Traumatic Brain Injuries, Mental Health and Incarceration
Traumatic brain injuries and mental health are linked to high levels of incarceration. However, rehabilitation behind bars doesn't always consider these circumstances. Discover the real connection between these situations, and possible intervention methods.

Did you know that the Centre for Mental Health estimates approximately 60% of adult offenders and 30% of young offenders have a history of traumatic brain injuries? In comparison, only 5% to 9% of the general population suffer from a similar injury.

adult offenders and TBI

Traumatic Brain Injuries

In many instances, a history of traumatic brain injuries (TBI ) comprises multiple injuries that contribute to a cumulative impact. This research has been further expanded to reveal that men and women who have sustained TBI are approximately 2.5 times more likely to be incarcerated than those who have not.

possibility of TBI

Melissa Bickford writes for The Marshall Project about brain injuries, describing them as the “criminal justice issue nobody talks about.” Through her firsthand experience of navigating the criminal justice system with a brain injury caused by domestic violence, she describes the repercussions of her trauma. 

TBI impacts both victims and perpetrators, and some individuals are pushing legislation to get neuropsychological exams for people inside. By impacting one’s ability to manage emotions, brain injuries contribute to impulsive and agitated behavior. It becomes increasingly more difficult to build a healthy and productive life with untreated brain injuries. 

Rehabilitation vs. Punishment

Incarceration is a consequence of action, but it still costs taxpayers money to house and feed those who have broken the law (as well as the wrongfully accused). Yet rates of criminal recidivism worldwide are reported to be as high as 50%, which begs the question — should incarceration be a form of punishment or a rehabilitation method?

Putting my personal opinions aside, the numbers show that rehabilitating offenders reduces recidivism, saves money, and makes communities safer. But more than that, rehabilitation reduces the severe mental health impact on incarcerated individuals.

In the United States, the “get tough on crime” approach has shifted the prison policy from being grounded in rehabilitation to being a severe form of punishment. The result is mass incarceration, with a higher percentage of the US population involved in the criminal justice system than in any other developed country.

Unfortunately, many incarcerated individuals have serious mental health illnesses, and need a nuanced approach to rehabilitation is needed.

Yet limited resources mean there are insufficient mental health professionals in prisons to make a meaningful difference. Basic philosophical differences between rehabilitative psychology and punishment-centric corrections also present a problem.

The dramatic reduction of inpatient mental health care has framed mental illness as a crime. Consider the following statistics from NYSBA:

  •  American citizens with mental illness are ten times more likely to be incarcerated than they are to be hospitalized
  • More than 70% of people in American jails and prisons have a minimum of one diagnosed mental illness or substance use disorder

Incarceration can cause lasting damage to mental health by triggering and worsening symptoms of mental illness — which lingers long after someone is released from behind bars.

Sadly, the crisis is worsening, and psychologists and advocates are feverishly working to present literature that could shift the direction to a productive and effective one.

Early Intervention methods

Understanding the risks of mental health behind bars, it’s important to implement early intervention efforts to prevent further damage.

There are reputable organizations, such as The Disabilities Trust, in collaboration with Royal Holloway, University of London, which implemented a study on brain injuries in female offenders and how a support pathway can better manage the health, cognitive, and behavioral issues that impact the likelihood of reoffending.

Their findings suggested the following changes in the system:

  • Including brain injury screening as a routine part of the induction assessment on entry to prison on probation services
  • All prison and probation staff are to receive brain injury awareness training
  • Provision of brain injury support in prisons and probation settings
  • Assurance that brain injury support should be aligned with gender-informed practice
  • Further research to examine the potential effect of brain injury on reoffending behavior

Similar action points are offered by Transition to Adulthood, which recommend criminal justice screening and assessment, various criminal justice responses, training for criminal justice professionals, managing young people with brain injuries in custody and probation settings, commissioning appropriate and effective services, and introducing early responses to children and young people with brain injuries.

There is a lot more opportunity for research and implementation for early intervention methods and more effective rehabilitation methods to reduce the prison population, offer necessary care for offenders, and make communities more safe.