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The primary work of a forensic hospital is to reduce the risks associated with offending by providing psychiatric assessment, care and treatment and wherever possible provide for offenders’ rehabilitation (Sederer, 2010). Within the UK, this must be accomplished by means of the least restrictive practice (Department of Health, 2007, 2012, 2015). Unless risk can be demonstrated to have been reduced to the satisfaction of the UK criminal justice system, residents in secure hospitals cannot be moved on, potentially leading to a hard-core population of long-term patients effectively warehoused, at great expense to their communities, with little chance of rehabilitation: frustrating for clinicians, and damaging both to communities and patients. The main focus of forensic hospitals in the UK is on those conditions traditionally associated with risky behaviours, such as psychosis, schizophrenia, and personality disorder. Until recently, identifying autism spectrum disorder (ASD) has hardly figured in the repertoire of skills of forensic psychiatrists (Haskins and Silva, 2006). ASD was not mentioned in the Royal College of Psychiatry’s core competencies until 2010 (Royal College of Psychiatrists, 2009, 2010), meaning that skills in rehabilitating risk in the ASD population are not explicitly developed in practitioners to the same degree as for the more traditional forensic conditions (Myers, 2004; Allen et al., 2008). Forensic patients who have ASD comorbid with intellectual disability are particularly vulnerable to this kind of institutional oversight (Barron et al., 2002; Myers, 2004).
The work of treating and rehabilitating forensic patients is a serious business. When it goes wrong, the consequences can be disastrous, a fact reflected in the vast amount of legislation and guidance with which forensic practitioners are conversant (e.g. Department of Health, 1983, 2007, 2015). This important work is carried out almost entirely by means of interaction (Dobbinson, 2016). Unsurprisingly, then, in their daily work clinical teams concern themselves minutely with the talk of their patients. When not directly engaged in interactions, practitioners are reflecting on them, hypothesizing about underpinning processes, offering and sharing interpretations, adapting approaches. The medium term aim is to reach an understanding of the factors underlying their patients’ offending behaviours, with the long term purpose of informing how they can be most safely managed in the future. Ideally, the patient’s own understanding of what makes them...