Traumatic brain injury

During the past decade, traumatic brain injury (TBI) has become a frequent topic in the media. It has been a decade of expanding awareness, increased research, and growing concern about TBI of all severity levels. Consistent with this increased attention, researchers and policymakers have made strides toward greater understanding of the risks of TBI, the scope and complexity of the symptom profiles seen after TBI, and the types of treatments that optimize recovery. Recent studies have confirmed a 50 to 60% prevalence of TBI among prisoners. Most have experienced multiple injuries and experienced their first TBI in their mid-teens. Routine screening for TBI is rarely done in these settings in spite of there being a number of tested instruments available. The cognitive deficits associated with mild to moderate TBI are often indistinguishable from those associated with many mental illnesses and substance abuse. Etiology is difficult to establish; nevertheless, the common symptom patterns often make adjustment to jail or prison difficult. Educational interventions designed to improve staff knowledge of the prevalence of TBI and frequent symptom patterns are important first steps. Training staff how to modify their behavior and facilitate communication with inmates expressing these symptoms may reduce episodes of misunderstanding and potential aggression. Similarly, current programming may be modified to accommodate the cognitive deficits suffered by inmates with TBI as well as other disorders. This chapter reviews the prevalence of TBI in correctional settings, its impact on co-occurring mental illness and substance use, and opportunities to recognize, intervene, and treat patients with TBI.