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 Transition to Adulthood Alliance (T2A) wholeheartedly welcomes the Justice Committee’s report of its Inquiry on Young Adult Offenders, and fully endorses its “blueprint” for a strategic approach to the treatment of young adults in the criminal justice system.

Reacting to the Committee’s unequivocal conclusion that “there is overwhelming evidence that the criminal justice system does not adequately address the distinct needs of young adults” and that “there is a strong case for a distinct approach”, Joyce Moseley OBE, Chair of the T2A Alliance said:

“18-25-year-olds in the criminal justice system have a hugely untapped capacity to address their behaviour and permanently “grow out of crime”. But all of us – particularly victims, the young adults themselves and their communities – are being let down by a lack of strategy at the top that takes account of their distinct stage in life. For too long, successive governments have overlooked the value of a delivering a specific criminal justice approach for young adults, leaving it to a patchwork of pioneers on the ground to do their best to meet the particular needs of this age group.

“Now, having reviewed the extensive and authoritative body of evidence from disciplines including neuroscience, criminology and psychology, all of which support calls for a distinct approach for young adults, the Justice Committee has rightly called on the government to pursue a robust and bold agenda dedicated to enabling young adults who commit crime to turn their lives around. T2A looks forward to working with the Ministry of Justice and other agencies to implement the Committee’s landmark and visionary report in full and without delay.”

The Committee’s report includes a bold blueprint for a distinct approach to young adults throughout the criminal justice system, which it says is presented “in the light of the Government’s failure to act and in recognition of the weight and wealth of evidence provided to us in the course of our inquiry, as well as the overwhelming enthusiasm within the sector for change”.

The Committee’s proposals include:

• That the prison sentence of ‘Detention in a Young Offender Institution’ (DYOIs) should be extended in forthcoming legislation to include all 18-25 year olds (it is currently restricted to those aged 18-20), and that various models of custody for young adults be piloted by the Ministry of Justice before any decision is made about long-term provision for this age group. T2A has campaigned strongly on both these points, in opposition to government proposals in 2013 to scrap the sentence of DYOI.
• Distinct young adult courts should be piloted, which T2A is currently developing in five sites across England and Wales in partnership with the Centre for Justice Innovation (CJI).

The Committee recognised that young adults are over-represented in the criminal justice system and also at greater risk of being victims of crime.  Its strong recognition that many young adults in prison have faced additional challenges such as being in care (who make up around two fifths of young adults in prison) and experiencing brain injury (up to 70% of young people in prison), is particularly welcome and long overdue. T2A has worked with the Care Leavers’ Association to develop a national toolkit for young adult care leavers involved the criminal justice system, undertaken specific research and demonstration projects to show how young people with brain injuries in prison can be rehabilitated.

The Committee has specific recommendations relating to the fact that young black and Muslim men are disproportionately likely to end up in the criminal justice system (recognising the important contribution of Baroness Lola Young’s 2014 report), and rightly highlights that young women’s particular vulnerabilities and needs are different both to those of young men and older women and that they require a tailored response.

T2A also welcomes the Committee conclusion that all 18-25 year olds should be recognised as a distinct group, not just those within a criminal justice context, but also with regards to welfare, work, education and health. T2A strongly agrees that there should be cross-governmental responsibility to enable young adults, particularly those who have faced challenge and difficulty, to thrive and not be thwarted.

Notes

1. Selection of T2A evidence: Brain injury: Repairing Shattered Lives: Brain injury and its implications for criminal justice, Prof Huw Williams; Young adult courts: Young Adults in Court – Developing a tailored approach, Centre for Justice Innovation; Young adults in custody: The Way Forward; Muslim young adults: Young Muslims on Trial, Maslaha
2. Baroness Lola Young’s Report on the over-representation of Black and Muslim young adult men in the criminal justice system is here: http://www.youngreview.org.uk/
3. Justice Committee website: http://www.parliament.uk/business/committees/committees-a-z/commons-select/justice-committee/inquiries/parliament-2015/young-adult-offenders/
4. T2A’s original submission to the Young Adult Offenders Inquiry is here

T2A has today provided oral evidence to the final session of the Justice Select Committee’s Inquiry on Young Adult Offenders.

The Committee, whose landmark Inquiry has lasted seven months and will likely report in the next few weeks, heard from a panel including Max Rutherford, Criminal Justice Programme Manager at the Barrow Cadbury Trust. He gave evidence on behalf of T2A, alongside Professor Huw Williams (who has led a number of T2A projects on neuro-maturation and crime) and Angela Cossins from the National Probation Service.

Footage of the panel is here, from 10.32.51

Questions put to the panel focused on the management of young adults in prisons, the merits of specialist young adult courts, and the opportunities for diversion. The discussion also featured an exchange on Ministry of Justice leadership, maturity assessments pre-sentence, and preventing deaths in custody.

During the session, Max Rutherford highlighted the potential that young adults have to desist from crime if the right intervention is made, and the wider benefits of a distinct approach to young adult offenders:

“Yesterday, a borough police commander, who is leading a bid to T2A to run a young adult court pilot in his area, told me the reason for him that 18-25 year olds should be a distinct group and should have a special effort of resources and capacity is that if we get it wrong with that age group, there is at least a decade-long consequence, socially and financially”.

Max Rutherford also highlighted T2A’s position that all 18-25 year olds in prison should be subject to a separate, purposeful prison regime. Asked about the Government’s plans for autonomous prisons, he noted that although the government’s prison reform agenda has potential, a more immediate issue is its current lack of a distinct strategy for managing young adults in prison:

“Containing young adults for 23 hours a day in their cells, albeit perhaps in cells where there are fewer ligature points from which to hang themselves, is not going to keep staff safe and it’s not going to achieve any positive outcomes post-release”.

You can watch footage of the panel here, as well as the preceding contribution from Andrew Selous MP, the Minister for Prisons and Probation and Michael Spurr, the Director General of the (NOMS) National Offender Management Service.