Traumatic Brain Injury and Prisons: A Case Manager’s Experience

A Case Manager’s View of Prison and TBI

By John Simpson

Brain injury is overlooked in prison

For over ten years I have done volunteer work in prisons in the Province of British Columbia, mainly in federal institutions. The inmates that I have been involved with range from petty criminals right up to murder and sex offenses. The following comments and life stories are drawn from my experience, not only in working with clients as a case manager, but also as a facilitator of support groups and through interviews with prisoners.

If there is one message that needs to be delivered loud and clear, based on my work, it is that children who have even the mildest of brain injuries should not be overlooked. Whilst the prisoners I have met have all had more than one period of unconsciousness, over 60% of them had their first period of unconsciousness as a child. This has been the result of sports accidents, falls, abuse, car crashes, near drownings and many other reasons. These individuals have not done well in school; many started abusing drugs and then went down the road of petty crime, which all too often led to very serious offenses.

Those who did not commit serious offenses often still had a very difficult life; this is particularly true if they had an abusive father. Again, they show a pattern of dropping out of school, difficulty holding down a job, getting involved in alcohol, troubled relationships, and often were physically abusive with their girlfriends, wives and children.

Then there is the group that were injured as children or teenagers who ended up doing very well indeed for themselves, but as the years advanced they started running into problems. One of the contributing factors was a change in work environment, particularly a new supervisor. There is yet another group that stuck with the same job, but got passed over time and time again for promotions.

There is also a group that has done very well for many years. Whilst their social behavior may, for most of that time, have been most appropriate in the twenty-first century, some of their comments can be considered sexist or racist. That gets them into trouble, but they see nothing wrong with their comments. In spite of this, they have had very successful lives.

Television can have good and bad influences on those living with a brain injury. There is one particular story that stands out and is retold here as an example of how it can have an adverse effect and lead to problems for the individual. The following are just a few examples of the individuals I have interviewed and the effects of brain injury upon their lives.

Physical abuse and head trauma

Physically abused on a number of occasions by his father from age five on, he was unconscious a number of times and hospitalized. His back was injured when he was struck by a baseball bat. He was struck again by a schoolteacher for not sitting up properly in school. After school, he started working odd jobs including truck driving and often got lost.

Handcuffed SuspectHis second crime was serious for kidnapping a woman, then raping and murdering her. He is serving a life sentence. Prior to that, he had committed another crime and served his time, but knew that he did not get the help he needed during his first incarceration.

Indestructible teenager

This young man was age 19 when he was involved in a serious single vehicle car crash in Ontario. He lost his left ear and was in a coma for two weeks and in the hospital for thirty-eight days, but received no rehabilitation. He decided that because God had spared his life, he would join the US Army and go to Vietnam. Prior to crossing the border, he saw a Canadian Forces Recruiting Office and joined up. He first became an M.P. and then a Pay Load Specialist.

He did not graduate from high school but he did get his G.E.D. after he left school. He got involved with a Christian group, left the army and went to a Bible College in Dallas, Texas. When he returned, he did not find any long-term work, so he rejoined the army. Since he had not been out of the Forces for any length of time, this was allowed. He spent a total of fifteen years in the Forces as well as holding down two jobs. He has been married for over 25 years and has two daughters. He was always somewhat impulsive, but some of his impulsivity began to get him into some problems with business deals.

Whilst he and his wife are still together, he no longer works full time and he does make inappropriate comments, particularly to females in restaurants. Perhaps five or ten years ago, this would not be a big deal, but not in this day and age. His wife is scared that this will get him into trouble. He has also started to deteriorate in many other ways – ways that would be expected in someone who has been living with a brain injury since 1966. Some of his problems include being unable to set realistic goals, extreme dependency on his wife, difficulty thinking clearly and with communication.


Injured at age 8 falling over stairs at school, he nevertheless finished school and worked very hard at different jobs. He worked for 13 years as a school janitor. Not only did he make a livable income, but he was able to buy his own home, plus two rental properties and save for his future. While he was working at his full-time job, he did other odd jobs as well.

