Traumatic brain injury (TBI) is a huge “hidden disability” within prison populations in the US and the UK. Despite evidence that TBI can lead sufferers to be more violent and reoffend, there is a worrying lack of information about the extent of the problem and there is no standard screening process. At a time when there is huge concern about escalating prison population rates, is it not time this issue was addressed?

Prisoners who have had head injuries are more likely to experience a variety of mental health problems including severe depression and anxiety, substance use disorders, anger and suicidal thoughts.

Surprisingly, it is only relatively recently that researchers have started investigating brain injury within the criminal justice context. But those studies show higher rates of TBI within incarcerated populations compared to the rate found in the general population.

Despite studies highlighting the significant prevalence of TBI in inmates, there has been little consideration of this in the development of policies and procedures. An important review conducted in the UK and published in 2009 exploring the mental health needs of prisoners made no reference to brain injury at all.

Yet evidence shows that TBI caused by a blow to the head (something which is common among people who have lived violent lives or been victims of childhood abuse) is a leading cause of death and disability worldwide. TBI can also lead sufferers to be more prone to violent behaviour and therefore reoffend.

There appears to be just cause for concern regarding the rate of recidivism in individuals with TBI. This year researchers published the findings from their study which investigated the rearrest post release from prison among a sample of Indiana inmates who were screened using the Ohio State University Traumatic Brain Injury Identification (OSU-TBI-ID) instrument. Their findings revealed that those with TBI were more likely to commit crimes post release.

Prevalence of TBI in inmates

In my review, I investigated studies which looked at the prevalence of brain injury in a prison sample. I also looked at studies which examined how brain injury is assessed in prisons and how effective these assessments or screening tools are in terms of being able to detect TBI in inmates .

I identified 17 studies worldwide looking at mainly US prisons. The review found huge discrepancies in the way this data had been collected. All 17 studies found high rates of TBI in prison populations. One study found a very high rate in their sample of more than 998 offenders. About 82 percent were found to have suffered a TBI at some point in their lifetime.

Clearly the need for the criminal justice system – in both the US and the UK – to recognise the importance of screening inmates for brain injury is imperative. When inmates are identified as having a TBI, they can then be placed into tailored programs which may reduce the risk of these potentially vulnerable individuals engaging in offending behaviour when they are released. The earlier in the criminal justice process that such screening can be made the better.

My review highlighted the importance of understanding the needs of inmates with such injuries, as TBI-related behaviours may make it more challenging for inmates to comply with prison regimes and rules.

Training and screening

So what can be done to help? A positive first step would be increased awareness of offenders with a TBI. This could be established with prison staff training. Staff could be taught how to recognise and understand certain behaviours which are a consequence of previous injuries – as opposed to a prisoner being deliberately defiant.

Training could take in the consequences of TBI, which include related behaviours like impaired impulse control, aggression, depression, anxiety and memory impairment. There is also a clear need for routine screening. This screening could take place at any stage, whether during parole, court appearances or while the prisoner is in a correctional programme.

It has also been suggested that specialised support should be made available to inmates who report having suffered one or more moderate-to-severe head injuries or multiple mild injuries.

A lot more work needs to be done in recognising the prevalence of TBI in inmates. But the simple steps outlined above would help manage the care of offenders with this condition and inform specific prison rehabilitation programmes. This needs to be built into the criminal justice system, from court appearance to parole. Such measures could help reduce the number of people reoffending. Ultimately, it would aim to reduce the overall prison population.