fb image 911 captis executive search management consulting leadership board services

Brain injuries are startlingly common among those who have committed crimes

MANUEL SUFFERED two serious brain injuries as a child in Denver, Colorado. The first was the result of a fall. The second occurred when someone threw a rock at his head, causing him to lose consciousness. He made it the short distance home before blacking out. On both occasions he received brain scans but he does not remember getting any other treatment.

As a teenager, Manuel was sent to a school for disruptive children. In his early 20s he tried to strangle his stepfather who, he says, was violent towards his mother. He was sent to prison. Last year he suffered a third brain injury when he fell out of a pickup truck travelling at high speed. He spent six days in a coma. When he woke up he had no recollection of what had happened. He was later jailed yet again for violating his parole.

Manuel’s story is far from unusual. Brain injuries affect about 8.5% of the general population but rates among prisoners are far higher. Kim Gorgens, a neuropsychologist at the University of Denver, reckons that between 50% and 80% of prisoners and those on parole in America have brain injuries. A review of research in America, Australia and Europe suggests that the average reported rate is around 46%. Research conducted in 2010 by Huw Williams of the University of Exeter put the rate among men in British prisons at 65%. A study published in 2017 found that nearly half of all prisoners in New Zealand had been hospitalised for a traumatic brain injury before committing their crime. Researchers suspect that the numbers may be even higher in poorer countries because road-traffic accidents and violence are generally more common.

People who sustain brain injuries are more likely to go on to commit crimes, including violent ones. They are more troublesome while in prison and more likely to reoffend on release. This is especially true for those, like Manuel, who are injured as children. Adrian Raine, a psychologist and criminologist at the University of Pennsylvania, is pretty convinced that there is a causal link. He points to research that follows people over time, as well as natural experiments in which otherwise law-abiding individuals suffer a brain injury and then display antisocial behaviour. “It’s a bit like saying smoking doesn’t cause lung cancer,” Dr Raine explains. “Most people do not get lung cancer. We will never do a randomised controlled trial for it. But do we act on it? Sure we do.”

For many the damage is done early. Brain injuries are particularly common among boys and young men, whose brains are still maturing. Those from poor backgrounds who live in cities are especially at risk. A curious child who is rarely supervised is more likely to fall and seriously hurt himself. A reckless adolescent who thinks he is invincible is more likely to crash his car or get punched in the head. They are then far more likely to drop out of school and end up in prison. Brain injuries are one of many risk factors for crime which disproportionately fall on poor people (though most lead law-abiding lives).

People tend to associate traumatic brain injuries with sports such as American football, boxing and rugby. In fact they are more usually caused by falls, road-traffic accidents and fights. The front of the brain, where the frontal and temporal lobes are located, is often damaged. Higher emotions, such as compassion, seem to be concentrated there, as does conscious decision-making. Long-term memory formation is mediated by the hippocampi, which are in the temporal lobes. Broca’s area and Wernicke’s area, both important in the development of language, are located in the frontal and temporal lobes respectively.

The longer a person is unconscious, and the more injuries they sustain, the more severe the effects. People become forgetful. Many find it hard to concentrate. They may struggle to manage their emotions and to understand the feelings of others. Their behaviour and personality may change, although many sufferers fail to recognise this in themselves.

Brain injuries seem to make a minority of people more violent. Paul (not his real name) had a number of minor convictions when he was involved in an accident which caused a bleed on his brain and left him in a coma. After that his crimes became more violent. Since his accident he has done things that were “out of character”, he says from a prison in Wales. He knows that he has hurt people but he does not remember his crimes. “When I get told later on what I’ve done and what’s happened, I’m gutted.”

Seena Fazel of the University of Oxford has made cross-references between Swedish health-care and crime records. He found that people who had gone to hospital for a brain injury were more than three times more likely then to commit violent crimes than the rest of the population. They were also twice as likely to do so as their siblings. Damage to the prefrontal cortex, which seems to increase aggression and impulsiveness, may explain this. Another Swedish study found that almost half of a sample of (mostly old) patients with frontotemporal dementia exhibited criminal behaviour. The figure for those with Alzheimer’s in the same study was 15%.