His son was born in 1980, but he never did marry and he is simply afraid of making that commitment. He has enjoyed a good relationship with his son and his son’s mother. He was enjoying his work and was an excellent employee, however, a new supervisor came on the scene, took a dislike to him and simply rode him until he was eventually fired. Being proud, he did not look for assistance, got no help from his union and ended up selling off one house. It was some years after being laid off that he eventually got some help. There are some psychiatric issues now and he certainly could not work in a competitive capacity anymore.

Case of TV

The next example is of a brilliant young man studying physics at a university, who is an ardent environmentalist and rock climber. Tragically when rock climbing, he fell and had a very significant brain injury. He uses a wheelchair, but gets himself around. Unfortunately some charges were made against him for patting women’s behinds when traveling on public transportation and in supermarkets. He has not been incarcerated but is in a facility. However, his explanation is, “Well, this is perfectly acceptable on TV.” He was only doing what Benny Hill did on his TV shows.

Multiple brain injuries

Born in 1959, he had his first brain injury at age 17. While riding his bicycle, he got caught in the railroad tracks and was unconscious for a period of time. He worked 40 hours a week and had a second job at a gas station working evenings, Saturdays and Sundays. His son was born in 1978 and he also got married in 1978. In 1979, he was driving too fast in bad road conditions and was in a single vehicle crash. He was in a coma for five weeks and was out of the hospital in approximately twelve weeks. He tried going back to work on limited hours, but that only lasted three weeks when his body shut down.

His second son was born in 1980 after a second car crash in 1979. Eventually, he and his wife split up and subsequently divorced. His former wife has remarried. He maintains a good relationship with his son and indeed with his former wife. He did get full time employment after his 1979 injury.

In 1986, he was involved in a third crash which was in fact not as serious as the other two with a very brief period of unconsciousness. He tried to return to work, but this time he was totally unable to get back to even part time employment. Almost weekly contact has been maintained with this man since December of 1979.

Some other stories of TBI

A young boy was injured at age four. Then at age nine, he started showing some sexual deviance. At first the school and his mom were somewhat reluctant to talk about this, however, they eventually did. The boy, the family and the school got some good counseling and fortunately some six years later, there have been no further problems.

In another case, a boy who was injured when he was a little older, had a fall and sustained a brain injury. In his early teens, there were some serious sexual issues involving him but unfortunately when these first came up, he got no help at all as the family was reluctant to seek help.

In a third case, a boy aged 13 fell playing with his siblings and sustained a brain injury. Pleading letters to agencies were not ignored, but the family was simply told there was no funding. When he was 19, further help was sought, again the family was told there was no funding for that year or that it had been exhausted. The young man committed a very serious crime resulting in three deaths. Found not criminally responsible, he later attempted suicide and is now physically disabled in addition to the previously existing cognitive and behavior problems, but he is in a good home.

About the author: John Simpson

I first became aware of and interested in acquired brain injury in 1975 as a claims adjuster in Canada. I subsequently got involved in setting up a rehabilitation department for an insurance company. In 1981, I started my own company doing case management, principally working for attorneys representing those who sustained a brain injury.
In 1982, I was one of the founding directors of the British Columbia Head Injury Association, later known as the Brain Injury Association (in Canada). In 1997, I founded the Fraser Valley Brain Injury Association. From 1981 to date, I have been facilitating support groups. Whilst I did retire in 2000, I still do volunteer work and this includes work with inmates at a federal medium security prison.

Contact information
John Simpson
PO Box 753
Harrison Hot Springs, BC V0M 1K0 Canada


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One response to “Traumatic Brain Injury and Prisons: A Case Manager’s Experience”

  1. sRae says:

    i have been with a person for over 16 years, who had a traumatic brain injury due to an assault a few years before we met. so much of your vignettes ring true, although my person is a female. i have not found enough {affordable} literature on dealing with and helping a person with a long term tbi. most of what i read is directed to those first coping with the issue. i did not have to deal with the three months in a coma, etc. however there are cognitive declines and increased difficulty in social interactions that i find home health attendants simply do not know can be present in adults. very frustrating, and extremely hard to keep a worker for more than a couple months. tbi should definitely be covered more in all levels of nursing training as well! thank you for recognizing that a person with a brain injury is going to have lifetime changes, there is no “cure.”

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