21 December 2016

Thinking ahead – early action and TBI

News and events

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.

 

1 August 2014

Official figures reveal rising violence in prisons in England and Wales

News and events

A rising tide of violence inside prisons across England and Wales has been revealed by official figures showing serious assaults soaring by 30%, three murders in the past 12 months and a 69% rise in suicides to the highest level for nine years.

According to Ministry of Justice figures, the number of self-inflicted deaths in prisons rose by 36 to 88 in the 12 months to the end of March – the highest level since 2005.

Prison governors have repeatedly warned that jails have been struggling to cope with a record population of more than 85,000 in increasingly crowded conditions while implementing budget cuts of up to 24% over the past three years.

The latest performance tables show that conditions inside 28 jails are now rated as being of official concern, with one – Brinsford youth jail at Featherstone in Staffordshire – rated as being of “serious concern”. This compares with only 12 jails being rated as being of concern last year, and a further three with the worst “serious concern” rating.

The prison ratings contrast sharply with those for the performance of the 35 probation trusts across England and Wales, which were all rated “good or exceptional” in their last year of operation. They were abolished last month and 70% of their workload is to transfer to community rehabilitation companies.

The detailed figures show that serious assaults inside jails have risen by 30% from 1,277 to 1,661, and all assaults on staff rose 15%, from 2,787 to 3,201. There were three homicides behind bars in the 12 months to March compared with two the year before.

The increasingly violent atmosphere has been accompanied by a reduction in the number of prisoners completing programmes to tackle their criminality. The number of sex offender treatment programmes were down from 2,757 to 2,576 despite a sharp rise of more than 700 in the number of sex offenders imprisoned. Similarly, the number of prisoners completing drug rehabilitation courses was also slightly down.

Political parties have said the increase in deaths in custody is being taken very seriously. The T2A recently submitted evidence to the Harris Review into deaths of young adults in NOMS custody. You can read the T2A response here.

(This news item was originally posted on the Guardian on 31/07/14. The article is available here)

5 February 2014

Government announces review of self-inflicted deaths of 18-24 year olds in custody

News and events

The Government has announced today that it is setting up an independent review to investigate self-inflicted deaths in custody of young people aged 18-24.  The announcement means that the proposal to scrap YOIs (see T2A’s December 2013 response to MoJ consultation) has been suspended pending the outcome of the review.

Justice Secretary Chris Grayling said the Government was committed to the safety of offenders and to reducing the number of people dying in custody and that lessons learned from the review would benefit all age groups.  In the past 10 years, 163 children and young people under the age of 24 have died in prison.

The review will be led by the Labour peer Lord Harris of Haringey, who is chairman of the Independent Advisory Council on Deaths in Custody.

Leading charities and NGOs, including Barrow Cadbury Trust, had joined the call for an independent review in a letter published in the Daily Telegraph newspaper yesterday. The Government had been considering whether to hold an independent review since Inquest and the Prison Reform Trust published Fatally Flawed: has the state learned lessons from the deaths of children and young people in prison, which examined the experiences of children and young people who died in prison between 2003 and 2010.