PTS-What?

As Amy mentioned in our first installment of this blog, we spent a great deal of time last year evaluating PTSD and TBI in relation to the Texas and federal prison systems in order to prepare a policy brief for TCJC (Texas Criminal Justice Coalition). Before we get going, we need to define PTSD and TBI, and take a look at how often they occur in prisons. PTSD, otherwise known as posttraumatic stress disorder, is defined by the American Psychological Association as an anxiety disorder that arises from a traumatic event such as a crime, accident, combat, or natural disaster¹.

Symptoms include:

• Re-experiencing the event through disturbing memories, dreams, illusions or hallucinations, and/or intense psychological and physiological distress when exposed to events or circumstances that remind someone of the original traumatic event
• Avoidant behaviors when presented with circumstances that remind someone of the event such as avoiding places, being estranged or detached from people and events, or displaying limited emotions such as love toward others


• Displaying increased arousal (recall the flight or fight response you learned about in Psych 101?) which may include problems with sleeping, difficulty concentrating, irritability, or hypervigilance

Recall an incident that was traumatic for you – perhaps you were in a car accident or were the victim of a crime. Were you jumpy for a while afterwards? Did you keep thinking about what happened, re-living it in your mind, and were you distracted by it enough that normal life and normal emotions just didn’t seem entirely real? That’s what our mind does when it is traumatized. That reaction isn’t actually a disorder, it’s normal. It becomes a disorder when you get stuck there. That’s what PTSD is.

Traumatic Brain Injury, or TBI, has been defined by the National Institutive of Neurological Disorders and Stroke as a brain injury stemming from sudden trauma that affects cognition, emotion, behavior, and inhibition. A person may develop TBI as a result of domestic violence, child abuse, a vehicular accident, combat, and a multitude of other events that may cause brain injury. TBI is one of those blessedly-straightforward names—a Traumatic Brain Injury is an injury to the brain. A traumatic one.

Now that we know what TBI and PTSD are, why is it important to give special attention to them in prison populations? First of all, because people with either PTSD or TBI tend to be more violent. Thus, they may engage in violent criminal behavior (as a result of difficulties managing their anger and stress) that results in them being sent to prison. Being in prison, however, can itself also result in TBI or PTSD. In addition, prison conditions often exacerbate symptoms of PTSD and TBI.

Picture yourself as a war veteran who experienced heavy combat and as a result developed PTSD, then imagine being in a prison where other inmates are yelling and violence is a daily event. Your ability to employ logic, reason, and problem-solving are hampered by your diagnosis of PTSD. On top of that, any suggestion of loud explosions sends you into a panic attack – a panic attack which a guard mistakes for you being disruptive or noncompliant. Now imagine that not only will you be unlikely to be screened adequately for TBI or PTSD upon entry to the prison system, but also that you will receive minimal (if any) care during your sentence. How might your mental state be negatively impacted by this lack of care?

Consider, also, the rates of mental illness in the general population versus the prison population. These numbers are staggering, and they speak to the chicken-egg dilemma alluded to above: having PTSD or TBI makes it more likely that you’ll be in prison; in turn, being in prison makes it more likely that you’ll develop PTSD or TBI. The table below was developed for the policy paper Amy and I co-wrote with several colleagues at the UT Austin School of Social Work². This data serves as a wake-up call: up to 88% of Texas prisoners are estimated to have experienced a traumatic brain injury, compared to 2% of the general populace. Houston, we have a problem.

	U.S. Population	U.S. Prisoners	Texas Prisoners	Female Prisoners (U.S. Population)
Serious Mental Illness (%)	3% 3	10% to 15% 4	Up to 30% 5	12%* 6
PTSD (%)	3.5% 7	21% 8	Not available	34% 9
TBI(%)	2% 10	60.25 11	Up to 88% 12	69.98% 13
Trauma(%)	66%14	Not available	Not available	98% 15

* This statistic is from a report on jails, not prisons.

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References

1. Elizabeth Endres, Noelle Garza, Corinna Jay, Amy Jones, K. C. Lawrence, and Jason Lee. “Posttraumatic stress disorder and traumatic brain injury in Texas prisons: seeking best practices in screening and care.” Policy brief prepared for Texas Criminal Justice Coalition. University of Texas; Austin, Texas. (2010).
2. Ibid.
3. "Health Care in the Texas Prison System: A Looming Fiscal Crisis," University of Texas Medical Branch 1-7.
4. Ibid.
5. Mike Ward, "Nearly a Third of State, County Jail Inmates Have Mental Health Diseases," The Statesman, 19 Feb 2007.
6. Henry J. Steadman and Pamela C. Robbins, "Developing and Validating a Brief Jail Mental Health Screen for Women (Final Report)," (2007).
7. National Institute of Mental Health, The Numbers Count: Mental Disorders in America, http://www.nimh.nih.gov/health/publications/the-nu.
8. Ashley Goff, Emmeline Rose, & David Purves, "Does PTSD Occur in Sentenced Prison Population? A Systematic Literature Review," Criminal Behavior and Mental Health 17, no. 3 (2007): 152-162.
9. Hills and others, Effective Prison
10. Eric J. Shiroma and others, "Prevalence of Traumatic Brain Injury in an Offender Population: A Meta-Analysis," Journal of Correctional Health Care 16, no. 2 (2010): 147-159.
11. Ibid.
12. Wald, Hegelson, and Langlois, Traumatic Brain Injury
13. Shiroma, Prevalence
14. Michelle F. Dennis and others, "Evaluation of Lifetime Trauma Exposure and Physical Health in Women With Posttraumatic Stress Disorder," 15, no. 5 (2009): 618-627.
15. B. Green and others, "Trauma, Exposure, Mental Health Functioning, and Program Needs of Women in Jail." Crime & Delinquency 51, no. 1 (2005): 133-151.