Canadians with traumatic brain injuries more likely to go to prison

Men and women who suffered traumatic brain injuries had more than twice the risk of winding up in a federal prison in Canada as their uninjured peers, a new study shows.

Corrections officers should recognize people with brain injuries may have memory lapses, trouble sitting still

Thomson Reuters Posted: Dec 08, 2016 1:24 PM EST | Last Updated: December 8, 2016

Multiple hands are seen holding bars at a prison. — There's probably a huge hidden cost to society from traumatic brain injuries. (Shutterstock)

Men and women who suffered traumaticbrain injuries had more than twice the risk of winding up in afederal prison in Canada as their uninjured peers, a new studyshows.

That doesn't surprise Dr. Geoffrey Manley, a neurosurgeonwho runs a trauma centre. He knows all too well the long-termstruggles of survivors of traumatic brain injuries.

"Because there's no system of care for these individuals,they fall into the cracks and get themselves in trouble. And wereally as a society are not doing a good job of taking care ofpeople with traumatic brain injuries," Manley, who was notinvolved in the study, said in a phone interview.

For 13 years, researchers followed more than 1.4 millionpeople who were eligible for health care in Ontario andwere between the ages of 18 and 28 in 1997.

As reported in CMAJ Open, the open-access journal of theCanadian Medical Association, the research team linked subjects'health records to correctional records, adjusted for a varietyof factors like age and substance abuse, and found that men withtraumatic brain injuries were 2.5 times more likely to servetime in a Canadian federal prison than men without headinjuries.

Female prisoners were even more likely to have survivedtraumatic brain injuries. For women with these injuries, the

risk of winding up in a Canadian federal prison was 2.76 timeshigher than it was for uninjured women, although the authorscaution that the pool of incarcerated females was small,accounting for only 210 of the more than 700,000 women studied.

"Some people might think women might be less likely to beincarcerated with a traumatic brain injury than men, but they'rejust as likely," senior author Flora Matheson said in a phoneinterview.

A traumatic brain injury, or TBI, can result from aconcussion, skull fracture or bleeding inside the skull.

Matheson, a medical sociologist with the Center for UrbanHealth Solutions at St. Michael's Hospital in Toronto, said thestudy's results could be just "the tip of the iceberg" of aconnection between brain trauma and imprisonment, because thestudy included only prisoners in federal Canadian correctionalfacilities and only serious traumatic brain injuries.

Itexcluded prisoners detained in Canadian provincial jails as wellas those who suffered mild traumatic brain injuries.

A mild TBI would be diagnosed in someone whose injuryresulted in only a brief change in mental status orconsciousness.

Perfect storm to for people to fall off the rails

Manley, who is also a professor at the University ofCalifornia, San Francisco, suspects that half of those whosuffer trauma to the brain never seek medical care and theirinjuries therefore go undetected and unconsidered in studies.

"We're not even identifying these traumatic brain injuries,and we sure aren't treating them, and it is a perfect storm forthese people falling off the rails," he said.

Six months after suffering a TBI, many patients still feeldepressed and anxious and some struggle with aggression andsubstance abuse, Manley said.

"A substantial number of people seen in emergencydepartments with traumatic brain injuries" don't get follow-upcare afterward, he said. "So we should not be surprised thatwe're seeing people who are unemployed, incarcerated."

Matheson pointed out that her study shows an association,not a causal relationship, between TBIs and incarceration. Moreresearch is needed to determine how the injuries andimprisonment connect, she said.

In 2010, traumatic brain injuries were diagnosed in 2.5million Americans, according to the U.S. Centers for Disease

Control and Prevention. Over the past decade, rates of visits toU.S. emergency rooms for traumatic brain injuries rose 70per cent, the CDC estimates.

Manley attributes the increase to greater awareness aboutconcussions in sports but said brain injuries are just as likelyto occur as a result of slips and falls.

Prior studies suggested links between TBI and criminaljustice involvement but the findings were not all statistically

significant, the authors write. The new study is one of thelargest of its kind and the first to examine the association in

Canada.

Matheson called for more screening for TBI in prisoners andsaid correctional programs should recognize that people withbrain injuries may have memory lapses and trouble sitting still.

Manley stressed the need for increased awareness about thepotential for debilitating long-term fallout from traumaticbrain injuries.

"There's probably a huge hidden cost to society here, not tomention the cost to individuals and their families," he said.

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Association between traumatic brain injury and incarceration, CMAJ Open

Canadians with traumatic brain injuries more likely to go to prison

Corrections officers should recognize people with brain injuries may have memory lapses, trouble sitting still

Perfect storm to for people to fall off the rails

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