The recent explosion of neuroscience techniques has proven to be instrumental in understanding the healthy brain, and in the development of neuropsychiatric treatments.
One of the key techniques available to us is functional magnetic resonance imaging (fMRI), which allows us to examine the human brain non-invasively, and observe brain activity in real time.
Through fMRI, we are beginning to build a deeper understanding of our thoughts, motivations, and behaviours.
As neuroscientists unravel the regions of the brain involved in reward and motivation, we are likely to develop the capacity to influence emotional responses, such as love, using drugs. fMRI studies have also been used to indicate that many people who would not regard themselves as racist show a racial bias in their emotional responses to faces of another racial group.
Sex, Lies, and Brain Scans, recent winner of the British Psychological Society Book Award for Popular Science, takes readers beyond the headlines.
Barbara J. Sahakian and Julia Gottwald consider what the technique of fMRI entails, exploring which applications are possible today, and which ones are merely science fiction.
They also consider the important ethical questions that these techniques raise. Should individuals applying for jobs as teachers or judges be screened for unconscious racial bias? What if the manipulation of love using ‘love potions’ was misused for economic or military ends? How far will we allow neuroscience to go?
The following extract separates the fact and fiction around mind-reading.
Every one of us is a mind-reader. We do it every day, and our ability to communicate and cooperate with our social group depends on it. What does my boss think of me? Is my partner happy?
Is my son going to run after his football and into the busy street? You might not be aware of it, but you are processing a great deal of social information whenever you interact with another person.
Your brain works like a detective conducting an investigation about another person’s thoughts and mental state, based on evidence from, for example, facial expression, body language, tone of voice, and your previous knowledge of the person.
These factors form a bigger picture and most of us are quite skilled at coming to the right conclusion—reading the mind.
We only become aware of our investigative skills when we ob- serve people who lack them. Social cognition is greatly impaired in some psychiatric conditions such as autism spectrum disorder.
The majority of patients have difficulty understanding their peers’ thoughts and feelings. They read facial cues less accurately,have trouble putting themselves into another person’s shoes,2 and are less able to form relationships. This shows how important social cognition is for our everyday lives.
Even though we are skilled mind-readers, we are far from perfect. Mistakes are common and some people are impressively capable of hiding their true feelings. Those in some professions have to be particularly good at hiding emotions, such as politicians, actors, and poker players.
What if there was an objective, accurate, scientific method of reading someone’s mind? Such a scenario could be both dream and nightmare: though undoubtedly useful, in the wrong hands such technology holds the potential for abuse.
How Much Mind-Reading Is Really Possible Today?
Some scientific studies have tested the possibility of mind-reading, and this has attracted much press attention.
Newspaper headlines claimed that we now have a ‘brain scan that can read people’s intention’, or ‘So our minds CAN be read: magnetic scanner produces these actual images from inside people’s brains.’ But what is the scientific evidence?
Many studies try to predict the actions of participants. Subjects perform tasks while their brain activity is recorded by an fMRI machine.
The scientists often use an approach called machine learning, in which a computer does not need a pre-programmed solution to a problem. The model learns from the data fed into it from a training set and improves over time to make predictions about new data.
This approach is highly useful, because it makes the model flexible and driven by the data, rather than the hypothesis of the researcher.
Machine learning technology is already used in many areas, such as the optimization of online search engines or self-driving cars. But it is also a valuable tool for research.
In the early stages of mind-reading experiments, John-Dylan Haynes and colleagues from the Max Planck Institute for Human Cognitive and Brain Sciences were able to predict whether you intended to add or to subtract two numbers presented to you or whether you were going to press a left or right button.
While this may not make a Hollywood thriller, it was a remarkable achievement around ten years ago. Since then, the techniques and computer power have improved, allowing the decoding of more elaborate processes.
One basic approach to ‘eavesdrop on one’s thoughts’ is to find out which nouns a person is thinking about. In 2008, Tom Mitchell and his colleagues at Carnegie Mellon University reported a breakthrough in the field of mental state decoding.
