As a Clinical Neuropsychologist I am interested in how the brain works, and what happens when people have injuries to the brain – from assaults, car accidents and falls and such like. Most injuries are “mild” – often thought of as “concussion” – but some – around 20% – are significant – with changes to the brain – and mind – that lasts a lifetime. The changes are typically in parts of the brain that allows people to remember, to plan ahead and to follow that plan (remember!). But also – importantly – to manage emotions. To rein ourselves in. How would it be if we acted on an impulse?
Injuries do tend to happen in younger people, before their brains are fully developed. Most commonly in teenagers – in car accidents, assaults, falls and in sports. But, importantly, we find that very young children are at risk.
As injuries happen in young people we may not know the full extent of injuries for a long time – and, of course, there may be a lifetime for the survivor of living with disability. This “invisible” disability has huge effects. We know, for example, that such children and young people are getting excluded form schools. And later on, being in trouble with the law. In general, 10% of the population have had a brain injury, but in people in prison, more than 50% have. These findings have made us aware of the need to try to get a better system in place, if in prison, to have a better system for care and rehabilitation to reduce the chances of a return to crime.
Crime carries huge economic and social costs. Prisons in UK cost Ł7 Billion a year to run. Re-offending costs up to Ł13 Billion a year. About a Million people a year go through UK courts per year. Around 4 Million people a year are affected by crime in UK.
When we look into the lives of prisoners we find that they were likely to be injured and traumatised. Indeed, we found in one study that, whilst a quarter of young people in prisons felt suicidal, more than half of those who had had a TBI were suicidal. The perpetrators are often – then, at some earlier point of life – victims themselves. Cycles of violence perpetuate.
In 2016 The Justice Committee held an inquiry into violence and suicide of young people in prisons. We submitted evidence to that inquiry, and were subsequently asked to provide evidence in person before the committee. They concluded that, given the compelling case for TBI being a factor in violence and suicidality, prisons needed to be thoroughly reformed to address such problems.
I subsequently found myself working with Police Commanders, Prison Governors, Justice and Health Ministry officials to try to develop better ways to intervene earlier in people’s lives to reduce risk of crime, and enable people at “risk” to less likely to offend and have the skills and support for finding a place in society. For example, with the Disability Trust we have worked to put “link” workers into prisons to help staff identify the effects of brain trauma and ways to help people change behaviour. Most recently, with to identify and manage such issues in women in prison. Many had suffered injuries due to domestic violence. Which is, of course, linked to a risk of greater mental health problems.
In 2018 Chris Bryant MP decided to set up an All Party Parliamentary Group on Acquired Brain Injury. We were asked to prepare a briefing for their group. Which happened on the launch day of a key paper in Lancet Psychiatry on TBI & Crime. MPs were struck by the impact of TBI on development and the likelihood that, with better interagency working (between health, school and courts, for example) there could be less potential crime and less people with TBI ending up in prisons. Our work has helped to provide evidence for Parliamentarians to debate how services could be developed and funded – such as more comprehensive screening and provision of support to help change behaviour.
With better awareness of the longer term problems after TBI, we are now working to ensure that magistrates and judges are aware of how trauma and TBI are key factors in crime, and in rehabilitation. Working, for example, with the UN office on Drugs and Crime, we have helped develop training modules to address trauma and neuro-disability in sentences. In some parts of the world, such as New Zealand, all young people who come before a judge, will be expected to be assessed for neurodisability, and for how they may need support to avoid a future of crime.
Prof Huw Williams is an Associate Professor of Clinical Neuropsychology and Co-Director of the Centre for Clinical Neuropsychology Research (CCNR) at the University of Exeter.
Author: Prof Huw Williams, Associate Professor of Clinical Neuropsychology and Co-Director of the Centre for Clinical Neuropsychology Research (CCNR) at the University of Exeter
