While serving a 21-year sentence, Marchell Taylor spent much of his time reading all of the available materials on business and marketing, seeking to “turn the prison into an educational institution.” He made connections with other incarcerated people who were also interested in entrepreneurship and had well-laid out plans for how he would hit the ground running upon his release. He had high hopes for establishing a life for himself after incarceration. 

Despite his studying, innate talent, and support from his friends, Taylor says he fell back into using “survival skills” to cope with both the difficulties of reintegrating into society and the emotional and mental trauma he had lived with for decades. Meanwhile, he felt like his friends, including his business partner Corey Shively, were treating him like a child, and neither he nor they could figure out why. Not long after his release Taylor was rearrested for robbing a Papa Johns and faced a sentence that would keep him imprisoned for the rest of his life. 

While awaiting trial in the Denver County Jail, Taylor began having suicidal ideations and was transferred to the jail’s Mental Health Transition Unit, where he learned that he and others detained in the unit would be screened for brain injuries through a new pilot program run by the Brain Injury Alliance of Colorado in partnership with the University of Denver. His neurological screening showed that he had sustained past head trauma that left him with the cognitive functioning of a 10-year-old. The discovery that he had been living with an unattended brain injury and could finally receive treatment would change the trajectory of his life. 

“I [learned that] I’m stuck—like psychologically frozen in time,” said Taylor. “I [was] a highly educated, mentally ill parolee with a traumatic brain injury and didn’t even know it.” 

An overwhelming percentage of the country’s incarcerated population and survivors of abuse (who may also be incarcerated) live with brain injuries, many of which are undiagnosed. The carceral system erroneously argues there’s a clear line between “victim” and “offender,” yet brain injuries are still incredibly high for people on either side. Research estimates that over half of the nation’s incarcerated population has sustained at least one brain injury in their lifetime, creating challenges that both amplify the horrors of life inside prison and could help explain past behavior that led to their incarceration. For survivors of domestic abuse, brain injury prevalence is notably high as well, making the quest to restabilize their lives more difficult while also heightening their vulnerability to criminalization. 

New programs and legislation that require brain injury screenings and treatment for incarcerated people and survivors of domestic violence have recently made waves in states like Colorado. Though focused on separate populations, these programs directly challenge the “victim” vs. “offender” dichotomy, highlight the profound impact of brain injuries, and prioritize the importance of treatment over punishment. 

How advocates frame these programs is critical, particularly around the idea of personal responsibility. Advocates are quick to point out that diagnosing people with brain injuries can give them a deeper sense of self-determination. By helping them understand the state of their mental health, advocates assert, people can then gain beneficial coping mechanisms for the cognitive deficits that brain injuries can cause. Screening and treatment efforts are ultimately about developing greater personal autonomy as opposed to providing absolution for any harm people may have enacted in the past. 

As these programs grow, they’ll be tasked with the challenge of offering much needed treatment to those living in the confines of the prison system without reinforcing the idea that the carceral state is the best place to cultivate personal responsibility and provide necessary mental health care for offenders. 

“A complicated soup of comorbidities”

The program that helped screen Taylor for his past brain injury used a model designed by researchers at the University of Denver. The program found that up to 96% of those incarcerated in Denver County Jail’s Mental Health Transition Unit had sustained one complicated brain injury in their lifetime. Other national studies on brain injury prevalence within the criminal legal system suggest that anywhere from 50-80% of those incarcerated have sustained a brain injury in their lifetimes. Across the entire American population that number hovers just around 59%.

The overwhelming rate of brain injuries amongst incarcerated people makes life inside prisons and jails even more challenging and also offers a glimpse into how brain injuries can become avenues into the carceral system to begin with. According to Dr. Kim Gorgens, a lead researcher at the University of Denver, the situation is, in a word, complicated.

“In clinical settings, brain injury is oftentimes part of a really complicated soup of comorbidities,” Gorgens said in an interview with Prism. “We coined the term the ‘superfecta’ because trifecta wasn’t enough to reflect the overlap between someone with a history in criminal justice, with a brain injury history, who also has significant long-term severe mental illness and long-term substance misuse or abuse disorder, cognitive impairment, and a history of suicide attempts.”

