Brain injury, a complex and often misunderstood condition, can have profound implications for individuals lives, particularly within the prison system. From cognitive impairments to emotional dysregulation, those with brain injuries face heightened difficulties that may worsen interpersonal conflicts and impede effective rehabilitation efforts. Recognising the pressing need for targeted support, a charity called BrainKind introduced a brain injury link-worker service. But how effective is this approach in addressing the complex needs of people with brain injuries in prison? Read on to find out….
Brain Injury: The ‘hidden disability’
Brain injury refers to the disruption of normal brain functioning as a result of contact with an external force. While it’s often associated with mobility and physical challenges, its effects extend far beyond this, impacting cognition, emotion and behaviour profoundly.
But here’s the catch: many brain injury symptoms remain hidden, lurking beneath the surface like a submerged iceberg. These symptoms, such as poor memory, impaired communication skills, and challenging behaviours therefore earn brain injury the title of a ‘hidden disability’. If left undetected, this can severely hamper a person’s ability to participate fully within society and the workforce. It’s like steering a ship through murky depths without a map, never knowing what obstacles lurk beneath the surface – Oh joy, what. a. blast 🙁
Brain Injury in the Prison System: Navigating Complex Challenges
Research suggests that between 8-12% of the general population experiences traumatic brain injury, but within the prison system, this figure soars to around 46%! In the context of a prison, where discipline and order are particularly prevalent features, brain injury impacts become glaringly amplified, impeding an individual’s ability to rehabilitate and function effectively.
Imagine grappling with the tumultuous mix of aggression, impulsivity, and emotional turbulence that often accompanies traumatic brain injury. Within the confines of a prison, these symptoms may ignite fiery conflicts between inmates and staff, heightening tensions, elevating the risk of violence, and boosting the likelihood of disciplinary infractions. Studies have shown that offenders with brain injury not only have a greater rate of disciplinary incidents but also take longer to adapt to the rules and routines of prison life.
Given this, one question arises: How can individuals with brain injuries in prison be supported effectively?
The Brain Injury Linkworker (BIL) service has emerged as one possible method to better support people with brain injuries in the prison system. ‘Linkworkers’ (graduate psychologists) provide targeted interventions (between 3-6 sessions) to individuals identified with brain injuries in order to 1.) increase their understanding of their own brain injury and its impacts, and 2.) address their specific cognitive and behavioural needs within the prison. Linkworkers not only facilitate rehabilitation but also collaborate with prison staff and external teams to better educate them on brain injury impacts.
This service is currently operating at HMPPS Swansea and HMPPS Cardiff, but how effective is it?
Current Study
To what extent do men who completed the BIL service in prison and probation services feel that they have benefitted?
Our investigation looked at data obtained from 70 men who fully completed the BIL service. Participants answered self-report questionnaires before and after completion of the service. The Key Variables of interest were:
- Mental Health: Did the BIL service lead to improvements in anxiety and depression?
- Impressions of Change: How did participants perceive their overall understanding of their brain injury and ability to cope within prison after completing the service?
Main Findings
Analysis revealed observable differences in all self-reported measures of anxiety, depression and impressions of change before and after intervention completion.
Mean scores of Depression and Anxiety were significantly improved:
- Participants self-reported anxiety and depression scores were significantly reduced at the end of the intervention.
- This was clinically significant: classifications of anxiety and depression improved after the intervention, with the majority of participants moving from a more severe classification (before the intervention) to a milder classification after.
Participants Impressions of Change were improved:
After completion of the BIL service, participants self-rated themselves better in their abilities to:
- understand their own brain injury
- explain their difficulties
- engage in prison activities
- control their behaviours
- keep themselves out of trouble.
Exploratory Findings
What was the impact of having a prior service referral (for mental health or for substance use) on BIL outcomes?
Further analyses found that participants with a prior history of service referrals for mental health or substance use experienced greater self-perceived improvements in their ability to control themselves and avoid trouble after completing the BIL service
What do these findings indicate?
The BIL service emerges as one promising avenue for offenders to gain insights into their brain injuries and access tailored interventions, filling a crucial gap in prison support aids. Given the self-reported improvements to mood and coping abilities, this study can advocate for the incorporation of neuro-rehabilitation services, such as the BIL service, to enhance the rehabilitation process for offenders through integrated support systems.
It is possible that prior service referral experience increased participants’ awareness of support resources; this may have facilitated their engagement with and response to the BIL service. Prior studies have observed similar findings. Hence, combining different types of support services could lead to greater benefits. However, the exact nature of participants’ prior engagement with other services was not monitored; future studies may need this to draw clearer conclusions.
Some Limitations to consider
- There was no control group, meaning a direct comparison of intervention outcomes could not be made.
- Data was only self-reported – this introduces potential bias and subjectivity in findings. In future, this could be corroborated with objective measures or external validation.
- Only Immediate effects of the service were evaluated, future research may want to explore longer term outcomes.
Key Takeaway
Despite its limitations, this study provides insights into the potential benefits of a linkworker approach to supporting offenders with brain injury. Investing in such interventions aligns with efforts to promote rehabilitation and may contribute to reducing recidivism rates among populations post-release.
References
Bogner, J. A., Corrigan, J. D., Mysiw, W. J., Clinchot, D., & Fugate, L. (2001). A comparison of substance abuse and violence in the prediction of long-term rehabilitation outcomes after traumatic brain injury. Archives of physical medicine and rehabilitation, 82(5), 571-577.
Durand E, Chevignard M, Ruet A, Dereix A, Jourdan C, Pradat-Diehl P. History of traumatic brain injury in prison populations: a systematic review. Annals of Physical and Rehabilitation Medicine. 2017; 60: 95– 101.
Frost, R. B., Farrer, T. J., Primosch, M., & Hedges, D. W. (2013). Prevalence of traumatic brain injury in the general adult population: a meta-analysis. Neuroepidemiology, 40(3), 154-159.
Morrell, R. F., Merbitz, C., & Jain, S. (1998). Traumatic brain injury prisoners. Journal of Offender Rehabilitation, 27, 1-8.
Ramos, S. D., Oddy, M., Liddement, J., & Fortescue, D. (2018). Brain injury and offending: the development and field testing of a linkworker intervention. International journal of offender therapy and comparative criminology, 62(7), 1854-1868.
Rusnak M. Traumatic brain injury: Giving voice to a silent epidemic. Nat Rev Neurol. 2013 Apr;9(4):186-7. doi: 10.1038/nrneurol.2013.38. Epub 2013 Mar 12. PMID: 23478463.
Timmer ML, Jacobs B, Schonherr MC, Spikman JM, Van der Naalt J. The spectrum of long-term behavioral disturbances and provided care after traumatic brain injury. Frontiers in Neurology. 2020; 11: 246.
Venville, A., Mealings, M., Ennals, P., Oates, J., Fossey, E., Douglas, J., & Bigby, C. (2016). Supporting students with invisible disabilities: A scoping review of postsecondary education for students with mental illness or an acquired brain injury. International Journal of Disability, Development and Education, 63(6), 571-592.
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