26 March 2024

Spotlight on Acquired Brain Injury – The Hidden Neurodisability

Brain injury, Young adults
A graphic of a young man unsure which road to take

Gemma Buckland, Policy and Public Affairs consultant for T2A, is the lead author of UKABIF’s latest report, Time for Change – Acquired brain injury and young adults involved in the criminal justice system. This new publication focuses on how young adults with an Acquired Brain Injury (ABI) are identified and assessed in the criminal justice system and the level of support they receive. Here she shares some key findings from the research project.

The impact of an ABI can vary hugely from person to person. Some may experience short-term effects, while others must manage the impact long term. It can present with relatively mild symptoms or as a profound disability, highlighting just how diverse and complex this condition can be.

In general, ABI leads to functional difficulties across cognition, memory, social communication, and self-regulation of emotions and behaviours. The impact varies according to the site and nature of the injury which can result in fatigue, increased irritability, frustration, agitation, stress and anxiety. Completing a series of tasks or remembering appointments and instructions may be challenging too. Unfortunately, as there may be no visible or obvious presentation of the condition, ABI’s behavioural effects can often be misinterpreted by professionals.

All these symptoms can pose significant challenges for young adults as they navigate the criminal justice system: What if your defense lawyer explains the court process using words you are unfamiliar with? What if your key worker doesn’t understand why you get angry and upset so easily? What if your probation officer doesn’t recognise why you have difficulty remembering your appointments or following what they are saying?

That’s why early identification and assessment is vital.

What led to the Time for Change report?

The United Kingdom Acquired Brain Injury Forum (UKABIF) is a membership charity that aims to promote better understanding of all aspects of ABI.

The UKABIF 2018 Time for Change report set out the “sequential intercept model”, a framework for where appropriate interventions could be made at different stages of the criminal justice system that could improve outcomes for individuals with an ABI. Its latest report aimed to dive deeper into this topic and look at the specific experiences of young adults. We chose this age group due to the potential for an ABI to delay the development of maturity and hence make it that much harder to shift towards a pro-social identity.

The prevalence of ABI in young adults aged 18-25 is not fully understood but is estimated to affect between half and three quarters of young people in custody1. However, the prevalence of ABI in data collected by Liaison and Diversion schemes is much lower. It was key for UKABIF to understand the reasons behind this discrepancy in the data, and what the consequences might be for young adults with an ABI.

Freedom of Information request to Police Forces

The police are often a young adult’s first point of contact with the criminal justice system, underscoring their crucial role in ABI identification and signposting for assessment.

To get a clearer picture of how the police respond to ABI, UKABIF sent out requests under the Freedom of Information Act 2000 to all police forces in England and Wales in January 2022. Its questions focused on practices and procedures regarding young adults with ABI in their custody suites.

Ten of the 44 forces didn’t have any screening or training in place, and most areas had not yet developed appropriate assessment processes, adjustments and referral pathways. Only one police force had data on prevalence of ABI and this was not broken down by age.

These findings suggest that many young adults with an ABI are not being identified by the police in custody suites. That means they may not be receiving appropriate interventions in the police station or in court that fully consider the effects of their ABI. This results in missed opportunities to enable young adults with an ABI to participate fully in justice processes, for example, by ensuring that they have access to appropriate adults who can support and advocate for them.

Neurodiversity Vs ABI

In recent years, awareness and understanding of neurodiversity amongst people in the criminal justice system has significantly increased – both at a government level and on the frontline. The 2021 Criminal Justice Joint Inspectorate Report ‘Neurodiversity in the Criminal Justice System’ was a landmark publication that played a key role in highlighting the importance of specialist screening, assessment and support for all neurodiverse needs.

Unfortunately, progress has been relatively slow when it comes to looking at ABI. Professionals are typically much more familiar with other forms of neurodiversity such as autism and ADHD.

That’s one of the reasons UKABIF created resources for young adults affected by ABI, so they feel empowered to navigate the criminal justice system and get the support they need.

Police forces rarely have specific assessments for ABI, and risk assessments commonly refer to a head injury as a physical injury. This could cause misconceptions on the part of officers about how an acquired brain injury might present in police custody. Furthermore, training for the police that raises awareness of neurodiversity may not cover ABI.

ABI is also one of a complex set of priorities for Liaison and Diversion services. ABI is unlikely to be identified by these services unless they use a specialist screening tool, like the Brain Injury Screening Index (BISI) developed by Brainkind or Do It Profiler. Knowledge of such tools heavily relies on staff champions sharing the information amongst their teams. But screening does not constitute a whole system approach that delivers for every young adult with an ABI.

UKABIF believe that funded community pathways, which make clear the responsibilities of all the different agencies which should support the young adult, including justice, health and social care, could be a viable, long-term solution.

Best practice

To understand what these pathways could look like, UKABIF turned its attention to areas pioneering innovative approaches.

Pathfinder, for example, is a deferred prosecution scheme used by Devon and Cornwall Police. All participants who take part in the scheme are screened for ABI. Young adults are assessed using Do-IT Profiler, an innovative tool that incorporates a variety of functional assessments to better understand what support a young adult might require. These assessments ensure that, if required, a young adult can have an Appropriate Adult present to support them during their interview.

In a separate study, the University of Exeter analysed the screening of all adults under the Pathfinder scheme. It found that 59.3% of those screened reported a lifetime traumatic brain injury (TBI). This confirms what UKABIF suspected about the prevalence of ABI in the justice system, and the high proportion of individuals who are not receiving appropriate support.

UKABIF also took into account the Collaborative approaches to preventing offending and re-offending by children (CAPRICORN) framework as a blueprint for how local agencies and organisations outside the justice system can prevent offending among young adults with an ABI.

The right support at the right time

By combining the learnings from CAPRICORN and Pathfinder with UKABIF’s “sequential intercept model”, UKABIF have been able to map out the opportunities for interventions and the partners involved at each stage.

For example, this could involve working with health and justice coordinators – a key link between the healthcare and justice systems – in probation settings to develop a strategic approach to working with young adults with ABIs. In prison settings, specialist training could be delivered to neurodiversity support managers, so they can effectively support young adults with an ABI while they are in custody and as they prepare for release.

  1. Page 20: https://barrowcadbury.org.uk/wp-content/uploads/2012/11/Repairing-Shattered-Lives_Report.pdf ↩︎