They invited nine participants to an fMRI experiment in which each of them was presented with sixty different nouns. The subjects had to imagine the properties of every word when it was presented, for example they saw the word ‘castle’ and might imagine ‘knight’, ‘cold’, and ‘stone’.
Their patterns of brain activity were fed into a computer model, for all nouns apart from two. The model then predicted the pattern of activity for the two excluded words, based on what it had learned from the other fifty-eight patterns. Afterwards, it was given the two scans that had been left out and matched them with the two words. On average, the computer was right more than seven times out of ten.
If that seems too easy, the model was then trained with fifty-nine out of sixty words, presented with a new activity pattern and asked to predict the matching word—this time, out of a pool of 1001 nouns.
The model performed equally well in this scenario. Impressive, isn’t it? Bear in mind, though, that this does not make the computer a perfect mind-reader. It needs a lot of training, and in about a third of the cases it was still wrong.
And our thoughts are a lot more complex than just single words. In order to decode a mental state, we need more sophisticated techniques.
Jack Gallant’s group from the University of California has developed a highly impressive method to reconstruct a film clip that a subject was watching purely based on the fMRI recordings.
The subjects—in this case, three researchers who are also authors of the paper—first watched a set of film trailers known to the computer. It was therefore possible to associate the trail- ers with brain activation patterns.
After this training stage, the subjects then watched a second set of clips, but this time the computer had no information about the content of the film trailers.
Instead, the model used the known associations to form a reconstruction of the clip. The reconstructions were blurry and not very detailed, as you can see in Plate 1 below.
Can you guess what the original trailers showed? Read the figure caption to find out. Brain signals are still too complex and the fMRI technology is not capable of capturing very rapid neurotransmission.
While there are considerable advances required, it is nonetheless remarkable what we are able to achieve at present. Technology is constantly evolving and this might be just the beginning.
One possible application of reconstructing film clips is to reconstruct our ‘inner films’: our dreams and memories. A Japanese research team led by Tomoyasu Horikawa tried its luck with the former in 2013.
They scanned the brain activity of three people while they were falling asleep and entering the dreaming stage, then woke them up and asked for a description of the dreams.
The subjects had to repeat this more than 200 times to give the researchers a good pool of data. Among the dreams were ordinary experiences (‘I saw a scene in which I ate or saw yoghurt’), but also some unusual scenarios (‘I saw something like a bronze statue […] on a small hill’). Key words were assigned to different categories (for example, ‘food’ or ‘geological formations’).
Subjects were then shown photos from each of these categories and again their brain activity was measured. These data were fed into the model.
The computer compared the activation of seeing an image while awake with the activation during the dream and made a prediction as to whether a certain content was present in the dream or not (‘Did the person dream about food?’).
The model does not work perfectly, but it is reasonably accurate: on average three out of five times. One important weakness is the lack of objectivity.
Participants had to describe their dream contents to the researchers and these reports form an important data set for the study. But who knows how accurately we remember our own dreams?
To date, there is no objective way of measuring this, so we have to rely on subjective reports. Nonetheless, the study illustrates an exciting way of analysing internal representations.
As we have discovered, neuroscientists are able to make good predictions about simple and straightforward thoughts. But this leaves out a big and important component of our mental state— our emotions. When your boss says he is happy with your work, a thought identification device may confirm that it is actually your work he is thinking about (and not his afternoon golf game).
But does that tell us that he is indeed happy? We need a different type of information to be sure: a peek at his emotions.
Karim Kassam and his colleagues from Carnegie Mellon University have taken that peek successfully, using actors from the local community for their study. The actors were asked to put themselves into nine emotional states (anger, disgust, envy, fear, happiness, lust, pride, sadness, and shame) while in the scanner.
They accomplished the experience of these emotions by imagining scenarios they developed before the scan. Rather than pretending, they were asked to actively immerse themselves into the feelings in more than a hundred trials, presented in a random order.
