The impact of brain injury on offending

In 2014 the Scottish BPS Divisions of Forensic Psychology and Neuropsychology held an event at the Scottish Parliament to highlight the impact of brain injury on offending. This was followed in September the following year by an evidence session, as a result of which the report into brain injury and offending was commissioned by the Scottish Government. 

Professor Huw Williams, Chair of the BPS working group on neurodisability and offending behaviour, started the day's talks by outlining the links between offending behaviour and head injury. He particularly pointed to early head injury, which he called a 'silent epidemic'; these are injuries from which people recover well physically but then still suffer from impaired social cognition. He also outlined the impact of repeated head trauma, which has a cumulative effect. 

Williams presented evidence to suggest that those offenders with a history of significant head injury had a significantly higher rate of recidivism, which had an obvious economic impact. Despite overall crime rates falling in the last few years, data suggests that a small number of offenders are repeatedly committing offences. He emphasised the need to find new ways of reducing the impact of head injury, particularly in the early years, to improve the lives of individuals and to benefit society as a whole.  

Professor Tom McMillan, Chair of the NPHN working group that produced the report, outlined its background and presented findings from the prevalence and epidemiological studies undertaken. He went on to present a flavour of the principal recommendations of the report, including the introduction of a question tapping recent head injury in police custody suites, a screening questionnaire at prison reception and the development of a low-secure forensic service specifically for brain-injured offenders. 

He proposed further research studies investigating the efficacy of specific screening tools, and for educational modules for both prison officers and offenders. Importantly, the need for transfer of information on head injury between NHS staff in A&E, custody and prison settings was highlighted, along with the need for referral and care pathways to aid appropriate rehabilitation, in line with BPS priorities.

Dr Fiona Summers, Chair of the Division of Neuropsychology Scotland and Ally Campbell, Head of Psychology, HMP Grampian, introduced the innovative neuropsychology service for brain injury offered to HMP Grampian, the only one of its kind. In this service forensic psychology and clinical neuropsychology jointly work to address the needs of offenders with brain injury. An initial assessment is carried out with offenders, which then may lead to a specialist neuropsychology assessment. 

This assessment then helps identify brain injury and at what level, advises on cognitive strengths and weaknesses and psychological functioning. It also leads to recommendations on whether programmes should be undertaken in a group or individual setting, what working parties might be appropriate, specific cognitive strategies for both the offender and staff, and effective management of their presentation. They also outlined their plans to pilot a brain-injury rehabilitation programme within HMP Grampian, with links to community agencies and neuropsychology services upon release, which would be unique in Scotland. 

Ruth Parker, Head of Health & Wellbeing, Scottish Prison Service (SPS), highlighted that the prison service in Scotland has 15 establishments looking after approximately 7500 people daily, across nine Health Board areas. She urged the need for consistency in implementation of the recommendations, and that continuity of information-sharing on brain injury between hospitals, the police service, criminal justice social work and SPS.

She assured that SPS will enable further research in the area, recognised that prison staff need to understand brain injury, and that the implementation of the pathway will ensure people are assessed appropriately at the right time, that they are offered appropriate treatment and able to participate effectively in rehabilitation, with the overall impact being to reduce the impact of reoffending.

A lively Q&A session then followed, with members of the audience including representatives of HM Inspectorate of Prisons, third sector organisations such as Headway, the Mental Welfare Commission, NHS and SPS about the report recommendations and how they would be resourced. The panel highlighted the need for political will and vision as both custody and rehabilitation are expensive, but implementing the strategies could achieve huge savings in the longer term.

- Find more on brain injury and offending in our archive.