By Sean R. Francis, MS
Justice Solutions of America, Inc.
The link between traumatic brain injuries ( TBI ) and criminal...

By Sean R. Francis, MS


Justice Solutions of America, Inc. 

The link between traumatic brain injuries ( TBI ) and criminal behavior can no longer be ignored or disputed. Inmates in America’s prisons who have suffered a TBI at some point in their life are overrepresented. Some studies have found that as many as 60 percent of inmates have suffered a TBI at some point in their lifetime. ( Nagele, Vaccaro, Schmidt., & Keating, 2018).

1. What are the implications of a link between traumatic brain injury and criminal behavior?
The implications of a link between TBI’s and criminal behavior are that people who have no control over their behavior, due to suffering a severe head injury, will likely end up in the criminal justice system.  Should they go to prison it is unlikely they will get the medical or mental health care they need and will deteriorate and have no realistic chance of re-integrating into society when their sentence is complete.
Lane, St. Pierre, Lauterbach, & Koliatsos, (2017). studied four individuals who ended up in the criminal justice system and had suffered TBI’s. The similarities between them was striking. Three of the subjects were in their mid to late 30’s and one subject was in his early 20’s. Three of the subjects had suffered TBI’s as a result of motor vehicle accidents. Two subjects suffered more than one TBI. (Lane, St. Pierre, Lauterbach, & Koliatsos, 2017). It appears that none of the subjects have ever been incarcerated prior to suffering a TBI.
Yet, after suffering a TBI all of the subjects of this study acted in ways that they had not acted prior to suffering the injury. Specifically, all of these subjects acted out violently and aggressively towards hospital staff and family members. They verbally abused staff and family and assaulted them. One subject even started to set fires. Additionally, some subjects were sexually inappropriate with female staff members at the hospital that they were being treated at.  (Lane, St. Pierre, Lauterbach, & Koliatsos, 2017). These actions resulted in petitions being filed for involuntary hospitalization and interactions with law enforcement, including arrest. (Lane, St. Pierre, Lauterbach, & Koliatsos, 2017)
Considering this research, the American criminal justice system must take a fresh look at the nexus between TBI’s and criminal behavior. If the research cited above is accurate, we have a true mental health, medical and moral crisis unfolding in our nation’s prisons.
Currently, only a person who is “insane” at the time they committed their criminal offense may be found not responsible for the crime. Insanity is defined as not knowing the difference between right and wrong due to severe mental disease or defect and thus not having the mens rea or “guilty mind.” 18 U.S.C § 17 (a). However, what if the United States has a vast number of offenders who do realize the difference between right and wrong but have no volitional control due to suffering a TBI and cannot control their behavior? They certainly do not meet the legal definition of insanity…..but should they be held criminally responsible for their actions and locked away in prison? 

2. Is incarceration for individuals with TBI an effective method of rehabilitation? Make a concise but logical argument for or against incarceration of individuals who engage in criminal behaviors with a TBI?
Incarceration is not an effective method of rehabilitation for individuals with TBI. To address this question, it must first be pointed out that rehabilitation in prisons is, for the most part nonexistent. The concept was widely abandoned in the mid 1970’s as crime exploded. This ushered in the era of long and unforgiving prison sentences. (, (Phelps 2011).
To the extent that rehabilitation in a correctional institution occurs, the vast majority of programing does not address the unique challenges that inmates with TBI’s will face. Programing focuses mostly on drug offenders and sexual offenders. All prison systems and even some county jails now have programing to assist these type of offenders with their issues. There is also some programing that focus on job skills such as HVAC and electrical training. In over ten years working inside prisons I have never seen programs that address the unique challenges offenders with TBI’s face. Often these inmates are lumped into the “mentally ill” category. Most prisons deal with this population through medication that will tranquilize them and, when needed, force.
While there are prison hospitals in every system, state and federal, these facilities are designed to treat mental illness or physical ailments such as cancer, injury and heart disease. Rarely is TBI recognized for what it is inside of a prison. Rather, the inmate is labeled as “problematic” and dealt with accordingly. The medical staff in correctional institutions often lack the complex medical background to address TBI related issues. The cost of sending the offender for care outside the prison is huge. This is why it doesn’t happen. Often mental health staff is limited on a prison compound. Two psychologists for 1200 inmates is normal. These psychologists often lack the time or specialized training to deal with TBI related issues.
Therefore, prison is absolutely not the right environment for an offender with TBI to be rehabilitated. Again, this is the moral dilemma. What do we as a society do with offenders who act out due to a brain injury that they have suffered and not consciously? 

An additional peer reviewed study that supports the link between traumatic brain injury and criminal behavior was “The Relationship Between Traumatic Brain Injury and Criminality in Juvenile Offenders” by Gordon, Spielman, Ketter & Therese ( 2017). The authors focused their study on adolescent offenders and found that over 72 percent of them had suffered a TBI. (Gordon, Spielman, Ketter & Therese  2017). Mood disorders were also more common among inmates that had suffered a TBI. The study also found that correctional institutions do not routinely screen inmates for TBI upon arrival to the institution. (Gordon, Spielman, Ketter & Therese  2017). Therefore, it is difficult, if not impossible to identify inmates who require special treatment due to their brain injury.

In  “Traumatic Brain Injury and Recidivism Among Returning Inmates by Ray & Richardson ( 2017). The authors confirm what other studies have found, TBI’s increase the chances that an offender will interact with the criminal justice system. All of the samples used for this study were males in their early 30’s in Indiana (Ray & Richardson 2017). One third of the sample had suffered a TBI at one point in their life. (Ray & Richardson  2017). The study found that screening for TBI was vital so that offenders could be placed into programs that provide them the proper structure and support they need to succeed. With proper screening I mates can actually be treated for their brain injury and be much less likely to come into contact with the criminal justice system. (Ray & Richardson  2017).
In conclusion, the link between TBI’s and criminal offending is real and creates some real moral questions about the treatment of these offenders and whether they should be held fully responsible for their actions moving forward. Failure to properly treat these offenders will likely result in increased recidivism and crime.

Lane, K. S., St. Pierre, M. E., Lauterbach, M. D., & Koliatsos, V. E. (2017). Patient profiles of criminal behavior in the context of traumatic brain injury. Journal of Forensic Sciences, 62(2), 545–548.
Gordon, W. A., Spielman, L. A., Hahn-Ketter, A. E., & Sy, K. T. L. (2017). The relationship between traumatic brain injury and criminality in juvenile offenders. The Journal of Head Trauma Rehabilitation, 32(6), 393–403.
Nagele, D., Vaccaro, M., Schmidt, M. J., & Keating, D. (2018). Brain injury in an offender population: implications for reentry and community transition. Journal of Offender Rehabilitation, 57(8), 562–585.
Phelps M. S. (2011). Rehabilitation in the Punitive Era: The Gap between Rhetoric and Reality in U.S. Prison Programs. Law & society review, 45(1), 33–68. to an external site.
Ray B, Richardson NJ. Traumatic Brain Injury and Recidivism Among Returning Inmates. Criminal Justice and Behavior. 2017;44(3):472-486. doi:10.1177/0093854816686631

Oct 12th, 2020

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