While the emotionally drained actors recovered, their data were fed into a computer model which could learn and improve its assessments with experience.
The model was able to identify the correct emotions of a subject on average four out of five times when comparing the scan patterns with previous trials of the same subject.
That is already remarkable, but here comes an amazing twist: the model was still correct on average seven out of ten times when comparing the neural activity of one subject with the scans from other individuals.
Thus emotions seem to have a similar neural basis among individuals (or at least among different actors). This seems to be more true for emotions like anger and less so for shame, but overall the model predicted all nine emotions with impressive accuracy.
While these recent advances are certainly remarkable, they only work within strict limits. There is no ‘one-size-fits-all’ approach, especially for complex thoughts, because our brains are like every other part of the body: they vary between individuals.
Your neural representation of eating a yoghurt (especially while being ashamed) might be different from that of your neighbour. To date, computers cannot handle this variability without being trained.
The participants in the described studies underwent functional imaging for extended periods of time; they saw a large number of video clips or were awoken from their dreams annoyingly often.
This initial training stage is important for the model to adapt to your personal activation patterns—to ‘get to know you’. Therefore, it is also impossible today to use these techniques ‘undercover’—you would certainly know if you spent hours in a big noisy fMRI machine, repeatedly drifting in and out of sleep.
Moreover, the widespread use for potential mind-reading would not be practical at present. The equipment is expensive, heavy, and not portable. It requires a special isolated room, trained personnel, and complex analyses.
You have to lie still in an MRI scanner for a relatively long period of time before researchers or clinicians can get a good scan of your brain. This is a challenge for young children, but some adults also struggle to lie still for any length of time—especially those with motor symptoms such as attention deficit hyperactivity disorder (ADHD) patients. Could we have much faster machines where only a part of the head needs to be immersed in the scanner?
Techniques such as magnetoencephalography (MEG) make this possible. In contrast to fMRI, MEG measures the magnetic field produced by the brain rather than blood flow. The magnetic fields change quickly and the technique is able to detect these rapid changes.
In fact, the temporal resolution of MEG is considerably higher than in fMRI. But nothing comes without a price: tracing the brain activity back to a precise location is much harder in MEG.
Researchers sometimes combine these techniques to get the best from both, but this approach is not very practical, since it requires multiple scans and the integration of big data sets. We are still looking for the ‘holy grail’ of neuroimaging: a temporally and spatially precise method that is also cheap, safe, easy, and portable.
There are some ideas about how to overcome at least the issue of portability. Some newer techniques, including diffuse optical tomography (DOT), which uses light rather than magnets, are in development.
The accuracy of these new systems seems to be catching up with the current gold standard in the field—fMRI.
Reading personal thoughts in great detail using fMRI is sci- ence fiction for now. The experimental conditions have to be tightly controlled and the context well defined. The computer predictions reflect blurry shapes of a seen film or the presence/ absence of food in your dream, to name a few. [Image A] below shows Adrian Owen, who was involved in remarkable work on patients in the vegetative state.
Next to him is a scan of his brain, taken while he was lying in an fMRI scanner performing a particular task. He asked the world’s top neuroimagers to identify what he was doing. Here are their answers:
- Remembering something
- Tracking a stimulus on the screen
- Shifting attention from one thing to another
- Deciding which of two responses to make
- Doing sudoku
- Switching attention
- Tapping a finger in response to a stimulus
- Looking at disgusting pictures
What was Adrian Owen really doing? He was telling a lie! Not a single expert could identify the correct activity. They clearly did not lack creativity, but reading someone’s mind from a brain scan without any information about the context is currently impossible. Mind-reading does not work in isolation and even the most sophisticated machine has to get to know the subject first.
But the field is moving ahead rapidly. Advances in machine learning techniques and new imaging methods could overcome the current limitations of mind-reading. In the future it might be possible to know what your favourite politician is really think- ing, no matter how good his acting skills are.
Good vs Bad Mind-Reading?
