Brain injury in adult males, women and young people within the Criminal Justice System is up to five times higher than the general population. The Disabilities Trust has, over the last ten years, developed an innovative service to challenge the criminal justice system to adapt to the needs of individuals with impaired neurofunction due to a brain injury. Here, the charity’s Linkworkers share what it is like raising awareness of this hidden disability in prisons
Brain injury Linkworkers offer a unique and individualised service, aiming to ensure that those involved in the Criminal Justice System, who have suffered a brain injury, are adequately supported.
Often, those with a brain injury can fall through the cracks or be missed by other services, perpetuating the cycle of reoffending as a result of a lack of appropriate help. Linkworkers act as the link between individuals and the support they need, improving engagement with staff and services, and helping to provide a structure and informed environment considerate of their difficulties and needs.
As a result of Linkworkers’ interventions we see significant reductions in severe anxiety and depression as well as fewer adjudications and incidents of challenging behaviour by as much as 93 per cent.
To give context, we already know that brain injury is incredibly prevalent amongst those who become involved in the criminal justice system, with research conducted by The Disabilities Trust finding rates of between 40 to 60 per cent.
The crucial first step towards supporting someone with brain injury is by identifying it. So often, we see someone who may not be aware they have sustained damage to the brain; having ‘brain injury’ and what this might represent to them would never have crossed their mind.
Despite this, they can rattle off a list as long as your arm of times they have had a severe head injury, have been knocked unconscious, and even ended up in hospital as a result. It is not uncommon for even documented brain injuries to not be considered as contributing factors in a person’s presentation or behaviour.
Instances where people have been left in comas and strokes may be in someone’s medical records, but they can walk, talk, and hold a conversation seemingly well – so they must be okay, right? We raise awareness of this ‘hidden disability’ and how, even in its mild to moderate forms, can have such an impact on the everyday lives of those affected.
Brain injury can have a diverse and profound range of consequences; in addition to the physical impacts we often see, it can affect someone’s behaviour, emotions, cognition, and personality.
What makes this problem more profound in the HMPPS and for those who have offended, is that the common consequences of brain injury such as apathy, impulsivity, increased aggression and memory deficits, result in behaviours that are so readily assigned to the ‘criminal’ stereotype. The difficulties of those affected are misattributed and the problem is perpetuated, people going their entire lives without receiving appropriate support
As Linkworkers, we screen individuals who may have experienced a brain injury and provide clinics to assess an individual’s difficulties. We encourage the use of cognitive rehabilitation skills and strategies, and support with signposting them to appropriate community services once released from custody.
Ultimately, the service takes a very person-centred approach, tailoring support sessions around level of insight, restorative capacity, readiness of change and areas of deficits. This is necessary as every individual has their own needs and expectations of ‘recovery’.
Intervention is goal-orientated and by encouraging service users to set their own targets, we support self-efficacy and help to rebuild confidence that is often lacking. When supporting those with brain injury, it’s amazing how a little education and the simplest of strategies can make such a difference to someone’s day-to-day life; by providing understanding and supporting independence you can add structure to the chaos and better enable someone to succeed in the community.
Another important aspect of our role is to provide staff support and training and The Disabilities Trust has provided Brain Injury Training to over 2000 professionals.
We promote the use of ‘Ask, Understand, Adapt’ which outlines the necessary first steps that we as professionals can make towards identifying and supporting those with brain injury.
As a two-woman team there are not enough hours in the day to support every individual in every prison and probation service. Instead, we train Brain Injury Champions; these are people who work within the criminal justice system, who become confident and competent in spotting and supporting those with a brain injury.
We are supervised by a Consultant Clinical Neuropsychologist who can offer expert guidance and consultancy in the care of complex individuals. By ensuring that staff feel supported in their role, we can facilitate better communication and engagement, which has a positive impact on both the service users and staff involved in their care.
A typical day in prison starts early. In order to catch residents before they head off to work in the morning or begin their daily routine, we are often found whizzing around the wings at 8am, performing brain injury screenings with residents who have been referred to the service.
These referrals can come from various prison staff including healthcare, prison officers and offender managers. Another useful tool in our belt are the Samaritan Listeners and Insiders; these are residents of the prison that support others who may be struggling or have never been in custody before. They are in a perfect position to identify brain injury, have received brain injury training in a similar way that the staff have, and often refer people to the service.
Later that morning, we might attend multidisciplinary team meetings headed up by the Safer Custody team. In these meetings, department heads come together to discuss residents who exhibit behaviours that challenge. This might include those with complex mental health problems, as well as brain injury.
Outside of these meetings, we liaise with staff on a 1:1 basis, typically to share information about specific individuals on our caseload, discussing where they require the most support and how to best provide this. We act as the link between residents and the staff responsible for their care, advocates for both parties.
In the afternoons, from 1pm to 4pm we run brain injury clinics, in these sessions, residents will be brought over to healthcare for their intervention session. If it is their first session, we take time getting to know their stories, and understanding their difficulties through assessment and clinical interview.
Together, we will set goals and plan how to action these, checking in every week on progress and any obstacles met. Those with brain injury typically learn best by repetition, habituation, and routine; this is considered and reflected in clinic plans whereby information and strategies will be rehersed together between sessions until it is fully understood and integrated.
The COVID pandemic presented a unique challenge and adaptations had to be made to our service. In the original lockdown, we adapted our interventions so that they could be delivered remotely. This meant that though we couldn’t be physically present, individuals were not left with nothing.
This was also the case with the probation hostels. With fewer individuals in residence, we spend less time being a physical presence in probation, instead working remotely with staff. We can be involved in MAPPA (multi agency public protection arrangement) meetings and offer insight into managing complex individuals in the community.
Services including mental health teams and teams supporting learning disabilities do great work, but they are not designed to meet the needs of those with brain injury. The Linkworker service sets out to give brain injured individuals a voice; By listening to their difficulties and communicating these with fellow staff, we can devise better care for people who would otherwise be stuck in a system with limited understanding of how to support them to succeed.
A Linkworker’s day involves banging the brain injury drum but is something we will continue to do until specific brain injury support is an established and integrated part of the prison and probation service.