In some ways, brain injury is like an accelerant in an already clinically vulnerable population.

Dr. Kim Gorgens

Gorgens is careful to note that brain injury isn’t a direct route into the criminal legal system, but it does pose an increased likelihood of developing mental illness, becoming substance dependent, or relapsing to past substance use—all of which can make one more vulnerable to criminalization. It also works in the other direction, since people who are substance dependent can be more likely to sustain a brain injury.

“In some ways, brain injury is like an accelerant in an already clinically vulnerable population,” Gorgens said. 

Common characteristics that can develop in the wake of a brain injury include impulsivity, memory loss, difficulty with problem-solving, inability to interpret social cues, inattention, cognitive fatigue, and poor judgment. And the longer someone goes without having an injury diagnosed and treated, the more damage can be done to their life. Failure to properly screen for neurological damage in the aftermath of head trauma means that instead of receiving information on how and why their brains are working differently, those with brain injuries are often blamed for their changes in mood and behavior. 

This can have particularly harsh consequences for those trapped in the carceral system. Gorgens says that for those within the system, such as people on probation, having a brain injury can make it difficult to keep scheduled appointments, make payments on time, and perform a host of other tasks that their freedom hinges upon. Research has shown that over half of individuals with brain injuries will be rearrested while the recidivism rate of those without brain injuries is roughly 33%.

“Rebuild Your Mind”

The pilot program, known as the Colorado Brain Injury Model, provides incarcerated participants with a summary report of what specific cognitive strengths and weaknesses they have after screening them for brain injuries. These reports also offer recommendations for how to develop new skills that can help mitigate the challenges that those weaknesses create.

Each assessment also includes a separate report for corrections staff detailing how to “tailor supervision” for each incarcerated individual found to have a brain injury and which accommodations should be made. This arm of the program also includes training for corrections staff, judges, attorneys, and law enforcement about what brain injuries are and the long-term effects they have on those who’ve sustained them. The goal is to help officials understand that noncompliance can often be a result of not being able to execute particular tasks as opposed to an unwillingness to perform them. Gorgens says that thus far, data from these trainings has been promising.

Early feedback from these trainings reveals that correctional officers, probation officers, and judges were already aware of signs that an individual might be suffering from a brain injury. They could identify issues like someone being slow to respond, inattentive, “spacey,” or seeming noncompliant, behavior that could in fact stem from poor short-term memory or other cognitive issues.

“In one of our pilot years, we invited correctional officers to make referrals for clients that they thought had a brain injury based just on their behavior on the unit, and they were 100% correct,” Gorgens said. 

For Gorgens, another integral part of the program is the introduction of a community care coordinator who assists with reentry. Incarcerated participants are connected to care coordinators while they’re still in the system, rather than after they are released. 

“Case managers and clinicians will do the best planning for someone’s community reentry and then the minute someone hits the door, [it’s like] they get sucked into a spaceship and are not seen again,” Gorgens said. “So we’re trying to increase the rate at which people access community services by introducing that coordinator to them while they’re in jail or at one of their probation meetings.” 

Taylor’s screening revealed that in addition to a traumatic brain injury (TBI), his diagnosis also included borderline personality disorder, anxiety, and PTSD. Through the program he began receiving treatment that included building a meditation practice, learning to reason and rationalize effectively, and developing self-regulation tools. Taylor, who had spent much of his past prison sentences studying business, saw the opportunity to use his time in treatment to understand the brain more deeply. Though still awaiting trial, he wanted to share what he’d learned by educating the public and authorities within the criminal legal system about the connection between mental health and incarceration. 

“I called Corey and said, ‘I know you can’t put the money behind me for an attorney, but what we can do as a team is shed as much light on my TBI as possible to this judge and to my DA,’” said Taylor. 

Taylor and the other 40 program participants penned letters to judges, parole board members, public defenders, and district attorneys explaining how their brain injuries had impacted their lives. The letters ended by asking each recipient to create a video talking about any mental health issues they had faced themselves and to share it publicly. The goal was to get officials throughout the criminal legal system to consider how mental health impacts one’s life and to interrogate whether those struggles should be met with punishment. Thus, the “Rebuild Your Mind Challenge” was born.

