Purpose – A consultant forensic psychiatrist and an individual with autism under his care discuss their experiences of working with autism in secure care. Dr Ghosh is a Consultant Forensic Psychiatrist who analyses some of the practice issues and concerns for clinicians working with people with autism in secure care. He includes comments on the issues raised by one individual with autism (who has consented to sharing his thoughts) in secure care based on his experiences. This is particularly relevant given the recent publication of Building the Right Support, which offers national guidance to develop community services and close inpatient facilities for people with a learning disability and/or autism who display challenging behaviour, including those with a mental health condition. The paper aims to discuss these issues. Design/methodology/approach – X is an autistic patient on a medium secure unit. His viewpoint, together with his then inpatient consultant psychiatrist ' s view, is given. Findings – There are multiple issues for patients and staff to consider when on a secure unit. The approach to take is focusing on holistic management. Originality/value – This paper starts with the patient perspective of his experiences with autism in the community and in hospital. This provides a framework for the paper to demonstrate how theoretical knowledge and holistic, patient-centred management can be applied to address the issues raised for an autistic patient who has spent a number of years as an inpatient on a medium secure unit. It shows how such plans can directly involve the patient and be adapted to suit the patient ' s self-identified needs and wishes. It also looks at the challenges longer-term inpatients with autism face in their rehabilitative journey from the patient and clinician perspectives.
