The scale of Traumatic brain injury (TBI) in the general population is only now beginning to be understood.  The T2A programme has published three reports on the TBI and young adult offenders: Repairing Shattered Lives: Brain injury and its implications for criminal justice (October 2012 with University of Exeter), Traumatic brain injury and offending – An economic analysis (July 2016 with Centre for Mental Health) and ‘Young people with TBI in custody’ (July 2016 – with Centre for Mental Health and Disability Trust Foundation) as well as currently supporting screening pilots in prisons.   The writer of this blog, Andy Bell from the Centre for Mental Health, organised a roundtable for experts from the West Midlands at the University of Birmingham to discuss the implications of CMH’s recent research on TBI.  Here he blogs about how early action in addressing TBI could have huge social and economic benefit.

Traumatic brain injury (TBI) is a common and serious health issue. It affects millions of people and carries an economic and social cost of £15 billion a year nationally. People who have sustained a traumatic brain injury have a greater likelihood of mental ill health and of offending, as well as suffering from many other life difficulties.

Barrow Cadbury Trust and Centre for Mental Health recently organised a roundtable for experts from the West Midlands, hosted by the University of Birmingham, to discuss the implications of recent research about TBI (https://www.centreformentalhealth.org.uk/traumatic-brain-injury) and the ways in which support might be improved in the West Midlands region.

Addressing TBI in an effective (and efficient) way requires collective action across public services. No agency or sector can deal with it alone. We need a comprehensive approach that includes prevention, early identification and effective support from early childhood and throughout life.

West Midlands Devolution

The West Midlands devolution deal presents a unique opportunity to take a ‘whole place’ approach to TBI. The Combined Authority has already prioritised mental health and youth justice as cross-sector issues it aims to address across the region. Developing an effective response to TBI would contribute to both and to the overall wellbeing of the population.

Preventing head injuries is challenging but action to reduce risk would include measures to tackle domestic violence (the cumulative impact of physical abuse has been noted as a significant problem for women in prison), to promote positive parenting and to tackle bullying in schools. These also have a major impact on emotional wellbeing and future life chances. Improved support for children with ADHD and autism spectrum disorders can also reduce the heightened risk of TBI in these groups of young people. All of these actions should also reduce health inequalities by addressing the greater risks among people in the most deprived and marginalised communities in the West Midlands.

For those who do sustain head injuries, and particularly those who have experienced multiple traumas, identification is vital to ensure that effective support is offered and adjustments are made to reflect their vulnerability. Schools, hospitals, police stations and prisons can all ask simple questions to screen for head injuries. This can help them to ensure they offer support where it is needed, for example to manage a child’s behaviour in school and avoid excluding a young person whose behaviour results from a head injury where some additional support might be of benefit.

TBI and the CJS

It is estimated that up to 60% of prisoners have sustained head injuries. It is therefore vital that the whole of the criminal justice system works with an awareness of TBI and an ability to respond effectively. Liaison and diversion teams, for example, can screen for TBI alongside other vulnerabilities. Prisons can offer all of their staff (including not just prison officers but education and other workers) training about TBI as part of becoming an enabling environment. Specialist linkworkers in prisons have also been found to provide effective support to individuals with TBI. And for people leaving prison, robust support is essential to help them to adjust to life outside and cope with the demands and difficulties they will face.

There are a number of initiatives already in place to build upon: HMP Drake Hall provides all staff with training in working with trauma and supports women prisoners who have experienced abuse and violence. The Geese Theatre Company provides ‘safe spaces’ for prisoners to explore their emotional wellbeing and what would help them to get back in control of their lives. And there are specialist services for offenders in the community, including for women, that offer peer support and help with health issues, that could provide more bespoke support for those with head injuries.

The significance of TBI is only beginning to be understood. But it is now clear that joint action that brings together local authorities, NHS organisations, schools, the criminal justice system and voluntary and community bodies (among others) will be essential to develop an effective response. From public health teams including TBI in local needs assessments and Health and Wellbeing Strategies to schools providing extra support to children who have sustained head injuries, we can bring about a bigger focus on prevention and early help. And by working across the justice system, we can enable some of the most vulnerable and prolific offenders to get their lives back on track.

The 2016 Criminal Justice Alliance Awards will give prizes of £4,000, £2,000 and £1,000 to three organisations or individuals who have contributed materially to improving outcomes across the criminal justice pathway, from policing to prisons and probation, in the last 12 months.  The Awards, supported for the second year by the Hadley Trust, acknowledge a ‘marked contribution to effectiveness, fairness or new models of delivery’.

Winners will be selected by a judging panel including crossbench peer Baroness Young of Hornsey, veteran legal journalist Joshua Rozenberg, Director of Anawim Joy Doal and Mark Johnson, founder and Chief Executive of User Voice.  The Awards will be presented at a ceremony in central London on 17 November.  A further award will also be given for the first time to a print, online or broadcast journalist (or journalists) who has made a notable contribution to a better understanding of criminal justice in the last 12 months.

Details of how to enter the CJA Awards can be found on the CJA website.

Entries are open until Friday 16 September 2016.

“There aren’t many good news stories around in criminal justice at the moment. Prisons are in crisis, probation is in meltdown, there’s been a spate of absconds by serious and violent criminals and the legal aid system has been decimated. With less money to spend than in the past, whoever wins power in 2015 will face huge challenges.

