People 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.

That doesn't surprise Dr. Geoffrey Manley, a neurosurgeon who runs a trauma center. He knows all too well the long-term struggles 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 we really as a society are not doing a good job of taking care of people with traumatic brain injuries," Manley, who was not involved in the study, said in a phone interview.

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

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

Female prisoners were even more likely to have survived traumatic brain injuries. For women with these injuries, the risk of winding up in a Canadian federal prison was 2.76 times higher than it was for uninjured women, although the authors caution 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 be incarcerated with a traumatic brain injury than men, but they're just as likely," senior author Flora Matheson said in a phone interview.

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

Matheson, a medical sociologist with the Center for Urban Health Solutions at St. Michael's Hospital in Toronto, said the study's results could be just "the tip of the iceberg" of a connection between brain trauma and imprisonment, because the study included only prisoners in federal Canadian correctional facilities and only serious traumatic brain injuries. It excluded prisoners detained in Canadian provincial jails as well as those who suffered mild traumatic brain injuries.

A mild TBI would be diagnosed in someone whose injury resulted in only a brief change in mental status or consciousness.

Manley, who is also a professor at the University of California, San Francisco, suspects that half of those who suffer trauma to the brain never seek medical care and their injuries 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 for these people falling off the rails," he said.

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

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

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

In 2010, traumatic brain injuries were diagnosed in 2.5 million Americans, according to the U.S. Centers for Disease Control and Prevention. Over the past decade, rates of visits to U.S. emergency rooms for traumatic brain injuries rose 70 percent, the CDC estimates.

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

Prior studies suggested links between TBI and criminal justice involvement but the findings were not all statistically significant, the authors write. The new study is one of the largest of its kind and the first to examine the association in Canada.

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

Manley stressed the need for increased awareness about the potential for debilitating long-term fallout from traumatic brain injuries.

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