Most researchers working on technological refinements such as the development of new imaging techniques or better computer modelling have worthy, ethical aims.
Better technology would make brain scans safer, easier, and cheaper. They could be used to advance our understanding of the brain and inner thought processes.
In some cases, they could also enable us to communi- cate with people who have lost their ability to speak, due to being in a coma or to muteness. However, there is also the poten- tial for abuse, especially if a large number of people suddenly have access to this technique. When do we have the right to keep our thoughts private?
When does the government, an organization, or an individual have the right to read our thoughts? Is it ethical to use mind-reading techniques, for example, at an air- port to screen for terrorists? Many people are already uncom- fortable with full-body scans: what if a machine had access to your thoughts and emotions?
Clear ethical guidelines for applications of brain scans and potential mind-reading will be needed. We as a society will have to debate where we want to draw the line between responsible, beneficial usage of the techniques and what constitutes their abuse.
The family experience of brain injury
After a person acquires a brain injury, the impact on the whole family can often be life changing as they adjust to a new reality and relationships come under intense pressure…
Karen Ledger (KL): When brain injury occurs, it’s like a bomb going off in the family. Life will never be the same again for any of the members of that family.
People will be shocked, bewildered and overwhelmed, and they then have to go through a complicated process of adjustment, and people reach that adjustment at different stages.
The person with the brain injury will generally have a neuropsychologist assigned to support them. Most will pay attention to people’s feelings and emotions, but the rest of the family may not have any psychological support.
This situation doesn’t get better of itself without professional input, it can get worse and people’s mental health can and often does spiral down.
Louise Jenkins (LJ): It’s a particular challenge if you’ve got someone with little or no insight. They often won’t recognise the need for or be willing to engage with neuropsychological treatment until much further down the line, by which stage, the family may have entered a more advanced stage of crisis and their whole family unit may be at risk of breakdown. There are complex emotions involved in the adjustment process following trauma which include shock, guilt and loss.
KL: That’s a scenario we see a lot. The client’s relationships may get to an advanced stage of deterioration and as Louise says, crisis, before they’re able to accept help. This is often because there is an immense amount to absorb from their new world of injury, rehabilitation and the medico-legal process and clients do not have the psychological space to consider how they are, never mind undertake the rehabilitation.
LJ: That’s where some of the challenges come in from the legal perspective. The compensation claim process is quite rigid in that generally speaking, only the injured person can claim for financial losses and for professional support, but we maintain that as the underpinning principle for compensation claims is to restore someone to their former lifestyle, you have to consider them both as an individual and as part of the family unit. We try to build into the claim some therapy sessions not only for the injured person but also for their spouse and their children.
Some defendants (compensators) say they’re happy to support that because, if the family unit breaks down and the uninjured spouse has been providing a lot of the day-to-day support, prompting and encouragement that the injured person needs, the cost of commercial care to replace that support is significantly more expensive than the amounts you can recover in a claim for support provided by a family member. It is also about embracing the spirit of the Rehabilitation Code and Serious Injury Guide in looking at the wider family need.
KL: Often, people can’t work anymore; they feel their work is taken away from them. People get their sense of identity out of work, as well as from being a spouse or a partner, a father or a mother. And if they lose their ability to earn and their relationships start to deteriorate these are often perceived as more failure and thereby serve to reduce a client’s confidence and self-worth.
LJ: It is akin to a bereavement process for the uninjured partner, yet the person is still there with you.
KL: People don’t have to have a death to experience loss, and loss can activate a bereavement process. So they’re grieving for the person they once knew, and now they’ve got this new person which makes adjustment to the injury complicated. And the thing about brain injuries is they’re hidden. The person looks the same but behaves differently to how they did before. It understandably takes a long time for clients and family members to really grasp the effects of brain injury, because they’re often traumatised, angry, discombobulated and distressed.
The family that includes somebody with a brain injury goes through a process of understanding, just as the client hopefully does. It’s a complex situation trying to comprehend what a brain injury means whilst feeling bereaved.