But it’s not all doom and gloom. Our youth justice system offers a glimmer of hope – and a pointer to reforms elsewhere. Although not perfect, over the past decade or so fewer under 18s have committed crimes and fewer are behind bars – a double success that has eluded the adult justice system.

This success has its roots in the radical changes that began under Labour in 1998. The key reform was the creation of local Youth Offending Teams – bringing together councils, police, probation, education, health and social services. Their task was to identify those at risk of drifting into a life of crime and to work together to stop them from committing further crimes.

The idea at the heart of this is simple: our justice system works best when, rather than treating everyone the same, services collaborate to get a grip on these people, dealing with the root causes of their offending behaviour.

Although not perfect, these bold reforms have seen dramatic reductions in first time offending – they are a third of what there were ten years ago. The numbers of young people sent to jail have been halved. Testimony to this is that prisons for young people have been closing.

So communities are safer and the taxpayer is better off to the tune of some £80 million.

At a time when we know budgets are going to remain under considerable pressure, these statistics are impossible to ignore.

Let’s be clear. The sanction of prison will always be needed for those who commit serious crimes. But the success of the youth justice system shows we can continue to drive down crime but also cut the numbers locked up. I want the next Labour government to build on these successes.

This week, the IPPR published a report recommending that the youth justice system is extended to young adults, up to the age of 21. This is a sensible idea and one that we will look at very seriously.

It won’t be easy. It will involve culture change in many agencies. It will need to be affordable. But much of the infrastructure is in place, and if we give local authorities the right incentives and support they’ll have powerful reasons to make this work, cut crime and save money.

For many young people, moving from adolescence to the cusp of adulthood sees support through the youth justice system stop, with young adults receiving no specific focus in the criminal justice system. Focusing attention on 18-20 year olds should help address what the House of Commons Justice Select Committee identified as a “period of high risk”.

The key to Labour’s past reforms and future policy is to follow the evidence of what works. The prize is to make our communities safer and to save precious resources. The contrast with how this Tory-led government operated could hardly be starker. They’ve declared war on evidence.

They’ve cancelled pilots which could have produced evidence of what works and what doesn’t work. Instead we have a Justice Secretary who prefers to follow his own ideological instincts. Trusting the instincts of a man who brought us the disastrous Work Programme is a big ask. He failed then and he’s failing now.

The grotesque manifestation of this triumph of ideology over evidence is the half-baked and reckless privatisation of probation. It goes against the grain of everything we know about what helps to reduce re-offending. It’s ripping apart multi-agency working, commissioning services direct from a desk in Whitehall, and handing over supervision of dangerous and violent offenders to private companies with little or no track record in this area.

The government is presiding over a giant experiment. Early reports are that probation privatisation is causing chaos, just as many including Ministry of Justice officials warned it would. At stake, if things go wrong, is the safety of communities up and down the country. I’m not prepared to be so casual with public safety.

The choice is clear. On one side a Tory-led government – driven by ideology – dismantling working relationships that reduce re-offending. And, on the other hand, a Labour Party promising to build on what works to reduce crime and prison numbers, and to do more with less. I am convinced the marriage of evidence-based policy and Labour’s principles will cut crime, reduce re-offending and cut the massive cost of crime to our society.”

Sadiq Khan is Labour MP for Tooting and shadow justice secretary

The focus of IPPR’s  newly-launched Condition of Britain report is how people can work together to build a good society in tough times. It sets out an ambitious agenda for social renewal across Britain covering social exclusion, housing and criminal justice.

One of the report’s chapters looks at enabling young people to have a secure transitions into adulthood, including a section on preventing young people from getting involved in a life of crime.  The main recommendation of this section reflect  T2A (Transition to Adulthood Alliance) thinking that: “The remit of youth offending teams should be extended to those aged up to 20, in order to provide locally-led, integrated support to help keep young adult offenders out of prison, cut reoffending and prevent them from entering a life of crime”.

The report states that the responsibility for tackling youth offending lies locally, with youth offending teams (YOTs), which are organised at the level of top-tier local authorities. YOTs were established in 1998, and have since performed well against their three core objectives. The number of young people entering the criminal justice system for the first time fell by 67 per cent between 2002/03 and 2012/13.  IPPR argue that instead of dealing with young adult offenders through the ‘transforming rehabilitation’ contracts, the next government should extend the successful YOT model to offenders aged 18–20. They suggest that managing this more effectively by reducing offending and reoffending, and ultimately bringing down the size of the prison population, would save money and free up capacity in the adult justice system.

Under the plans outlined in the report, the responsibilities of the YJB would be extended to 18–20-year-olds to ensure that local areas are focused on tackling criminality and anti-social behaviour among young people and young adults, and new community sentences should also be put in place as an alternative to short prison sentences for young adults. In order to boost the financial incentives for local areas to reduce reoffending and keep young adults out of custody over time, the budget for youth custody could be devolved to local areas. IPPR say this would give local areas resources to invest in alternatives to custody.

The plans set out in this report would mean local areas would be held responsible for accounting for their progress in reducing first-time contact with the criminal justice system, keeping all but the most serious young adult offenders out of prison, and attempting to bring down reoffending rates.