Traumatic Brain Injury: A Guide for Criminal Justice Professionals

Centers for Disease Control and Prevention

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• Slowed verbal and physical responses may be interpreted by corrections officers as uncooperative behavior.^36,37
  • Management strategies:
    • Give directions, or ask questions, slowly; repeat if necessary
    • Allow the inmate additional time to respond
• Irritability or anger may be difficult to control which can lead to an incident with another inmate or corrections officer. Such incidents can lead to further injury for the inmate with TBI and others.^37,38
  • Management strategies:
    • Avoid arguing with the inmate
    • Try re-phrasing the problem, breaking it down into parts
    • Reinforce positive behaviors
• Uninhibited or impulsive behavior, including unacceptable sexual behavior, may provoke other inmates or result in disciplinary action by jail or prison staff.^36,39
  • Management strategies:
    • Tell the inmate calmly that the behavior is unacceptable
    • Seek assistance from mental health professionals

How can the problem of TBI in prisons and jails be addressed?

A recent report from the Commission on Safety and Abuse in America’s Prisons recommended increased health screenings, evaluations, and treatment for inmates and development of partnerships with community health providers to assure continuity of care and case management for released inmates.⁴⁰

In addition, TBI experts and some prison officials have suggested the following:

• Routinely screen jail and prison populations to identify a history of TBI.^41,42
• Screen inmates with TBI for possible alcohol and/or substance abuse and provide treatment for these co-occurring conditions.^25,43,44
• Conduct additional evaluations to identify specific TBI-related problems and determine how they should be managed.⁴¹ Special attention should be given to impulsive behavior, including violence,³⁹ sexual activity,³⁶ and suicide risk if the inmate is depressed.⁴⁵

How should TBI-related problems be addressed after release from jails and prisons?

Lack of treatment and rehabilitation for inmates with mental health and substance abuse problems while incarcerated increases the probability that they will again abuse alcohol and/or drugs when released.^25,44 Persistent substance abuse can lead to homelessness,⁴⁶ return to illegal drug activities,⁴⁷ re-arrest,⁴⁸ and increased risk of death⁴⁹ after release. As a result, criminal justice professionals and TBI experts have suggested the following:

• Community re-entry staff should be trained to identify a history of TBI and have access to appropriate consultation with other professionals with expertise in TBI. ^29,41,42
• Transition services should be capable of accommodating the effects of an inmate’s TBI upon their release and return to the community.^29,41,42
• Released inmates with mental health and/or substance abuse problems should receive case management services and assistance with placement into community treatment programs.^40,43,49
• CDC supports new research to develop better methods for identifying inmates with a history of TBI and related problems and for determining how many are living with such injury.

References

1. Department of Health and Human Services (US). National Institutes of Health. NIH consensus statement: rehabilitation of persons with traumatic brain injury (October 26-28, 1998). Ragnarsson KT, editor. Washington (DC): Government Printing Office; 1999.