Family and children’s therapy is relevant too. Children often get missed because they deal with loss and trauma in different ways to adults. Children tend to get on with their lives, as if it’s not happening, so they need particular attention. They won’t be talking about it so much, but they’ll be experiencing it. The sooner that’s managed by specialists, the better it will be for children in the longer term, giving children the best chance of allowing normal development to take place.
LJ: It’s difficult because there’s a significant investment of time and energy put into implementing a rehabilitation programme and support around the injured person. This is integral to the claims process. The spouse can feel as if all the focus is on the injured person and they’ve been left out.
From a legal perspective, we try to involve the uninjured spouse as much as possible in discussing what we’re doing and why we’re doing it. We try to weave in that therapy support for the uninjured spouse so they come along the journey with us rather than becoming a disrupter to the rehabilitation programme because they feel excluded and unsupported. If securing interim payments through the claim to fund support is challenging at an early stage, our in-house team of client liaison managers, all of whom have a healthcare background, can provide time and input in discussing the challenges and in signposting for support both for the uninjured spouse and children as well as for the injured client. There are some really valuable resources for children, for example, which explain some of the problems that can arise in a parent who has sustained a brain injury to help them to understand and come to terms with changes in the family dynamics.
KL: People affected by brain injury can feel deserted by their partner and like a single parent. This is because they’ve lost their partner’s contribution to childcare and work in the home. The complexity and challenges of living in these circumstances should never be underestimated.
LJ: At the point of injury, they are in shock and just want to be there for the person who’s injured. I’ve worked with a number of people where the grief and adjustment process is very substantially delayed. These delays extend to weeks, months or even years.
They’re in a fight/flight/freeze situation. They’re managing a situation that’s about life and death initially in the most serious cases. When the acute stage is over and they have some space to start thinking about themselves, rather than the person who’s injured, they can start reflecting. It’s an emerging awareness that it’s never going to be the same again, that some degree of permanence will remain with the injuries, that this is how it will be in the longer term and a realisation that you need support to adjust to the new normal.
KL: It takes a while for that realisation to come in. I am often working with partners who are in that process of adjustment and what initially attracted them to the person pre-injury has been lost post injury, for example agile thinking and intelligence. Moreover they now find themselves in a caring role and one where many strangers are entering their home and talking to them in alien language! It’s not surprising that for many people this is often too challenging for them to manage and why therapy is needed as soon as possible for clients to regain their own personal power as soon as possible. They will have a private listening, respectful and tender place for them when the rest of their lives are so exposed.
LJ: They don’t know where that injured person is going to land with their recovery in the longer term. There’s a natural recovery process of a minimum of two years following brain injury, often longer, and they don’t know how much recovery the person’s going to make. They’re living with that uncertainty for a long time before being able to understand and adjust to what the long term will look like, often with significant physical, cognitive and behavioural changes which place great strain on sustaining relationships. Independent family law and financial advice is often essential to protect both parties in the event that the relationship does break down.
KL: I believe that acquired head injury is usually devastating to the person and those around them. However, in my experience, people are often amazing in how they find the strength to establish new ways of being and making their life work for them. Therapy can often speed up that process because clients feel heard, respected and understood, a powerful combination for a restorative process particularly when they are so often feeling powerless. This process can help families stay together or decide to go their separate ways and with support they are more likely to do this without acrimony and additional trauma. Observing and supporting clients and their loved ones to dig deep to find the strength and commitment to establish a new life is such an amazing privilege and honour for me.
LJ : When the claims process is managed by expert serious injury lawyers, early access to specialist rehabilitation and support will enable an injured claimant to restore their life to the best possible position and allow them to maximise their potential for the long term, restoring a sense of control and positivity for the future. Working together with therapists like Karen is essential to ensure that a multi-disciplinary network of support can be put in place in order to support an injured person to achieve their goals and rebuild their life as an individual and as part of a family unit after a life changing injury.