In prison 9 times out of 10 they’re going to dope [incarcerated people] up without looking at other areas of what possibly can be wrong with a person. 

Keith Parker

“There were a lot of unique situations that took place, and a lot of people got involved and are still involved,” said Keith Parker, a participant in Taylor’s challenge. “Just overall there was a whole lot of community building just from that demonstration.”

Parker met Taylor while detained in the Denver County Jail’s Mental Health Transition Unit for a parole revocation. He also hadn’t known about brain injuries before going through the pilot program but quickly saw its value and the degree to which the information could impact people’s lives, especially those who are currently incarcerated. 

“If you don’t get tested for a TBI that will be an issue or problem that will just linger on and be an ongoing mental health issue that clinicians, therapists, and psychiatrists don’t know how to deal with, especially in prison,” said Parker. “In prison nine times out of 10 they’re going to dope [incarcerated people] up without looking at other areas of what possibly can be wrong with a person.”  

Taylor’s campaign quickly gained traction and media attention. Eventually, his judge sentenced him to Mental Health Probation instead of the potential life sentence he was facing. Soon after his release, Taylor began drafting legislation requiring the Colorado Department of Corrections to create a brain injury pilot program that would include screening and support for those who have sustained brain injuries and are currently incarcerated. Community leaders and advocates, including Parker, who has since built his own organization focused on mental health and community wellness, have supported the bill and helped draft it. 

While developing that legislation and testifying on behalf of others who were struggling with brain injury effects in jail, Gorgens caught wind of Taylor’s advocacy, reached out to him, and began supporting both his policy work and the nonprofit he has since founded called Rebuild Your Mind. Informed by both his own experience and Gorgens’ research, Taylor’s bill SB21-138 was approved by the Colorado legislature last summer. 

“I was just so confused all the time”

Melissa Bickford first heard of Taylor’s proposed legislation through her work tracking bills as a volunteer for the nonprofit Colorado Victims for Justice. Her immediate reaction was shock and dismay. 

“I was like, wait a minute … that’s not fair,” said Bickford.

Bickford had been diagnosed with multiple brain injuries that were sustained over six weeks at the hands of an abusive ex-partner. If anyone should be prioritized for brain injury screenings, she thought, it ought to be crime victims, not their offenders. Her perspective started to shift after learning more about how cycles of violence work and how those who cause harm are often themselves victims as well. It’s an idea that calls to mind a popular quote from Common Justice founder Danielle Sered, “No one enters violence for the first time having committed it.” 

Now, Bickford feels that the program Taylor is advocating for could also help prevent future harm by providing offenders with a chance to understand how brain injuries can affect behavior and how they can control their actions.

“I think we just have such an opportunity to be able to stop a lot of [violence] before it goes on,” said Bickford. “I’m in a lot of support groups, and rage is a big problem with people who have brain injuries. It’s scary how little support and help there is in dealing with that rage and getting medication to help keep it in check.” 

Still, Bickford wanted to see legislation that would ensure survivors of abuse also received brain injury screenings. She drafted a bill that has since garnered immense support from state elected officials as it travels through Colorado’s legislature. On April 29, Bickford’s bill SB 22-057 passed the House.

“People are really excited about it,” said Bickford. “I think it’s kind of a game changer.”

Understanding the relationship between domestic violence and brain injury is particularly important for the overwhelming number of survivors who are criminalized, often for acts of self-defense.

Brain injuries are incredibly prevalent amongst domestic violence survivors, and yet they remain largely overlooked. According to the Brain Injury Association of America, an estimated 36% of domestic violence survivors have sustained injuries to the head, neck, or face. Women seeking medical attention for injuries to these areas are 7.5 times more likely to be domestic violence survivors than women who report other types of bodily injuries. In a 2002 study analyzing 53 domestic violence survivors, 92% reported having received blows to the head during the course of their relationship and 40% reported having lost consciousness.

Understanding the relationship between domestic violence and brain injury is particularly important for the overwhelming number of survivors who are criminalized, often for acts of self-defense. The specific source of their brain injuries is a part of why Gorgens and her colleagues deliberately worked to revise their brain injury screening model to include both those who have TBI and those who have Acquired Brain Injuries (ABI)—which could be caused by strangulation or overdose. 

