Nearly 65% of prisoners at a women’s jail may have suffered traumatic brain injuries at some point in their lives, a study has found.

Research by the Disabilities Trust and Royal Holloway, University of London, found that of the 173 women screened at Drake Hall prison in Staffordshire answering questions about blows to the head, 64% gave answers consistent with having symptoms of a brain injury. The symptoms of 96% of the women suggested that these arose from physical trauma.

The work adds to a growing body of research on the over-representation of people with brain injuries in the prison population. In 2012, a university of Exeter report described traumatic brain injury as a “silent epidemic”. In 2010 a study of 200 adult male prisoners found 60% had suffered a head injury.

Research has suggested that traumatic brain injury (TBI) could increase the likelihood of violent behaviour, criminal convictions, mental health problems and suicide attempts.

“The needs of somebody in prison with TBI are likely to be complex, and the lack of understanding and identification of a brain injury results in a higher risk of custody and reoffending,” said the Disabilities Trust.

As part of its research, the trust established a Brain Injury Linkworker Service in the prison to provide specialist support to women with a history of brain injury.

62% of the women supported through the service said they had sustained their brain injury through domestic violence.

Nearly half (47%) of the women had been in an adult prison five or more times. The statistics revealed that 33% had sustained their first injury prior to their first offence.

The scandal of ex-prisoners released into a new life – on the streets
 
The Disabilities Trust called for the inclusion of brain injury screening to be a routine part of the induction assessment on entry to prison or probation services, and for staff to be given basic brain injury awareness training.

The law not only focuses on mental health treatment, but encourages patient rehabilitation as well.

The law states that the Ministry of Health will establish shelters for patients who do not need to stay at a mental health facility and whose families refuse to provide appropriate care. Further, the law permits the Ministry of Health to grant private shelter licences for these purposes.

The law also highlights that a person treated in a mental health facility or who has a mental health condition should not be precluded from obtaining a job with a government entity.

By encouraging employment of individuals with mental health conditions, the law intends to further prevent stigma and isolation for mental health patients.

The first of its kind in Kuwait, the Mental Health Law highlights the government’s continuous effort to improve patient protections in a region where mental illness remains taboo.

​The law implements strict penalties for individuals who violate the law, as it dedicates five articles out of 40 clearly listing the consequences of violating the law.

Although still in its early stages, the Mental Health Law indicates an important step in improving healthcare development as well as the rights and treatment of mental health patients and communities in Kuwait.

It was clear to everyone the old system wasn’t working. We needed radical change.

It is important that they are tenants: each has a contract, pays rent and (if they need to) applies for housing benefit. That, after all, is all part of having a home – and part of a housing policy that has now made Finland the only EU country where homelessness is falling.

When the policy was being devised just over a decade ago, the four people who came up with what is now widely known as the Housing First principle – a social scientist, a doctor, a politician and a bishop – called their report Nimi Ovessa (Your Name on the Door).

“It was clear to everyone the old system wasn’t working; we needed radical change,” says Juha Kaakinen, the working group’s secretary and first programme leader, who now runs the Y-Foundation developing supported and affordable housing.

 Juha Kaakinen, CEO of the Y-Foundation, which provides low-cost flats to homeless people across Finland. 

“We had to get rid of the night shelters and short-term hostels we still had back then. They had a very long history in Finland, and everyone could see they were not getting people out of homelessness. We decided to reverse the assumptions.”
 
As in many countries, homelessness in Finland had long been tackled using a staircase model: you were supposed to move through different stages of temporary accommodation as you got your life back on track, with an apartment as the ultimate reward.

“We decided to make the housing unconditional,” says Kaakinen. “To say, look, you don’t need to solve your problems before you get a home. Instead, a home should be the secure foundation that makes it easier to solve your problems.”

With state, municipal and NGO backing, flats were bought, new blocks built and old shelters converted into permanent, comfortable homes – among them the Rukkila homeless hostel in the Helsinki suburb of Malminkartano where Ainesmaa now lives.

When Europe gets it right
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Housing First’s early goal was to create 2,500 new homes. It has created 3,500. Since its launch in 2008, the number of long-term homeless people in Finland has fallen by more than 35%. Rough sleeping has been all but eradicated in Helsinki, where only one 50-bed night shelter remains, and where winter temperatures can plunge to -20C.

The city’s deputy mayor Sanna Vesikansa says that in her childhood, “hundreds in the whole country slept in the parks and forests. We hardly have that any more. Street sleeping is very rare now.”

In England, meanwhile, government figures show the number of rough sleepers – a small fraction of the total homeless population – climbed from 1,768 in 2010 to 4,677 last year (and since the official count is based on a single evening, charities say the real figure is far higher).

But Housing First is not just about housing. “Services have been crucial,” says Helsinki’s mayor, Jan Vapaavuori, who was housing minister when the original scheme was launched. “Many long-term homeless people have addictions, mental health issues, medical conditions that need ongoing care. The support has to be there.”

At Rukkila, seven staff support 21 tenants. Assistant manager Saara Haapa says the work ranges from practical help navigating bureaucracy and getting education, training and work placements to activities including games, visits and learning – or re-learning – basic life skills such as cleaning and cooking.


“A lot of it is really about talking,” says Henna Ahonen, a trainee social worker. And that is “easier when you are actually doing something together, rather than in a formal interview”, Haapa says. “The connection is just … easier. You can spot problems more readily.”

. . .

Housing First costs money, of course: Finland has spent €250m creating new homes and hiring 300 extra support workers. But a recent study showed the savings in emergency healthcare, social services and the justice system totalled as much as €15,000 a year for every homeless person in properly supported housing.

Interest in the policy beyond the country’s borders has been exceptional, from France to Australia, says Vesikansa.

The British government is funding pilot schemes in Merseyside, the West Midlands and Greater Manchester, whose Labour mayor, Andy Burnham, is due in Helsinki in July to see the policy in action.

But if Housing First is working in Helsinki, where half the country’s homeless people live, it is also because it is part of a much broader housing policy. More pilot schemes serve little real purpose, says Kaakinen:

“We know what works. You can have all sorts of projects, but if you don’t have the actual homes … A sufficient supply of social housing is just crucial.”


And there, the Finnish capital is fortunate. Helsinki owns 60,000 social housing units; one in seven residents live in city-owned housing.

It also owns 70% of the land within the city limits, runs its own construction company, and has a current target of building 7,000 more new homes – of all categories – a year.

In each new district, the city maintains a strict housing mix to limit social segregation: 25% social housing, 30% subsidised purchase, and 45% private sector. Helsinki also insists on no visible external differences between private and public housing stock, and sets no maximum income ceiling on its social housing tenants.

It has invested heavily, too, in homelessness prevention, setting up special teams to advise and help tenants in danger of losing their homes and halving the number of evictions from city-owned and social housing from 2008 to 2016.

“We own much of the land, we have a zoning monopoly, we run our own construction company,” says Riikka Karjalainen, senior planning officer. “That helped a lot with Housing First because simply, there is no way you will eradicate homelessness without a serious, big-picture housing policy.”

 Lessons from Finland: helping homeless people starts with giving them homes

 
Finland has not entirely solved homelessness. Nationwide, about 5,500 people are still officially classified as homeless. The overwhelming majority – more than 70% – are living temporarily with friends or relatives.