the screening questions. The person who conducts the screening will click into a link, then the Microsoft form will take them through the screening questions. The first part of the form is to capture consent of the individual to be screened, some basic demographic details like age range, biological sex, if they have any addiction issues etc. Then the second part of the form is where the main screening questions are asked. The form automatically creates a score at the end of the process, which is then emailed to a shared inbox so that the details can be provided to the detainee who has been screened.

ADHD screening requests

ADHD screening requests can be made when the custody sergeant asks the detained person or volunteer if they would like to take part. If they answer yes, the custody sergeant will click on a link which would initiate an automated email to the volunteer inbox. The information within the email includes only the detained person or volunteer’s custody reference number. For those who do not want to be screened, the custody sergeant asks if they have previously been screened to prevent repetition.  

ADHD screenings

Once a request has been made, it is added to the individual’s custody record. This can include whether the individual has received external support or if there is a child request whether an appropriate adult has been notified about the screening.

All volunteers were contacted prior to the launch and were offered support. It was explained that anything disclosed by the detainee which caused concern regarding their health or mental wellbeing was to be brought to the attention of the custody officer, who may consider referral to an HCP or learning and development (if screening is not being conducted by HCP or a volunteer).

Once the screening pilot was launched, the response inspector liaised with the learning and development team to establish whether they would see individuals who had scored high likely and consented. This ensured individuals could have a further NHS screening completed and offered additional support.

During the first week of the pilot phase, the response inspector liaised with learning and development and the HCPs for feedback on the form as well as the guidance notes. As a result of the feedback, changes were made to the supporting letter of the individual and the Microsoft screening form. The changes included the following additional questions:

• any current diagnosis
• any addictions
• the offence for which they had been arrested

The force also recorded personal data such as sex at birth and age range. However, to ensure the confidentiality of the results, they chose not to capture names, dates of birth, or addresses.

To provide a visual explanation of “why screen for ADHD in custody”, the force created a short video to explain the process. The marketing and media team created an external link which allowed the video to be accessed by individuals on Vimeo. IT also added the link to the end of the Microsoft form to ensure individuals were given the opportunity to watch the video at the end of their screening.

At the end of the screening, the individual has the option to have their results emailed to them along with two attachments summarising the “why screen for ADHD in custody” video and a letter signposting to support services.

The custody sergeant on duty at the time of the screening is notified if an individual has scored highly likely, to ensure this is taken into consideration during the interview(s).

Resourcing

Due to the demand on shift and from neighbourhood policing teams (NPTs), the screenings were predominantly conducted by the response inspector, an inspector, and NPT sergeant. HCPs also completed some of the screenings.

Cost

The initial outlay was approximately £100, which covered the cost for printing the neurodiversity leaflets. This was funded by the force’s custody budget and approved by the chief superintendent.

Following negotiations with Mountain Healthcare, they provided £2,000 which covered the cost of updates to their IT software. This enables them to document the screening process on the NHS system. 

Post pilot launch

Following the media release, Cumbria Constabulary were contacted by the National Crime Agency, North Cumbria integrated care board, and other forces enquiring about the process. The force has also spoken at the N8 Policing Innovation Forum focussing on Neurodiversity in the criminal justice system.

An evaluation was launched in 2025 and is being led by Cumbria Constabulary. The aim of the evaluation is to see if there is a reduction in offending and reoffending by comparing offending rates six months prior to screening and six months post screening. The evaluation is using a mixed method approach examining quantitative and qualitative data. 

The quantitative analysis is using data captured from the screenings via a SharePoint. The data which is held on Power BI looks at the following:

• the number of individuals screened
• how many individuals were shown to be “highly likely" ADHD
• demographic information such as age and gender
• if they have addiction issues
• what offences they have been arrested for
• if they have any other diagnosis of a neurodiverse condition

The qualitative analysis is using the information from the feedback forms to understand the views of those screened, how they found the process and if there was relevant impact on them.

A social economic cost analysis will also be utilised to compare against the reduction in any offending rates. This will only be completed once the force have collected data to see if reoffending rates have reduced. 

• the initial pilot found 75% of individuals who were screened were identified as "highly likely" ADHD
• when combining the data of those who were identified as "possible ADHD" and "highly likely ADHD", this increased to 96%

During the initial pilot, the force encountered problems in the practical screening process. Initially the force utilised volunteers, a mixture of operational police officers and staff, however this was not sustainable long term. Due to operational demand, the availability of volunteers has been limited which led to missed screening opportunities.

The force also found that there was a mixed response to individuals willing to be screened with many not feeling comfortable to participate. This meant that a portion of detainees were not screened. Subsequently, custody sergeants stopped asking whether individuals would like to be screened, as there was no guarantee of the availability of a volunteer. Hence the initiative has gradually come to a standstill.

To ensure the longevity of the initiative, the force needed to identify a reliable resource within the custody department. Detention officers, custody sergeants, liaison team and diversion team were ruled out. The force identified that HCPs were the most appropriate resource to conduct the screenings. Cumbria Constabulary had to consider both the financial and contractual implications of using HCPs, as they were under the contract of the force, and this was seen as an additional piece of work. Through negotiations with the NHS trust, HCPs are now able to conduct screening at no extra cost.