Michael has a scar on his head where he was hit by a car at the age of seven. None of his six siblings has ever been in any serious trouble, but he started stealing cars and motorbikes and breaking into factories when he was a teenager. Drugs made his problems worse. He also suffered from anxiety and depression. Michael is now in his 50s. He reckons that he has spent more than 20 years in prison over the course of his life.

His experience fits with what Dr Gorgens has found studying inmates and probationers with traumatic brain injuries in Colorado. Some 96% had problems with substance abuse and 79% suffered from some kind of mental illness. It is a vicious cycle, says Dr Gorgens. Substance abuse is more likely in people who have suffered brain injuries, and people with brain injuries are more likely to develop addictions. Separate research shows that after suffering a brain injury, people with mental-health problems were four to seven times more likely to commit a crime than before. When you are dealing with so many problems at the same time, it is easy for them to spiral out of control, explains Dr Gorgens. This is especially true for those who have alienated their family and friends, as people with brain injuries tend to do. They are more likely to end up homeless, unemployed and to commit suicide.

Addressing the problem head-on

Michael has turned his life around. He and other campaigners want officials to acknowledge the problem of brain injuries among prisoners. Some are beginning to do so. The British and Australian governments are carrying out reviews of how they treat such offenders. They are also looking at a broader set of “neurodiverse” conditions which are disproportionally common among inmates, including learning and intellectual disabilities and autism. Criminal-justice systems need to work better for those whose brains work differently. That might also reduce crime.

In New Zealand, a pioneer in this field, the focus has been on reforming courts. Andrew Becroft, a judge who used to run the Youth Court, was shocked by how many young offenders had neuro-disabilities. “History will judge us very harshly,” he says. The court now screens defendants for brain injuries and has tried to adapt its procedures to take account of their needs. So does the Young Adult List court, which deals with 18- to 25-year-olds. Officers of the court talk to defendants in clear English instead of legal jargon, and provide handouts to those who struggle to understand what is being said. “It’s fundamentally a matter of fairness,” says John Walker, the court’s founder and chief judge. “If a person came into the court who couldn’t speak English, they would be given an interpreter.” He argues the same should be true for those with neuro-disabilities.

fb image 911 captis executive search management consulting leadership board services

Philippa Birch works for the Disability Trust, a British charity that trains people to go into prisons to raise awareness of brain injuries among inmates and staff. People working in prisons often think those with brain injuries come across as aggressive or rude, says Ms Birch. They stand too close or do not pay attention to instructions. She explains the effects of brain injury and reassures prisoners about how they can manage them. Prisoners find lessons in controlling their emotions and anger particularly helpful. Overworked prison staff are grateful for the smoother interactions.

TBI in Criminal Justice, a collaboration between the University of Denver, various charities and the Colorado courts and sheriff departments, is helping prisoners with brain injuries adapt better to prison and prepare for the world beyond. Some learn how to use a diary to get to appointments on time. Others master breathing techniques to help them stay calm under pressure. These cheap but effective strategies can be the difference between someone avoiding a needless parole violation and going straight back to prison. The team hopes the project will reduce the state’s recidivism rates which, at 50%, are among the highest in the country.

Some could benefit from better medical treatment. That might mean medication: antidepressants for anxiety or stimulants for fatigue and improved cognitive function. But in the long term most treatments for brain injuries are largely therapeutic. Neuro-rehabilitation relies on recognising that the brain is to an extent able to adapt its structure and function, a process known as neuroplasticity. Physical and speech therapy can help people regain lost function. Computerised “brain training” games can improve recall and attention. The earlier and more intense the intervention, the better the prospects of recovery. But coping strategies can be taught at any stage after an injury.

Identifying those who need support could prevent people from drifting into crime. Mr Becroft, now New Zealand’s children’s commissioner, argues that children should be screened for brain injuries and other neuro-disabilities when they start secondary school to ensure that those who need help get it. Campaigners are also keen to prevent more brain injuries from happening in the first place. That might mean teaching parents about the risks, or encouraging people to wear helmets.

A report in 2016 by the Centre for Mental Health estimated that in Britain the cost of traumatic brain injury in a 15-year-old who goes on to offend is around £345,000 ($475,000). The cost to those affected—and society more widely—is incalculable.

This article appeared in the International section of the print edition under the headline “Banged up”

This is not a CAPTIS article. Originally, it was published here.