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Understanding Traumatic Brain Injury in Prisons

Offenders with brain injuries make up a huge percentage of prison populations; they also enter the criminal justice system earlier, and stay in it longer.
The Denver Police  administration building (left) in downtown Denver. The building on the  right is the former pre-trial detention facility. (Photo: Jeffrey Beall/Wikimedia Commons)

The Denver Police administration building (left) in downtown Denver. The building on the right is the former pre-trial detention facility. (Photo: Jeffrey Beall/Wikimedia Commons)

When a group of neurology students from the University of Denver decided to screen inmates in a local jail for traumatic brain injury, they expected to find it in high numbers. “But the results were high enough to shock them,” wrote Jennifer Brown in the Denver Post this week.

“Nearly every inmate screened—96 percent—had a traumatic brain injury,” Brown continued. “That's significantly higher than national statistics showing from 67 percent to 80 percent of inmates in jails and prisons have a traumatic brain injury, and far higher than the estimated 6 percent to 8.5 percent of the general population.”

The inmates the researchers screened were all in the “high risk” unit of the Downtown Detention Center because they had been deemed a risk to themselves or others. Almost all of them said they had had serious head injuries at some point in their lives—whether they had been knocked unconscious in a fight, hit by cars, beaten as children, or shot.

The Denver screening found a surprisingly high percentage of brain injury, but the correlation between traumatic brain injury and criminal behavior is already well known. Over 50,000 people die from serious brain injuries in the United States every year, but those who survive them can have long-lasting and very difficult side effects.

“Nearly every inmate screened—96 percent—had a traumatic brain injury. That's ... far higher than the estimated 6 percent to 8.5 percent of the general population.”

Traumatic brain injury has been proven to be a major risk factor for depression, post-traumatic stress disorder, aggressive behavior, substance abuse, and homelessness. But it’s also often associated with criminal behavior because it can, in some people, seem to alter all their behavior. Studies have shown that “the amount of verbal aggression, temper outbursts, and disinhibition” can increase after an injury, and that the aggression can become chronic if it isn’t addressed. According to a 2010 study in the journal Brain Injury, adult offenders with histories of traumatic brain injury also tend to enter the criminal justice system at a younger age than offenders without injuries, and to stay in it for longer.

Others have pointed out that people who are prone to aggression or recklessness may be more likely to sustain these kinds of injuries in the first place; a survey of inmates in a Midwestern prison back in 1998 found that the most frequent sources of prisoners’ brain injuries was fighting. (“Blows to the head with steel bars, baseball bats, or fists were reported by many of the prisoners. Gun shot wounds and automobile accidents were also frequent.”)

Regardless of which direction the causation runs, it seems clear that the period of time right after a traumatic brain injury can be a dangerous one. In a 2003 study, 87 percent of the inmates in a U.S. county jail said they had had an injury at some point in their lifetimes, and 36 percent had had one in the past year. And the latter group, who had been hurt more recently, “had significantly worse anger and aggression scores and had a trend towards poorer cognitive test results and a higher prevalence of psychiatric disorders than the group without TBI in the prior year.”

That said, the effects of older injuries can also be long lasting, and can crop up in unexpected ways. If very young children suffer brain injuries, it can affect important stages of development—not just basic cognitive development, but psychosocial development as well, as psychologist James Tonks and his colleagues at the University of Exeter argue in Developmental Medicine & Child Neurology. Brain injuries can affect a child’s growing “emotion-processing systems,” empathy for others, and impulse control. The authors describe how children under the age of five who suffer injuries can display “disruptive behavior, poor empathy, and lack of moral reasoning” in older years.

Tragically, after-effects can last into adulthood if they aren’t treated; adults who were seriously injured as children are twice as likely to develop mental health disorders later in life. Still, Tonks and his co-authors write, “Despite such enduring difficulties, the relationship between brain injury in childhood and lasting socio-emotional disturbance has received little attention, or scientific scrutiny, and is relatively unexplored in comparison to adult brain injury.”

So what does this mean for prisons and their inmates? It certainly doesn’t mean that every person with a head injury is destined for a life of crime. But the high rates of traumatic brain injuries within prison populations show that both the medical and criminal justice industries could do with better screening procedures—to get people help if they need it, after (or ideally before) they commit a crime.

As for the University of Denver neurologists, what started as a simple screening exercise has grown into an inmate treatment program for that jail and 13 others, thanks to a partnership with the Colorado Brain Injury Program and some new funding. The therapy they develop will likely focus on “helping patients understand why it is hard for them to follow directions, how to understand sarcasm and why it's important to react immediately when a law officer asks them to put their hands up or come out of their cell,” reports the Denver Post’s Jennifer Brown.

The program isn’t limited to inmates, either, as Jennifer Gafford, a staff psychologist for the Denver County sheriff's office, told Brown: “The flip side is to help officers understand maybe they are not being obstinate, maybe it's that they don't understand.”

True Crime is Lauren Kirchner's weekly column about crime and criminal justice issues.