De Geus demonstrates that this brain injury affects behavior, treatment, and the likelihood of reoffending, and that early detection and personalized treatment are essential for a safer society.
Brain injuries are strikingly common in prison
Millions of people are incarcerated worldwide, and a large proportion reoffend after release. At the same time, it appears that acquired brain injury is much more common among prisoners than in the general population: an estimated 40 to 60 percent, compared to 8 to 12 percent among adults in the general population. Brain injuries can result from, for example, an accident, stroke, or violence and often have long-term consequences. These include problems with memory, impulse control, or behavior. According to De Geus, this is important to understand: “These cognitive and behavioral changes can influence how someone reacts, makes decisions, and participates in treatment.”
Involved in violence earlier and more often
Research in a prison psychiatric ward shows that more than half of the male patients (55%) have a brain injury. On average, this group begins engaging in criminal behavior at a younger age and is more frequently involved in violent crimes. It is striking that their cognitive skills are not always worse than those of inmates without brain injuries. However, certain skills, such as language use and word retrieval, appear to be associated with a higher likelihood of violent offenses. This shows that it is not only whether someone has a brain injury that matters, but also which specific cognitive characteristics play a role.
Brains function differently after injury
In an fMRI study, De Geus investigated what happens in the brains of male inmates with brain injuries. De Geus explains: “No differences were found at the behavioral level regarding behavioral inhibition. However, we did find that offenders with ABI showed different types of activity in certain brain regions. This led us to conclude that offenders with ABI use compensatory mechanisms to successfully perform cognitive control functions.”
These insights help us better understand why behavior is sometimes difficult to control—and why standard treatments are not always effective.
Treatment works better when it is personalized
The research also shows that treatment is more effective when it is tailored to an individual’s situation. Factors such as motivation, self-awareness, and social support play a major role in this. Yet, in forensic practice, brain injury is still only taken into account to a limited extent. This is striking, given its significant impact on behavior and treatment. According to De Geus, this presents a clear opportunity: “By taking a closer look at brain injury and a person’s cognitive profile, treatments can become more targeted and effective.”
Early detection is crucial
De Geus advocates for standard screening for brain injury within the justice system. This could involve looking at characteristics such as an early onset of criminal behavior or prior violent offenses. In addition, it appears that people with brain injuries sometimes have difficulty fully understanding and participating in court proceedings, which raises important questions regarding the administration of justice. It is important to explicitly address cognitive problems and behavioral changes in treatment. This can help reduce recidivism and ultimately contribute to a safer society.