The surprising connection between brain injuries and crime

A traumatic brain injury, or TBI,

is a disruption in brain function
caused by an external blow to the head.

And when you hear that definition,

you might think about sports
and professional athletes,

since it's the kind of injury
we're used to seeing on the playing field.

And this imagery has really come
to define TBI in the public consciousness.

I myself do research on TBI
in retired and college athletes.

I stood on a TED stage in 2010

talking about concussions in kids' sports.

So I have to say, as someone
who researches and treats these injuries,

that I've been really gratified
to see the growing awareness

of TBI and specifically the short-
and long-term risks to athletes.

Today, though, I want to introduce you
to a larger but no less controversial

group of people impacted
by traumatic brain injury

who don't often show up in the headlines.

I've come to recognize
these inmates and probationers

as surprisingly among the most
vulnerable members of society.

For the last six years, my colleagues
and I have been doing research

that has completely changed
the way we think

about the criminal justice system
and the people in it,

and it may change the way
you think about those things too.

So I'll start with a shocking statistic;

50 to 80 percent of people
in criminal justice

have a traumatic brain injury.

Up to 80 percent.

In the general public,
in this room, for example,

that number is less than five percent.

And I'm not just talking about
getting your bell rung.

These are the kinds of injuries
that require hospitalization.

Most of them are the product
of a physical assault,

and some of them
are actually sustained in jail.

All of these numbers are even higher
among the women in criminal justice.

Almost every single woman
in the criminal justice system

has been exposed to interpersonal
violence and abuse.

More than half of these women have
been exposed to repeated brain injuries.

In this way, these women's brains look
like the brains of retired NFL players,

and they'll likely face the same risks
for dementing diseases as they age.

The same risks.

TBI, together with mental illness
and substance abuse and trauma,

makes it hard for people to think.

They have cognitive impairments like
poor judgment and poor impulse control,

problems that make
criminal justice a revolving door.

People get arrested and booked into jail.

They oftentimes get into trouble
while they're in there.

They get into fights.
They fall out of their bunk.

And then they get released
and do stupid things

like forgetting mandatory check-ins,
and they get re-arrested.

Statistically speaking,

they're actually more likely
to be re-arrested than not.

A colleague calls this serving
a life sentence 30 days at a time.

And oftentimes, these folks
don't know why this is so hard for them.

They feel out of control and frustrated.

So knowing that TBI is at the root
of so many of these challenges,

the mission for a group of us in Colorado

has been to disrupt that cycle,

to jam the revolving the door.

So working together with my state
and local partners,

we crafted a plan
to meet everyone's needs:

the system, the inmates and probationers,

my graduate students.

In this program, we assess
how each person's brain works

so that we can recommend
basic modifications

to make this system more effective

and safer.

And here when I say safer I mean safer
not only for the inmates,

but safer also for correctional staff.

In some ways, this is
such a simple approach.

We're not treating the brain injury,

we're treating the underlying problem
that gets people into all of this trouble

in the first place.

We do quick neural
psychological screening tests

to identify strengths and weaknesses
in the way an inmate thinks.

Using that information,
we write two reports.

One, a report for the system

with specific recommendations
on how to manage that inmate.

The other is a letter to the inmate

with specific suggestions
for how to manage themselves.

For example, if our test result suggests
that a probationer has a hard time

remembering the things they hear,

that would be an auditory memory deficit.

In that case, our letter to the court
might suggest that that probationer

get handouts of important information,

and our letter to that probationer
would say among other things

that they should carry a notebook
to record that information for themselves.

Now, most importantly

is that I pause here

to be really clear about one point.

This program does not
minimize responsibility

or make excuses for anyone's behavior.

This is about changing longstanding
negative perceptions

and building self-advocacy.

It's actually about taking responsibility.

The inmates move from,

"I'm a total screwup, I'm a loser,"

to, "Here's what I don't do well,

and here's what I have to do about it."

(Applause)

And the system comes to see
an inmate's problematic behavior

as the things they can't do

versus the things they won't do.

And that change,

seeing behavior as a deficit
rather than outright defiance,

is everything in these settings.

We hear from inmates around the country,

and they write, and more than anything,
they want to know how to help themselves.

This is an excerpt from
a letter from Troy in Virginia,

an excerpt from a 50-page letter,

and he writes,

"Can you tell me what you think
of all the head traumas I've dealt with?

What can I do? Can you help me?"

Closer to home, we have
thousands of stories like this,

and smart stories, stories
that have a great outcome.

Here's Vinny.

Vinny was hit by a car when he was 15,

and from that moment forward
spent more time in jail than in school.

With some basic skill-building,

after our assessment revealed

that he had some pretty
significant memory impairments,

Vinny learned to use the alarm
and reminder function on his iPhone

to track important appointments,

and he keeps a checklist
to break larger tasks

into smaller, manageable ones.

And with basic tools
like that under his belt,

Vinny's been out of jail for two years,

clean for nine months,

and recently back to work.

(Applause)

What's so striking for Vinny

is that this is his first time
off of court supervision

since his injury more than 15 years ago.

He made it out of the revolving door.

(Applause)

He says now, "I can do anything.

I just have to work a lot harder at it."

And here's Thomas.

Thomas has some pretty significant
attention and behavior problems

after an injury landed him in a coma
for more than a month.

After re-learning how to walk,

his first stop? Court.

He couldn't imagine a future
where he wasn't in trouble.

He now carries a calendar
to avoid being held in contempt

for missed court dates,

and he schedules a break
into his day every day

to recharge before he gets agitated.

And nobody knows the revolving door

better than the person sitting
at the front of the courtroom.

This is my good friend and colleague
Judge Brian Bowen.

Now, Judge Bowen was already on a mission
to make the system work for everyone,

and when he heard about this program,
he saw the perfect fit.

He actually sits down
with all of his prosecutors

to help them see that there's basically

two categories of defendants
in the courtroom:

the ones we're afraid of,
oftentimes rightfully so,

and the ones we're mad at.

These are the ones who miss
all of their scheduled appointments

and they blow through
the best-laid probation plans,

and Judge Bowen believes that,
with a little more support,

we could move people
in this latter category,

the maddening category,

through and ultimately out of the system.

He proved that with Navy veteran Mike.

Judge Bowen saw the correlation between
Mike's history of a massive 70-foot fall

and his long-standing pattern
of difficulty showing up

on the right day for court appointments

and complying with mandatory
therapy requirements, for example,

and instead of sentencing him
to more and more jail time,

Judge Bowen sent him home
with maps and checklists and handouts

and recommended instead
vocational rehabilitation

and flexible scheduling
for those therapies.

And this with those supports,

Mike's back to work

for the first time since his injury
while he was in the service.

He's repairing relationships
with his family,

and just last month,

he graduated from
Judge Bowen's veteran's court.

(Applause)

This program shows us
the overwhelming prevalence

of traumatic brain injuries
and cognitive deficits

and the accumulation of brokenness
in the criminal justice system.

And it highlights the extraordinary power
of resilience and responsibility.

In Mike and Thomas and Vinny,

even Judge Bowen's story,

you saw the transformation made possible
by a change in perception

and some simple accommodations.

All told, in this program,

these inmates and probationers
come to see themselves differently.

The system sees them differently,

and when you meet them in the community,
I hope you see them differently too.

Thanks, guys.

(Applause)