A new report has found 80 per cent of women in the criminal justice system in Wales may be living with a traumatic brain injury (TBI), calling for urgent solutions and increased awareness.
The report reveals the prevalence of brain injuries in women in contact with the Welsh Criminal Justice System for the first time, showing these women face significant social disadvantages and exclusion, often starting from a young age.
It further reveals that over 90 per cent of women surveyed said they had experienced domestic abuse, 92 per cent had experienced a serious blow to the head, 78 per cent reported being held in a way they could not breathe, 84 per cent of women self-reported two or more mental health conditions, and 68 per cent said they had made an attempt to take their own life.
The Complex Lives report, carried out by TBI charity Brainkind and commissioned by the South Wales Police & Crime Commissioner for the Welsh Government’s Women’s Justice Blueprint – a partnership to improve experiences and outcomes of women in contact with the criminal justice system in Wales – emphasises the need for increased awareness of TBIs and the implementation of integrated support pathways.
It puts forward recommendations such as the creation of a steering group, providing training for staff, and enhancing community support.
Brainkind’s head of policy influencing and social change, Davina Jones, and consultant clinical neuropsychologist, Dr Annmarie Burns, speak to Neuro Rehab Times about the report’s findings and recommendations.
Higher prevalence of TBIs in the CJS
Brainkind emphasises that the prevalence of brain injury for people in the criminal justice system has been found to be significantly higher than in the general population, falling at around 50 per cent and for women around 60 to 80 per cent, compared to around 8 to 12 per cent prevalence in the general population.
As shown in the report, women in contact with the Welsh CJS often have complex mental and physical health needs, with many reporting domestic abuse, substance misuse, having their children removed by social services, or themselves experiencing the care system as a child.
Jones and Burns emphasise that many of these women are unaware they may have a brain injury, and that brain injuries also impact women’s ability to advocate for themselves.
“For there to be adequate care, support pathways, and access to support, there needs to be sufficient knowledge and awareness of the type of support that people need. I think one of the issues, particularly with brain injury, is that people are not aware that they may have a brain injury,” says Jones.
“They’re not aware that lots of instances across their life, or one big incident, one head injury may have led to a brain injury, and some of the things they’re experiencing are a consequence of that.
“The professionals that support them are professionals who support a huge range of very complex lives – people live with challenges around mental health, physical health, substance use, and homelessness. All of these factors are part of a big package of challenges that women face.”
Burns adds: “There could be excellent care available, say, for mental health or substance use, but because of a person’s brain injury, they might struggle to access it. If they don’t even know that they’ve got a brain injury, and the people supporting them don’t know that they’ve got a brain injury, then they’re not going to be making those adaptations to facilitate that person at the service.
“So there’s lots of different layers to the availability of services and how they access those services in a coherent and integrated way because many of these women have really complex lives. They’ve got lots of different diagnoses. They might have a physical health problem, a mental health problem, a brain injury, and use substances, and that might mean they’re supposed to be accessing four or five different services.
“How do they do that in a way that’s helpful to them and manageable for the services that they’re accessing as well? It is a very complicated picture.”
Lack of knowledge of a brain injury may be due to lack of awareness of symptoms such as anxiety, brain fog and depression, say Jones and Burns.
Improving outcomes for women in Wales
In this light, the report urges a need for increased awareness around brain injuries and non-fatal strangulations along with their potential consequences, including symptoms such as difficulties with memory, extreme fatigue, or difficulty concentrating.
Improving awareness of TBI and their symptoms is also important among CJS staff, and the report shows that CJS professionals are eager to learn more and adapt.
Feedback from survey interviewees suggested implementing strategies to improve services such as further staff training, the appointment of co-ordinators or case managers to oversee comprehensive support for women with complex circumstances, and the creation of centres of best practice and collaboration.
The report reads: “Together with training and awareness about brain injury for all staff, good practice was felt to include the increased use of personal assistants to offer support for women. Professionals hoped the support would increase the ability of women to articulate their own needs, leading to women who are empowered to make informed decisions about their lives.
“This will enable professionals to advocate for more effective sentences that focus on improving life chances for women, and ultimately reducing reliance on prison.”
Equally, women feedback that they are like enduring barriers to successfully remaining out of prison, alongside finding accommodation after prison, and ending up homeless.
Jones explains: “Wales’s vision for the Women’s Justice Blueprint is, in effect, to not have some of these big, institutionalised settings, they’re looking at more localised, supported living and transitional accommodation, accommodation where women can move into as part of an early intervention instead of having a typical prison probation setting.”
Recommendations have also been put forward in a bid to improve outcomes for women in contact with the CJS in Wales.
Some of the report’s recommendations include:
- Establish a Brain Injury Awareness Pathway for women across the CJS in Wales, including establishing key touchpoints in Women’s Centres and Healthcare Services in Prison.
- Review the accessibility of support available to women in contact with the CJS in Wales.
- Implement a comprehensive brain injury training offer, building on Ask, Understand, Adapt which is already freely available across the CJS in Wales.
- Create a Brain Injury Steering Group to provide a framework to support greater collaboration, and the sharing of best practice in the approaches taken to support women with potential brain injuries in the CJS in Wales.
Jones says: “The Welsh Government and the Women’s Justice Blueprint are really committed to the steering group and the planning for that is already underway. Having a group of people who constantly reiterate the message of the report and also identify ways that those messages can be shared, can have an impact for women in Wales long term.”
Brainkind already provides ‘ask, understand, adapt’ training, which is designed to help CJS and NHS professionals understand the effects of brain injuries.
“In order to be confident using the training, there needs to be some next steps,” says Jones.
“This is why the pathway is so important, because as a professional, the last thing you want to do is have a conversation with somebody or screen somebody, and then have absolutely no way of supporting them. This is why we’ve looked at a pathway for this particular group of women. Training is really important, but it needs to be accessible for people the whole way across the system and linked to pathways for the right support.
“I don’t think this is unique to Wales. We’ve seen this in our other studies in England as well, that awareness of brain injury amongst the general population is not that high, and if you have lived for a long period of time in a domestic abuse situation, you may not realise the potential seriousness of having a blow to the head or being held in a way that you can’t breathe.
“If you’re in rural Wales, the physical difficulty of getting to a hospital or getting to your GP, it might mean that you’ve never had these things investigated, and then a period of time passes and you don’t really associate the memory difficulties or the planning difficulties or difficulties with regulating your emotion with that event in the past.
“So I think there is some work to be done raising awareness, more generally, of brain injury, so that people know how important it is to seek support when they can.”
Brainkind will now present the report to the All Wales Board for Women, begin to work with third-sector charities across Wales to educate on the report’s findings, and disseminate the report to those in contact with women in the criminal justice system.
