Four in five female prisoners in Scotland have a history of significant head injury, with sustained domestic abuse the most likely cause, according to research that experts argue bolsters the case for routine screening of inmates.
The study – led by Glasgow University, funded by the Scottish government and published in the Lancet Psychiatry – also found that violent criminal behaviour was three times more likely in women with a history of significant head injury, and that these women spent three times longer in prison.
The work adds to a growing body of research on the over-representation of people with brain injuries in the prison population, in particular among women.
Domestic violence was cited by 89% of survey participants who reported repeat head injuries. Two-thirds (66%) reported repeat head injuries over many years, and 40% had an associated disability. A first head injury before the age of 15 was reported by 69% of the women.
Common effects of significant head injury include the impairment of information processing, impulsivity and egocentricity, which can increase the risk of offending. Injuries incurred before adulthood can affect how the brain matures.
For the study, researchers interviewed 109 women – around a quarter of Scotland’s female prison population – between 2018 and 2019 and assessed them for a history of head injury as well as for disability and mental and physical health conditions.
Almost all participants in the study, 95%, reported a history of abuse, with more than half reporting sexual abuse in childhood and 46% reporting sexual abuse in adulthood. A history of alcohol or drug misuse was common, and 92% complained of mental health difficulties, with anxiety and depression the most common.
Tom McMillan, a professor of clinical neuropsychology at Glasgow University and the lead author of the study, said: “It is already recognised that women in prison are vulnerable because of histories of abuse and substance misuse. However, this research shows that a history of significant head injury is also a vulnerability and needs to be included when considering mental health needs and in developing criminal justice policy.
“We need routine screening to identify women with serious head injuries, and also to educate them, as they often don’t realise that repeated knocks have an impact. We know that the Prison Service is considering placement and custody for women more generally, and this really needs to be included in their assessment.”
