Recently I had a chance to review a publication of the Brain Injury Association of Wyoming: Study of Undiagnosed Brain Injuries in Wyoming's Prison Population. The study, involving 195 inmates, used the Brain Injury Survey Questionnaire (BISQ), a reliable tool developed by Dr. Wayne Gordon at the Mt. Sinai School of Medicine and the results were evaluated by Dr. Gordon. Wyoming has a higher rate of brain injury in the general population than most states (3% vs. 2%) according to the Center for Disease Control and Injury Prevention (1999). Studies of jail and prison inmates in the United States indicate a range of brain injury from 25-87% of the inmates reporting a Traumatic Brain Injury. 82% of the individuals in the Wyoming Prison study showed a high to moderate likelihood of brain injury.The study revealed High Probability in 44% of the incarcerated men and 43% of the incarcerated women. Multiple injuries were a 71% for men and 70% for women. Loss of consciousness was noted in 67% of the men and 79% of the women. Multiple events associated with loss of consciousness were high. Motor vehicle accidents, assaults, abuse and falling during an alcohol or dug blackout were the source of injuries most frequently reported by men and women. Education was also a factor, with a higher percentage of likely brain injuries occurring among individuals with less education.
The Wyoming Prison Study is not out line with our understanding of the prevalence of brain injury in the prison population. Dorothy Lewis, M.D. in her Death Row Study found an alarmingly high rate of brain injury and neurological disease among inmates awaiting execution, substantially higher than in the general prison population. If brain injury exists at these levels in our incarcerated populations we need to consider what happens when an inmate with a brain injury is released. Prison has a highly structured and controlled environment. Upon release from prison the individual may be left without direction, structure and control and without basic tools for interacting with others, working and living. While prisons do not provide brain injury rehabilitation, we must consider how to develop effective transition plans and supports that may help the individual avoid the cycle of recidivism.
The Wyoming report makes recommendations for recognizing brain injury in the prison population and providing resources for an effective transition to the community. The incarcerated population is a group which society exiles and makes certain restorative resources scarce if not, impossible to access. We need to look at the causative factors in recidivism and take a realistic inventory of the skills and resources which are required to keep a person from entering into the cycle. The Wyoming Report sheds light on a subject that is not often discussed. Can we change how we deal with individuals with brain injury who are imprisoned?