Louise Jenkins is a partner at Irwin Mitchell and leads the serious injury team at the firm’s Sheffield office. Karen Ledger is managing director of KSL Consulting and a therapist, counsellor and supervisor with over 30 years of experience.
From brain injury to Bafta
Hannah Currie lovingly captured her uncle’s struggle with brain injury through a lens, and shared his story with the world, as Jessica Brown reports.
When they first got together, Paul and Lindsay Devereux didn’t seem like the most obvious match. Paul was from Dublin, and he ticked more than a few of the stereotypical Dubliner boxes – he liked a pint and didn’t take himself too seriously, and he had a thick Dublin accent.
Lindsay was the sensible one. She was a nurse from Scotland, with a master’s degree. But they clicked.
They both loved travel and adventure, and travelled the world together, driving through the US in a campervan.
On their return, they settled down and built a home together in the mountains outside Dublin. Paul worked as a painter and decorator – until he had an aneurysm ten years ago.
He had surgery to remove a second aneurysm from his brain, leaving him with a brain injury, and severe short-term memory loss.
Now, Lindsay gets up at 5am to get to Dublin, where she works as a nurse, and on top of this she helps care for Paul.
The couple are in debt, and they don’t have much support outside immediate family.
But this year, things took a turn for the better after a documentary about the couple, made by their niece, documentary filmmaker Hannah Currie, premiered internationally and won a Bafta Scotland award for ‘best short film’.
Currie, 31, has wanted to make a film about her uncle since the injury. She worked in media, but worked on the production side, helping other people make their films.
“I always wanted to be a documentary film maker, but thought it wasn’t accessible to me as a woman, and as someone who didn’t have the confidence in her abilities,” Currie tells NR Times.
“But the urge wasn’t going away, and I decided to go back to university and do a documentary directing course, which was the first time I picked up a camera.”
After completing her Masters in Screen Documentary course, Currie successfully applied for funding from the Scottish Documentary Institute and finally got to work on the documentary she’d been wanting to film for ten years. But it was a much more difficult experience than she could’ve anticipated.
“It was a really hard film to make because there’s so much to their story,” she says. “Paul’s aneurism and the fall-out from that affected every area of their lives.”
Paul smokes and drinks, she says, and doesn’t understand why this puts his health at increased risk, given his medical history.
But his maladaptive behaviours were one of the reasons she wanted to make the film in the first place.
“Some members of my family got frustrated at Paul because he kept on drinking and smoking. They said he needed to take responsibility for his behaviour. I was curious to hear his side of the story; if you’ve gone through this and your only crutch is smoking or drinking, then why not? I was keen to explore that.”
But somewhere along the way, the film became more about Lindsay, and not just Paul.
“Paul’s not going to get better, he’ll make small improvements but he’s always going to live with his injury. But I hope my aunt will find light in the situation.”
Currie hopes her aunt can start speaking to other families going through this and help them.
“If something good can come from this, I think she’ll feel validated that her decision to stay in this situation and sacrifice her life for another person will be worth it.”
Her grant was for a short film, and Currie found it difficult to know which bits of footage to leave in.
“When I finished it, I thought it missed the mark. But when people started contacting me, especially families of people with brain injuries, saying the film had had a big impact on them and brought them a lot of comfort, I realised I was being harsh on myself.”
Devlin says she felt enormous pressure to do the film, and her family, justice, especially because the funding came from public money.
She also struggled to get a balance between handling it sensitively and making something that people would want to watch.
“When you’re making a film, you’re making a piece of entertainment. It needed to hold people’s attention long enough to get an important message across.”
The film’s title, ‘That Joke Isn’t Funny Anymore,’ references Paul’s habit of repeating jokes.
“It’s funny and bizarre to watch, then it becomes not so funny. But I wanted to do him justice, because he does talk about things other than jokes.”
She was in her early twenties when it happened, and she remembers her uncle being a ‘burst of energy’.
