Many prison and jail inmates are living with traumatic brain injury (TBI)-related problems that complicate their management and treatment while incarcerated. Because most inmates will be released, these problems also pose challenges when they return to the community. The Centers for Disease Control and Prevention (CDC) recognizes TBI in prisons and jails as an important public health problem.
What is Traumatic Brain Injury?
- A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain.1
- Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from “mild,” with a brief change in mental status or consciousness, to “severe,” with an extended period of unconsciousness or amnesia after the injury.1
- A study of young adults found that those with a TBI were at risk for sustaining another,2,3 and that a history of multiple TBIs is associated with slower recovery.4
How many people have TBI?
- Each year, on average 1.4 million people in the United States sustain a TBI. Of this number, 50,000 die, 235,000 are hospitalized, and 1.1 million are treated and released from an emergency department.5
- At least 5.3 million Americans are living with TBI-related disabilities.6
- The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.7
What are the causes of TBI?
- The leading causes of TBI are falls, motor vehicle-traffic crashes, struck by or against events, and assaults.5
- Blasts are the leading cause of TBI among active duty military personnel in war zones.8
What are the long-term consequences of TBI?
- A person with a TBI can experience short- or long-term problems, requiring help in performing activities of daily living.1,6
- A TBI can cause a wide range of problems in thinking, sensation, learning, language, behavior, and/or emotions.9-11
- Persons with TBI may experience mental health problems such as severe depression,12 anxiety,13 difficulty controlling anger14 and alcohol or substance abuse.15,16
- TBI can also cause epilepsy and increase the risk for both Alzheimer’s and Parkinson’s diseases and other brain disorders associated with increasing age.9
What is known about the extent of TBI and related problems within the criminal justice system?
- According to jail and prison studies, 25-87% of inmates report having experienced a head injury or TBI 17-19 as compared to 8.5% in a general population reporting a history of TBI.20
- Inmates who reported head injuries are more likely to have disciplinary problems during incarceration.21
- Inmates with head injuries may have seizures19 or mental health problems such as anxiety22 or suicidal thoughts and/or attempts.22,23
- Studies of inmates’ self-reported health indicated that inmates with one or more head injuries have significantly higher levels of alcohol and/or drug use during the year preceding their current incarceration.22
- The U.S. Department of Justice has reported that 52% of female and 41% of male offenders were under the influence of drugs, alcohol, or both at the time of their arrest,24 and that 64% of male arrestees tested positive for at least one of five illicit drugs (cocaine, opioids, marijuana, methamphetamines, or PCP).25
- Although more than half of prison inmates have a lifetime history of drug use disorders,26 fewer than 15% receive substance abuse treatment services while in prison.27
Women and Families:
- Female inmates who are convicted of a violent crime, are more likely to have sustained a pre-crime TBI and/or some other form of physical abuse.28
- Children and teenagers who have been convicted of a crime are more likely to have sustained a pre-crime TBI29 and/or some other form of physical abuse.29-31
- Among male inmates, a history of TBI is strongly associated with perpetration of domestic violence and other kinds of violence during their lifetimes.32
Corrections and Law Enforcement Officers:
- Corrections personnel and law enforcement officers are at risk for head injury or fatal head trauma.33,34
- Interactions with suspects prior to arrest and with inmates during their incarceration are considered high risk situations for injury or death due to head trauma.35
How might inmates with TBI and others be affected by TBI-related problems?
Within the correctional setting, TBI can contribute to situations that lead to disciplinary action. Here are some common TBI problems and strategies for management:
Attention deficits may make it difficult for the inmate with TBI to focus on a required task or respond to directions given by a corrections officer. Either situation may be misinterpreted, thus leading to an impression of deliberate defiance on the part of the inmate.17,36
- Ask the inmate to repeat what you have said to confirm that he or she has heard and understood your directions
- Encourage the inmate to write down steps for the task
- Allow extra time for the task to be done
- Clear or reduce environmental distractions
- Management strategies:
Memory deficits can make it difficult to understand or remember rules or directions, which may lead to disciplinary actions by jail or prison staff.21
- Explain rules or directions slowly, step-by-step
- Ask the inmate to repeat the steps and encourage him or her to write down the information
- Provide examples and ask the inmate to provide his or her own
- Teach the inmate to ask questions when he or she doesn’t understand
- Management strategies:
From the Centers for Disease Control and Prevention. www.cdc.gov.