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Female offending and brain injury
Disabilites Trust report finds 64% prisoners at HMP Drake Hall had indicative brain injury.

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Last week (6 February 2019) the Disabilities Trust published a new report, Making the Link: Female Offending and Brain Injury, the first study of its kind into brain injury in female offenders.

The study, funded by the Barrow Cadbury Trust and The Pilgrim Trust, was carried out from 2016 to 2018, with an accompanying independent evaluation by Royal Holloway, University of London. The findings highlight the need for a support pathway to help manage the health, cognitive and behavioural issues associated with brain injury, which may impact on likelihood of re-offending.

The research found that of 173 women within HMP/YOI Drake Hall who were screened using the Brain Injury Screening Index tool, 64% reported a history indicative of brain injury, and of those, almost all (96%) reported a history indicative of traumatic brain injury (TBI). From the women supported through the service, 62% reported they had sustained their brain injury through domestic violence.

It is widely acknowledged that TBI is over-represented in prison populations, with the likelihood of increased risk of violence, earlier age of first incarceration, a greater number of convictions, re-conviction, mental health problems and a greater number of attempts at suicide.

The needs of women in prison with TBI are likely to be complex, and the lack of understanding and identification of a brain injury may result in a higher risk of custody and reoffending. Therefore, the study introduced a Brain Injury Linkworker Service in HMP/YOI Drake Hall to provide specialist support to women with a history of acquired and traumatic brain injury.

The Linkworker service

Linkworkers aimed to develop a sustainable pathway of support for rehabilitation and help prisoners to manage the transition between custody and the community.

From the women supported through the service, there were 196 reports of severe blows to the head and distressingly, 62% of 100 women reported they had sustained their brain injury through domestic violence.

Nearly half (47%) of the women had been in an adult prison five or more times and 33% sustained their first injury prior to their first offence.

The trauma in the lives of the women with TBI is evident in the accounts provided by interview participants. Some of the accounts and case studies presented in the independent evaluation written by Royal Holloway, University London are distressing to read.

The independent evaluation also showed a female Linkworker was sensitive to the gender-specific needs of those being supported. The women who were seen by the Linkworker experienced improved mood and self-esteem, and enhanced confidence and positivity; key factors that have been previously identified as being essential for a woman to engage in rehabilitative programmes.

The Linkworker service also offered practical guidance for staff working with women with a brain injury, and alleviated pressure from other service provisions (e.g. mental health) with the conclusion that a Brain Injury Linkworker service provides a strong framework which will benefit offenders and prisons to identify and manage brain injury.


The report makes five key recommendations:

  • The inclusion of brain injury screening as a routine part of the induction assessment on entry to prison or probation services
  • All prison and probation staff to receive basic brain injury awareness training
  • The provision of brain injury support; similar to the Brain Injury Linkworker (BIL), in prisons and probation settings
  • Assurance that brain injury support would be aligned with gender-informed practice
  • Further research to be conducted to examine the potential effect of brain injury on re-offending behaviour, how effective neurorehabilitation can contribute towards the reduction of recidivism and the role of early intervention approaches.

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