“He’s a great guy. He hasn’t changed. If you catch him on a day where he isn’t too fatigued or he hasn’t had a drink, you can have a conversation with him, but he’ll forget things when he gets tired.”
Currie had sleepless nights over the decisions she made when editing the film, but her uncle was ‘over the moon’ when she sent him the final cut.
“Even though it might’ve been difficult for him to watch, he needed to sign it off. I sent it to him and he said everything in it was true.”
Currie says the feedback she’s had since the film’s release has been ‘overwhelmingly positive’. It premiered at DOC NYC in New York and DOCFEED in the Netherlands, and Currie took Lindsay with her.
“She’s been suffering in silence for ten years and had to get on with it and provide. A lot of friends abandon you when this kind of thing happens, because they find it difficult to be around someone who displays this behaviour,” Currie says.
The reaction to the film is helping her learn to believe positive feedback and be more confident in her abilities.
“The first minister Nicola Surgeon tweeted about it, she probably didn’t feel the need to be nice, she probably just liked it,” Currie laughs.
“I might not be super confident, but I have empathy with my characters and I’m able to make people feel confident enough to tell me their stories,” she adds.
You can watch That Joke Isn’t Funny Anymore on BBC iPlayer here.
Time for domestic abuse legislation – Lord Ramsbotham
Lord Ramsbotham, treasurer of the criminal justice and acquired brain injury interest group and former chief inspector of prisons, has vowed to help get screening domestic abuse victims for brain injury into legislation
Earlier this month, MP Chris Bryant put forward two amendments to the Domestic Abuse Bill, stated that female prisoners must be screened for acquired brain injury, including concussion, within two weeks of starting their sentence.
Bryant also put forward an amendment that women who have been the subject of domestic abuse should be screened for traumatic brain injury.
Ramsbotham is in touch with Bryant and has told NR Times he will take the amendments through the House of Lords, propose them at second reading and follow them through to the committee stage.
“I’m looking forward to the Domestic Abuse bill coming to our house in the autumn. I think they will have a lot of support because there’s a lot of cross-party interest in all these issues,” he says.
Testing female prisoners for brain injuries when they come into a prison could help to improve staff members’ understanding of what treatment the prisoners will need, and could help give rehab efforts sharper focus, he says.
Ramsbotham says he first became an advocate for improved support for prisoners with a brain injury when he was chief inspector of prisons in the late 1990s, on a visit to young offender’s institute HMP Glen Parva in Leicestershire.
“I found a 16-year-old boy sitting on his bed, rocking. He’d suffered a brain injury when he was three months old, when his dad picked him by the ankles and swung him against a radiator. The prison could do nothing for him.”
Ramsbotham then visited a brain injury unit at St Andrews hospital in Northampton.
“I discovered there that the treatment of brain injury was completely alien to what was going on in prisons because the treatment at St Andrews required stimulation – not being locked up in a prison cell for 23 hours a day.”
In a follow-up report at the time, Ramsbotham called for assessments, arguing that they help shed light on which part of the head has been hit or damaged, which can help staff predict a prisoner’s behavioural outcomes. But it was turned down.
There hasn’t been any progress in legislation, he says, since then-prime minister Theresa May dropped the government’s commitment to a prison reform bill in 2017.
“So when the criminal justice and acquired brain injury interest group asked me to be their chairman, I leapt at it because it seemed it was the place for which I could continue my campaign,” he says.
Ramsbotham hopes the reform will come soon, especially since the Covid-19 pandemic has highlighted the ‘unacceptable’ conditions in prisons, where mental health, he says, has come to the forefront, particularly those with brain injuries, he says.
Ramsbottom is strongly in favour of link workers going into prisons and making contact with people with brain injuries during their time in prison and for six months following their release.
“I don’t think the probation service is yet attuned to the needs of people with acquired brain injuries. We no, at the last count, only 18 per cent of community commissioning groups realise they have any responsibility for funding probation. I would wish to get that amended, too.”
The second reading of the Domestic Abuse bill in the House of Lords yet to be scheduled.
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