Traumatic Brain Injury in Prisons and Jails:

An Unrecognized Problem

Many people in prisons and jails are living 

with traumatic brain injury (TBI)-related 

problems that complicate their management 

and treatment while they are incarcerated. 

Because most prisoners will be released, 

these problems will also pose challenges 

when they return to the community. The 

Centers for Disease Control and Prevention 

(CDC) recognizes TBI in prisons and jails 

as an important public health problem.

What is known about TBI 

and related problems in 

prisons and jails?

General:

•	 More than two million people 

currently reside in U.S. prisons and 

jails.1 

•	 According to jail and prison studies, 

25-87% of inmates report having 

experienced a head injury or TBI 2-4

as compared to 8.5% in a general 

population reporting a history of 

TBI.5

•	 Prisoners who have had head 

injuries may also experience mental 

health problems such as severe 

depression and anxiety,3 substance 

use disorders,6-8 difficulty controlling 

anger,6 or suicidal thoughts and/or 

attempts.6,9

Women:

•	 Although women are outnumbered 

by men in U.S. prisons and jails, 

their numbers more than doubled 

from 1990 to 2000.1,10 As of June 

2005, more than 200,000 women 

were incarcerated.1 Women now 

represent 7% of the total U.S. prison 

population and 12% of the total U.S. 

jail population.10

•	 Women inmates who are convicted 

of a violent crime are more likely 

to have sustained a pre-crime TBI 

and/or some other form of physical 

abuse.11

•	 Women with substance use 

disorders have an increased risk for 

TBI compared with other women in 

the general U.S. population.12

•	 Preliminary results from one study 

suggest that TBI among women in 

prison is very common.13

Substance abuse, violence,

and homelessness:

•	 Studies of prisoners’ self-reported 

health indicate that those with one or 

more head injuries have significantly 

higher levels of alcohol and/or drug 

use during the year preceding their 

current incarceration.6

•	 The U.S. Department of Justice 

has reported that 52% of female 

offenders and 41% of male 

offenders are under the influence 

of drugs, alcohol, or both at the 


time of their arrest,14 and that 64% of male 

arrestees tested positive for at least one of 

five illicit drugs [cocaine, opioids, marijuana, 

methamphetamines, or PCP].15

•	 Among male prisoners, a history of TBI is 

strongly associated with perpetration of 

domestic and other kinds of violence.16

•	 Children and teenagers who have been 

convicted of a crime are more likely to have 

had a pre-crime TBI17,18 and/or some other 

kind of physical abuse.17,19,20

•	 Homelessness has been found to be related 

to both head injury21 and prior imprisonment.22 

How do TBI-related problems 

affect prisoners with TBI and 

others during their incarceration?

A TBI may cause many different problems:

•	 Attention deficits may make it difficult for 

the prisoner with TBI to focus on a required 

task or respond to directions given by a 

correctional officer. Either situation may be 

misinterpreted, thus leading to an impression 

of deliberate defiance on the part of the 

prisoner.2,23

•	 Memory deficits can make it difficult to 

understand or remember rules or directions, 

which can lead to disciplinary actions by jail or 

prison staff.24

•	 Irritability or anger might be difficult to control 

and can lead to an incident with another 

prisoner or correctional officer and to further 

injury for the person and others.23,25

•	 Slowed verbal and physical responses may 

be interpreted by correctional officers as 

uncooperative behavior.23

•	 Uninhibited or impulsive behavior, including 

problems controlling anger6 and unacceptable 

sexual behavior, may provoke other prisoners 

or result in disciplinary action by jail or prison 

staff.23,26

What is needed to address the 

problem of TBI in jails and prisons?

A recent report from the Commission on Safety and 

Abuse in America’s Prisons recommends increased 

health screenings, evaluations, and treatment for 

inmates.27

In addition, TBI experts and some prison officials 

have suggested:

•	 Routine screening of jail and prison inmates 

to identify a history of TBI.28,29

•	 Screening inmates with TBI for possible 

alcohol and/or substance abuse and 

appropriate treatment for these co-occurring 

conditions.15,30,31

•	 Additional evaluations to identify specific 

TBI-related problems and determine how 

they should be managed.28 Special attention 

should be given to impulsive behavior, 

including violence,2,26 sexual behavior23 and 

suicide risk if the inmate is depressed.32

What is needed to address TBIrelated problems after release 

from jails and prisons?

Lack of treatment and rehabilitation for persons 

with mental health and substance abuse problems 

while incarcerated increases the probability that 

they will again abuse alcohol and/or drugs when 

released.15,31 Persistent substance problems can lead 

to homelessness,33 return to illegal drug activities,34,35

re-arrest,36 and increased risk of death37 after release. 

As a result, criminal justice professionals and TBI 

experts have suggested the following:

•	 Community re-entry staff should be trained 

to identify a history of TBI and have access 

to appropriate consultation with other 

professionals with expertise in TBI.17,29,30

•	 Transition services for released persons 

returning to communities should 

accommodate the problems resulting from a 

TBI.17,28,29

•	 Released persons with mental health and/or 

substance abuse problems should receive 

case management services and assistance 

with placement into community treatment 

programs.27,30,37 

CDC supports new research to develop better 

methods for identifying inmates with a history of TBI 

and related problems and for determining how many 

of them are living with such injury. 


Further information is available from these websites:

Traumatic Brain Injury (TBI):

CDC, National Center for Injury Prevention and Control

www.cdc.gov/ncipc/tbi/TBI.htm

This site provides information for professionals and the general public regarding TBI. Topics include 

prevention, causes, outcomes, and research. Data reports regarding TBI in the United States and many free 

publications and fact sheets can be downloaded. Materials are available in English and Spanish. 

Health Issues in Correctional Settings:

CDC, National Center for HIV, STD, and TB Prevention

www.cdc.gov/nchstp/od/cccwg/default.htm

This site provides information for public health and criminal justice professionals about health topics with an 

emphasis on infectious diseases in the correctional setting. It also has materials for the general public with 

links to related organizations.

Intimate Partner Violence (IPV):

CDC, National Center for Injury Prevention and Control

www.cdc.gov/ncipc/factsheets/ipvfacts.htm

The site provides information for professionals and the general public regarding IPV. The site contains an 

overview and fact sheet about IPV, prevention strategies, links to other IPV prevention organizations, and a 

list of current CDC publications. 

Legal Issues of Persons with TBI within Correctional Settings:

National Disability Rights Network

www.ndrn.org/aboutus/consumer.htm

This site provides information about the laws protecting the civil and human rights of persons with 

disabilities, including TBI. Incarcerated persons with disabilities, or their families, can receive help from 

the Network regarding prisoners’ legal rights, access to mental health services and/or medication, and 

restoration of benefits upon release. 

Substance Abuse:

Substance Abuse & Mental Health Services Administration

www.samhsa.gov

This site provides information about treatment resources for persons with, or at risk for, mental and/or 

substance abuse problems. Also, the site provides information for professionals regarding alcohol and other 

drug-related disorders. The site has materials for specific populations and age groups and hotline numbers 

for support organizations.


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