TBI and the Prison Population

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Death Row is home to an alarming number of individuals with histories of neurological injuries. Dorothy Lewis, M.D., in her classic study revealed that 95% of the Death Row inmates she studied had signs and symptoms of neurological injuries or disease, including histories of multiple brain injuries.While 8.5% of non-incarcerated individuals have a history of TBI, the studies of individuals in the prison populations with TBI range from 25-87%. In a recent study in Minnesota of male inmates 82.8% reported having one or more head injury in their lifetime. Assaults, automobile accidents and sports injuries were the major causes of TBI in this group.In a study of women in federal prisons, a high percentage report histories of multiple concussions, including concussive injuries sustained in prison assaults. A study of the prison population in Wyoming reveals similar high numbers of brain injuries in both the male and female prison populations.

Is Traumatic Brain Injury a factor in the cause of incarceration? We do know that TBI is a factor in domestic violence. In the mid-1970’s when I was operating a forensic clinic, we saw a significant number of individuals involved in the court process and in prison with signs and symptoms of neurological injuries and disease. Many of these individuals suffered childhood accidents, came from abusive homes or grew up having many fights. They almost universally had problems with irritability, substance abuse and temper control. Screening individuals for brain injury needs to become part of the criminal justice system in terms of pre-trial and pre-sentence evaluations and as part of the prison health assessment. We also need to develop resources for individuals with a history of brain injury who are leaving prison and returning to the community. Without adequate screening and support, these individuals are likely to re-offend and return to the criminal justice system.

Doctor Lewis’ study alerted us to the high incidence of brain injury in the prison population. More recent studies in several states as well as national studies continue to indicate that the problem is great. Incarceration is not rehabilitation and treatment and certainly rehabilitation for brain injury. Many of the individuals with brain injury who are in prison also have problems with substance abuse and co-existing psychiatric disorders.These problems will enhance their risk for continuing problems while in prison and upon their release. It is important that we establish screening to determine who has a brain injury and, of equal importance, to devote resources to these individuals to prevent the problems that will return them to the criminal justice system. The issue of violence and TBI is well covered in Brain Injury Professional, V.5, Issue 1and is worth reading.

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