Gorgens says that she and her colleagues have seen a lot of ABIs in prisons, particularly among women. According to a 2001 study, 68% of women who had experienced domestic violence had been strangled.

“It isn’t even a thing that happens every now and again,” said Gorgens. “It’s just … it’s kind of mind boggling.”

For Bickford, her brain injuries have resulted in the development of Pseudobulbar affect, a nervous system disorder that causes episodes of sudden, uncontrollable, and often inappropriate laughter or crying, as well as post-concussive problems like headaches, balance issues, and short-term memory loss. Those issues could create challenges under any context, but the implications were particularly dire as a survivor navigating the court system. As charges were pressed against her abusive ex-partner, Bickford was expected to show up fully at court despite contending with cognitive impairments that she wasn’t aware of.

Bickford struggled with thinking clearly and ended up agreeing to a plea deal that reduced the number of charges against her abuser from 17 to two, giving him a lighter sentence. She hopes that by making brain screenings more accessible for abuse survivors, people like her will have more support and assistance in understanding exactly what the plea deals they’re asked to sign off on entail. 

“Every single time I went to court, I was just so confused all the time,” Bickford said. “Now I know why—but I didn’t know at the time that it was due to my brain injury.”

“The potentially traumatic environment of jail”

In Dr. Gorgens’ popular 2018 TED Talk about her research on brain injuries and incarceration, she takes a beat after explaining the Colorado Brain Injury Model. The pause seemingly comes in anticipation that the audience is developing a certain critique of the program.  

“Now most importantly, is that I pause here to be really clear about one point,” Gorgens says to the crowd. “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 screw up, I’m a loser,’ to, ‘here’s what I don’t do well, and here’s what I have to do about it.’”

The audience breaks into applause. 

Both Gorgens and Bickford are keen to emphasize that brain injury screenings for those within the criminal legal system are not meant to pardon anyone of their responsibility. Bickford is careful to note that she and other advocates don’t want people to begin “blaming their actions on a brain injury,” drawing a firm line between self-understanding and absolution. However, the emphasis placed on the program’s ability to “cultivate personal responsibility” among incarcerated participants raises questions about just how effective a program like this can be when it relies on the carceral system to operate. 

The term “corrections” belies the fact that the prison-industrial complex readily offers little rehabilitation and instead reproduces violence and thrives on the economic exploitation of those inside. The existence of the carceral system then depends on a steady churn of people who often become trapped within a continuous cycle—or the “revolving door”—of release and reincarceration. The notion of personal responsibility can easily deflect critiques of this revolving door by blaming recidivism on individual failures as opposed to interrogating how the system itself allows for and benefits from that cycle. 

However, greater access to brain injury screenings and resources post-diagnosis could threaten to disrupt that cycle if utilized to its full potential. If, for instance, defendants were screened pretrial and found to have sustained a brain injury, couldn’t there be an option for them to receive treatment and work on developing healthy coping mechanisms outside of a carceral context? 

Further, programs providing brain injury screening and treatment for incarcerated patients risk being less effective if they rely on the assumption that partnering prisons and jails are committed to the mental health and well-being of those they incarcerate. Undermining this assumption is recent research that points to an alarming frequency of brain injuries being sustained by patients while inside prisons and jails. 

In a 2017 study analyzing head trauma incidents in New York City jails, researchers explored not just the high rates of injuries sustained but also the degree to which these cases are severely underreported. Incidents of mild traumatic brain injuries amongst those incarcerated in the city’s jail system were 50 times higher than estimates from the surrounding community. Over 42 months, 10,286 incidents of head trauma occurred within the New York City jail system, 15% of which were classified as mild traumatic brain injuries. The two most frequent causes of these incidents were fights amongst those incarcerated and use of force by jail staff. 

For judges already considerate of the risks of violence within jails and prisons, the data gleaned from the study has raised “the willingness of judicial personnel to work harder to keep people out of corrections.”

