Brain injuries plague city jail inmates

Health officials have discovered a disturbing trend among adolescents incarcerated at Rikers Island — an extremely high prevalence of traumatic brain injuries.

In Department of Health and Mental Hygiene (DOHMH) study conducted last year, health officials found that 50 percent of male juveniles incarcerated at Rikers have experienced significant traumatic brain injuries. The rate among young women was even higher at 65 percent.

The average rate among Americans is around 8.5 percent and the leading causes are falls, traffic accidents and assaults.

Research has shown that such head injuries can be debilitating. People who have suffered what is commonly referred to as “TBI” can experience memory difficulties and behavioral problems, or even depression, anxiety, substance abuse disorders and suicidal thoughts.

The study at Rikers Island was the first of its kind in New York City and began in mid-2012. In all, 450 adolescents of the roughly 1,000 incarcerated at any given time by the Department of Correction were screened.

This illustration from the U.S. Centers for Disease Control shows a concussion, the most common form of traumatic brain injury.

This illustration from the U.S. Centers for Disease Control shows a concussion, the most common form of traumatic brain injury.

The results will be submitted for publication in a peer-reviewed journal in the coming year.

“This shows us that we have a real serious organic medical problem among the adolescents,” Dr. Homer Venters, assistant commissioner of the city’s Correctional Health Services, said at a Board of Corrections meeting in March. “We often end up giving someone a mental health diagnosis, who does not have a mental health problem, but rather TBI.”

Venters pointed out that many of the individuals identified during the study are the same inmates who run afoul of jail rules and receive infractions.

In 2008, the city Department of Health and Mental Hygiene, which runs Correctional Health Services, created a surveillance and tracking system for new injuries suffered by inmates at Rikers Island, including head injuries. But Venters recognized that head injuries sustained even before an individual is incarcerated could also impact his patients and affect their mental health and even their length of stay in jail.

Two of the most significant manifestations of traumatic brain injuries are emotional dysregulation and impaired processing speed. “This means you can’t control your emotions and you can’t follow directions,” Venters told the corrections board. “These are two very serious complications for people who find themselves in jail.”

Although further research is required, the the higher prevalence of TBI among young women may be explained by domestic violence and sex work that exposes them to physical abuse.

The federal Centers for Disease Control and Prevention have called traumatic brain injuries in prisons and jails a nationally unrecognized problem. According to the CDC, as many as 87 percent of inmates report having experienced some kind of head injury, though the rate is generally believed to be around 60 percent on average.

Inmates with these injuries can experience cognitive difficulties that include problems with impulse control. These may explain how they entered the criminal justice in the first place and why they may struggle disproportionately in a correctional setting.

The phenomenon is beginning to receive attention in several states. South Carolina and Minnesota have both undertaken studies on the prevalence of brain injuries among prison populations.

In 2012, Texas received more than $2 million from a federal health research agency to begin a brain injury screening program for juveniles in the justice system and offer them rehabilitative support.

In New York City, health officials appear intent on using the results of their screening to begin educational programs that inform both the incarcerated and Department of Correction staff about effects of head injuries.

And efforts are underway to collaborate with the Tribeca Film Festival to create videos about traumatic brain injuries as represented in films and TV shows to be shown to inmates. Venters believe the videos can show adolescents how these kinds of injuries are made light of when in fact they are very serious.

“Most of our patients have never heard about TBI,”  said Venters to the Board of Corrections. “They are walking around either with a mental health diagnosis or a ‘knucklehead’ label.”

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