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Brain injury and the criminal justice system

Understanding the prevalence of traumatic brain injury in prison populations

Brain injury and the criminal justice system

6 out of 10 people in prison may have a brain injury. 

Our studies, backed up by international research, indicate that brain injury is over-represented in the criminal justice system, affecting approximately six out of ten people in prison. Brain injury is often called a ‘hidden disability’ as the cognitive, behavioural, and emotional consequences may be overlooked or misinterpreted as behaviour that challenges.

The impact of brain injury within the criminal justice system (CJS) is wide-reaching. Brain injury has also been linked to:

  • increased risk of violence
  • earlier age of first incarceration
  • greater number of convictions
  • institutional infractions
  • reconviction
  • alcohol and drug misuse
  • mental illness
  • a more significant number of suicide attempts.

Despite this, there is a lack of awareness of this issue, and evidence suggests there is limited support for offenders with brain injury in the CJS.

Our work in this area to date

Brainkind (formerly The Disabilities Trust) has delivered various projects in forensic settings over the last ten years.

Our Linkworker service provides a range of effective interventions and support to those identified as likely to have a brain injury within a prison setting.

The Linkworkers use the Brain Injury Screening Index (BISI ®), a validated screening tool developed by our expert clinicians to help identify those with a history indicative of brain injury. This tool is available to anyone with a Ministry of Justice email.

From 2016-2018, our Linkworker service supported female offenders with brain injuries in HMP/YOI Drake Hall, a closed female prison in Staffordshire.

Brainkind currently provides two Brain Injury Linkworker services in HMP Cardiff and HMP Swansea, together with two Approved Premises supporting men with a brain injury.

Data from these services show a significant impact, including:

  • 95% reduction of open Assessment, Care in Custody and Teamwork (ACCTs) – the care planning process for prisoners at risk of suicide or self-harm (compared to the three months before accessing the BIL service).
  • 93% reduction in adjudications and incidents (compared to the three months before accessing the BIL service).

Throughout these projects, Brainkind consistently found a disproportionately high number of male (47%) and female (64%) prisoners who had injuries indicative of brain injury compared to the general population.

Results also showed that 70% of male prisoners had sustained a brain injury before their first offence, and amongst women, the leading cause of BI was domestic violence (62%). This work contributed to national and international research examining the prevalence and impact of brain injury, particularly on offending populations.

You can read our work in our archived document.


In 2021, Brainkind launched a new Brain Injury Awareness training programme, ‘Ask, Understand, Adapt’. This is available to all healthcare prison and probation staff in England and Wales.

The training is designed to help practitioners identify and support those who may have a brain injury, and it gives examples of how a brain injury may present within prison and probation settings.

You can watch ‘Invisible Me’, a video produced as part of the training, here.


In 2023, Brainkind developed the MindsMe app. MindsMe can be introduced at pre-release or within probation services, and aims to support all prison leavers, prison staff, and probation officers to have an increased understanding and awareness of brain injury. It also provides access to simple tools and systems to help prison leavers’ transition into the community.

Creating real change

Brainkind works with experts and policymakers to improve the lives of people with brain injury in the criminal justice system, including the ABI Justice Network and the All-Party Parliamentary Group (APPG) on Brain Injury.

Following campaigning from Brainkind in 2020, the Ministry of Justice and NHS England introduced a standard question on ABI into the service specifications for prison healthcare, both during induction and the later in-depth screening. Screening can identify those who have a history indicative of brain injury and who may require an onward referral to a specialist service.

In December 2021, the government announced a new cross-departmental strategy for ABI. The strategy involved a consultation process and a Patient and Public Voice Reference Group (PPVRG), where those with lived experience and stakeholders participated in the drafting of the strategy. Brainkind was involved at all stages of the process.

We look forward to the publication of the strategy later this year.

What next?

Brainkind will be extending its Linkworker service into more prisons throughout the UK in 2024.

The Policy and Social Change team is also working on a new research project on the experience of women with a brain injury in Welsh prisons. More details can be found here (to be filled in).

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