It’s impossible to know the rate of brain injuries sustained in carceral settings nationally since many correctional health services don’t collect data on head trauma, but authors of the report suggest that based on New York City data, over 598,370 incidents of head trauma likely occur in U.S. prisons and jails annually. Researchers write that incarcerated people who are often already contending with mental health issues before their arrest must struggle to “maintain safety and stability in the controlled, yet frequently inconsistent and potentially traumatic environment of jail.”

Advocates say it’s important to recognize how detrimental it is to wait to provide treatment for brain injuries until after someone is incarcerated, particularly given the dangers inside prisons and jails. Initial drafts of Taylor’s legislation required that brain injury screenings be performed at every stage of the criminal legal system, including before trial, but eventually, funding concerns forced those requirements to be scaled down to only include those currently incarcerated. 

The potential to divert defendants suffering from brain injuries away from incarceration before their cases go to trial isn’t lost on Gorgens, who often cites the New York City study. While her work in the adult criminal legal system has mostly centered on those whose cases have already gone to court, she says that her team has been able to focus on adding brain injury screenings prior to sentencing in the juvenile system. Getting information about traumatic brain injuries to judges, she says, has also been effective. For judges already considerate of the risks of violence within jails and prisons, the data gleaned from the study has raised “the willingness of judicial personnel to work harder to keep people out of corrections.”

“I missed out on a lot of that healing”

Ultimately, it is most crucial to prevent brain injuries in the first place. Gorgens notes that this means making interventions in spaces outside of the criminal legal system as well, such as the child welfare system. 

“To start that far upstream? Think how much more robust the outcomes for those kids might be,” said Gorgens. “There’s no question that if you had stronger primary prevention efforts [such as] reducing interpersonal violence, people being helmeted, [wearing] seatbelts—all the basics, that would make a difference.”

Other advocates on the issue have also noted the importance of language. For instance, news stories involving former professional athletes who have either harmed themselves or abused their loved ones often lack any mention of whether or not they had previously sustained head trauma. Discussing the role brain injuries may have played in acts of violence isn’t intended to excuse harm, but it may help educate the public about what brain injuries are, the impacts they can have, and why we should invest in prevention.

Gorgens cites additional interventions, such as better injury identification, rehabilitative services, and immediate care in the wake of head trauma, as ones that can help mitigate some of the consequences of brain injury. Improving our ability to recognize brain injuries—even amongst those already working in health care—is particularly crucial. Both Bickford’s and Taylor’s lives were acutely shaped by the failure of health care providers to recognize what they were going through and offer proper treatment. 

After leaving her relationship, Bickford saw a therapist as well as an advocate at a safe shelter. Still, she says she had to advocate for herself just to receive the neurological screening that would lead to her diagnosis of Psuedobulbar affect. She spent four months telling her therapist that she felt different, that she could laugh and cry and feel anger but struggled to feel anything else.

“[When] I went back to her [with] my diagnosis she looked it up, looked at me, and said, ‘Oh my God, this is what you’ve been telling me for months,’” Bickford said. “So even in our health care [system], people are not recognizing brain injury. I spent all this time in therapy getting the wrong help.” 

Advocates like Bickford, Taylor, and Gorgens are hopeful that the slate of bills they’ve been drafting and supporting around brain injury screening will help people receive the care and self-knowledge they need more swiftly. 

“That first year after a brain injury is so critical for healing,” said Bickford. “I missed out on a lot of that healing because I didn’t know.”

Taylor’s story echoes Bickford’s, reinforcing why brain injury screenings, treatment, and interventions for people navigating different parts of the carceral system must be a part of the same conversation. After his brain injury screening at the Mental Health Transition Unit, Taylor recalled a car accident he was in at the age of 9 that resulted in head trauma. Despite the known relationship between car accidents and head trauma, and the stitches in his eye socket and his head, the doctor dismissed Taylor without any neuropsychological screening. In the absence of immediate care, the consequences of that medical neglect only compounded over the course of Taylor’s life.

““[They said] ‘Patch him up [and] bring him back in a few days. We’ll get the stitches out and he’ll be OK—he’s a boy!’” Taylor said. “[They didn’t realize] that I would start developing into this angry kid and get very violent. If no one comes and catches this, then that child goes off and sits in prison for 24 years.”  

Tamar Sarai is a features staff reporter at Prism. Follow her on Twitter @bytamarsarai.