Traumatic Brain Injury in Prisoners

What Is Known about Traumatic Brain Injury and Related Problems in Prisons and Jails?

General

• More than two million people currently reside in U.S. prisons and jails.
• According to jail and prison studies, 25 to 87 percent of inmates report having experienced a head injury or TBI as compared to 8.5 percent in a general population reporting a history of TBI.
• Prisoners who have had head injuries may also experience mental-health problems such as severe depression and anxiety, substance use disorders, difficulty controlling anger, or suicidal thoughts and/or attempts.

Women

• Although women are outnumbered by men in U.S. prisons and jails, their numbers more than doubled from 1990 to 2000. As of June 2005, more than 200,000 women were incarcerated. Women now represent 7 percent of the total U.S. prison population and 12 percent of the total U.S. jail population.
• Women inmates who are convicted of violent crime are more likely to have sustained a precrime TBI and/or some other form of physical abuse.
• Women with substance use disorders have an increased risk for TBI compared with other women in the general U.S. population.
• Preliminary results from one study suggest that TBI among women in prison is very common.

Substance Abuse, Violence, and Homelessness

• Studies of prisoners' self-reported health indicate that those with one or more head injuries have significantly higher levels of alcohol and/or drug use during the year preceding their current incarceration.
• The U.S. Department of Justice (DOJ) has reported that 52 percent of female offenders and 41 percent of male offenders are under the influence of drugs, alcohol, or both at the time of their arrest and that 64 percent of male arrestees tested positive for at least one of five illicit drugs (cocaine, opioids, marijuana, methamphetamines, or phencyclidine (PCP).
• Among male prisoners, a history of TBI is strongly associated with the perpetration of domestic and other kinds of violence.
• Children and teenagers who have been convicted of a crime are more likely to have had a precrime TBI and/or some other kind of physical abuse.
• Homelessness has been found to be related to both head injury and prior imprisonment.

How Do Traumatic Brain Injury-Related Problems Affect Prisoners with Traumatic Brain Injury and Others during Their Incarceration?

A TBI may cause many different problems:

• Attention deficits may make it difficult for the prisoner with TBI to focus on a required task or respond to directions given by a correctional officer. Either situation may be misinterpreted, thus leading to an impression of deliberate defiance on the part of the prisoner.
• Memory deficits can make it difficult to understand or remember rules or directions, which can lead to disciplinary actions by jail or prison staff.
• Irritability or anger might be difficult to control and can lead to an incident with another prisoner or correctional officer and to further injury for the person and others.
• Slowed verbal and physical responses may be interpreted by correctional officers as uncooperative behavior.
• Uninhibited or impulsive behavior, including problems controlling anger and unacceptable sexual behavior, may provoke other prisoners or result in disciplinary action by jail or prison staff.

What Is Needed to Address the Problem of Traumatic Brain Injury in Jails and Prisons?

A recent report from the Commission on Safety and Abuse in America's Prisons recommends increased health screenings, evaluations, and treatment for inmates.

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

• Routine screening of jail and prison inmates to identify a history of TBI
• Screening inmates with TBI for possible alcohol and/or substance abuse and appropriate treatment for these co-occurring conditions
• Additional evaluations to identify specific TBI-related problems and determine how they should be managed. Special attention should be given to impulsive behavior, including violence, sexual behavior, and suicide risk if the inmate is depressed.

What Is Needed to Address Traumatic Brain Injury Related Problems after Release from Jails and Prisons?

Lack of treatment and rehabilitation for people with mental health and substance abuse problems while incarcerated increases the probability that they will again abuse alcohol and/or drugs when released. Persistent substance problems can lead to homelessness, return the drug to illegal activities, rearrests, and increase the risk of death 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.
• Transition services for released people returning to communities should accommodate the problems resulting from a TBI.
• Released people with mental health and/or substance abuse problems should receive case management services and assistance with placement into community treatment programs.

The CDC supports new research to develop better methods for identifying inmates with a history of TBI and related problems and for determining how many of them are living with such injury.

You can find more information in Traumatic Brain Injury Sourcebook.