By Fiona Summers, Chair of the BPS Division of Neuropsychology in Scotland and a consultant clinical neuropsychologist with NHS Grampian.

AS a society, we recognise those who offend and reoffend tend to live in chaos, and often act impulsively, not thinking things through. But individually, most of us are not aware that brain injury increases the chances of risk-taking behaviour and criminal activity

Traumatic Brain Injury (TBI) is the most common cause of death and disability in people under 40 in the developed world. TBI commonly occurs as a result of road traffic accidents, assaults and sporting injuries and is particularly common in prison populations.

Research from Finland suggests that childhood brain injury increases the chances of subsequent offending, with those injured being four times more likely to become “mentally disordered” offenders by their thirties, compared to those non-injured. Research in Glasgow has shown high rates of disability up to 15 years after head injury, with increased rates of mortality, especially for younger adults.

Our lack of understanding is leading to offenders – children and young people – not being properly rehabilitated once they enter the criminal justice system.

There are around 8,000 inmates in Scottish prisons; and work conducted at Exeter University has shown that around 60 per cent of prisoners, including both young and adult offenders, report they have suffered from a head injury at some point in their life. In addition, 45 per cent report being unconscious as a result of a head injury. These numbers represent about three to four times as many people compared to those with a head injury in the general population.

Despite an obligation for the NHS to ensure equal access to services for all who need them, offenders with a head injury are not having their needs assessed, let alone met, within the secure estate. These individuals fall through the cracks upon release into the community, where they may miss out on community brain injury rehabilitation input because of lack of continuity and communication between systems.

Is it any wonder 40 per cent of prisoners reoffend in two years? With the total cost of reoffending in Scotland now close to £3 billion, and health and prison budgets facing increasing pressure, we no longer have the luxury of inaction.

There is no doubt that prevention is better than cure. It is important to find a way to help children and young people who have, or are at risk of, a TBI and offer them a way to change their behaviour. The risks of failing to do so may result in these young people falling behind, dropping out of school, and potentially engaging in various risky behaviours such as being in gangs or being involved in various criminal activities.

In terms of the justice system it is vital that probation staff, police, judges and lawyers can be supported to take into account the presence of injury. It is also crucial that such professionals understand to what extent such injuries are contributing factors to the crimes committed, and how these should be addressed in the planned rehabilitation.

As young people and adults enter the criminal justice system, brain injury must be identified at an early stage and certainly before starting a sentence. Progress is being made but we need a new, nationwide system of assessment and treatment throughout the criminal justice system, with a focus on preventing future crimes, as well as rightly punishing people for offences committed.

When a brain injury is identified, a path out of future crime can be determined. For example, an offender who is impulsive and has a poor memory would benefit greatly from strategies on how to manage anger, stop using drugs and make constructive plans for the future.

Across Scotland, only HMP Grampian has a dedicated neuropsychology service for inmates to help meet their complex needs. However, given the prevalence of brain injury among inmates, this is not enough.

The British Psychological Society is calling on Scottish ministers to provide new guidelines for identifying and managing neuro-disabilities such as TBI in young offenders in custody or others at risk of head injury.

This will provide clear direction to the prison service and NHS about how to best identify and manage brain injuries. This will also ensure we have services which help rehabilitate former inmates and address offending behaviour. In doing so, we will help prioritise the role of prevention that must be at the heart of any effective criminal justice system.

Children and young people with head injuries are being failed by both the NHS and the criminal justice system. Until we focus on and invest in preventative services, such as screening, assessment and rehabilitation then we will continue to see individual’s lives and billions of pounds wasted every year.