A KNOCK ON the head can change the course of a whole life. Traumatic brain injuries affect around one in ten people in rich countries. Those who have experienced such injuries are more likely to suffer mental-health problems and loneliness. They are more likely to struggle with addiction to drink or drugs, or to be homeless. They are also more likely to commit crimes, including violent ones, although most do not. Estimates vary, but they consistently show that people in prison are many times more likely to have brain injuries.
Those whose brains are not “neurotypical” in other ways also make up an extraordinarily large share of the prison population. People with learning difficulties, intellectual disabilities and autism are all over-represented behind bars. In Canada young people with fetal alcohol spectrum disorder, which is the result of exposure to alcohol in the womb and which damages the brain’s frontal lobe, are incarcerated at 19 times the rate of the wider population.
A traumatic brain injury is caused by a blow to the head powerful enough to disrupt brain function. The most common causes are falls, fights, assaults and car accidents. The people most prone to suffering them are young men, especially poor ones. A child from a poor background is four times more likely to suffer a brain injury before the age of five than a child from a wealthy background. Even mild concussion can cause long-term damage. Brain injuries can impair the way people think, experience emotions and control their own behaviour. Problems often occur when there is damage to the prefrontal cortex, which is associated with aggression and a lack of inhibition.
Preventing brain injuries would avert much suffering, both directly (by reducing the number of people so impaired) and indirectly (by reducing the number who hurt others). Education is a good place to start. Parents and children need to be taught about the risks, urged to wear bicycle helmets and deterred from drunk-driving. Schools and police should do more to curb violence—by far the main cause of traumatic brain injuries affecting women in prison is domestic abuse. Prevention policies would pay for themselves, because brain injuries are expensive. In Britain the average lifetime cost of one in a 15-year-old who goes on to offend is estimated to be around £345,000 ($475,000).
Not all injuries can be averted, of course. So more help is needed for those who suffer them. Most important such injuries need to be identified earlier, especially in children, and teenagers. Hospitals need to try harder to spot and report brain trauma in children who show up with other injuries, and to ensure that they receive follow-up care. In the most neglected schoolchildren, screening might catch injuries. Once identified, they can be treated—sometimes with medication (such as stimulants for cognitive functioning and fatigue), most often with neuro-rehabilitation. Physical, speech and occupational therapies can help people to regain lost functions, learn new skills and overcome difficulties with attention and impulse control. Psychological support can help them control their emotions.
And those who end up in prison need help turning their lives around. From April, British prisons will have to screen all inmates who have experienced domestic violence for brain injuries. Such screening should be extended to all prisoners. It would enable staff to identify those whose brains have been damaged and offer them appropriate support. Those with the most severe brain injuries should probably not be in prison at all. Mental-health courts in parts of America have done a good job of diverting prisoners away from jail and into places where their mental-health problems can be treated. For many such people, neuro-rehabilitation centres would be cheaper than prison and better at reducing recidivism.
Acknowledging the link between brain injuries and criminal behaviour is not to excuse lawbreaking. Most people with such injuries are capable of taking responsibility for their actions. However, it is easier to curb crime if you understand the factors that make it more likely, of which neurodisabilities are an important and neglected one. More research is needed, but it is striking that offenders with attention-deficit hyperactivity disorder who take their medication are a third less likely to reoffend than those who do not. Punishing people without also offering them the help they need is short-sighted and wrong. ■
This article appeared in the Leaders section of the print edition under the headline "Knocked out and locked up"
