Forum Explores Dangerous Intersection of Brain Injury and Law Enforcement

The impact of brain injuries are widely misunderstood. This can be especially dangerous in confrontations with police, who are likely to read symptoms of brain injury as aggression or intoxication.

The Portland Committee on Community-Engaged Policing brought together members of the legal and medical fields, as well as two individuals who have survived brain injuries, for the Brain Injury, Policing, & Public Safety Forum on June 26.

“Someone with a brain injury can appear to be intoxicated when they’re not,” cognitive neuropsychologist Dr. Andy Ellis told The Skanner. Ellis was one of the featured speakers, and has run the Brain Rehab Network for the past 24 years.

Those with a brain injury “can have a lot of trouble regulating behavior, so they might have trouble keeping their mouth shut in a confrontation with law enforcement when clearly being quiet would be the smart move,” Ellis said.

“They might have trouble keeping their temper in check if they felt like they were being confronted aggressively. They might not be fearful at times when being fearful would be good for them.”

This can put them at odds with police during any kind of confrontation. 

“I think one of the biggest things is law enforcement often feels like it needs to assert dominance or power to get control of a situation in a way that someone with a brain injury might find really overwhelming, terrifying, stressful – and they might react to it in a very atypical way, in a way that the officer doesn’t really understand,” Ellis said.

Invisible Injuries

At the PCCEP event, Ellis joined two individuals who have grappled with brain injury and its life-altering impacts: Jonathan Boland, a Parkrose High alum who received a football scholarship to Portland State but was sidelined after a series of concussions. His personality, focus and general physical well-being took a major hit as the result of his injuries, and he ended up behind bars for his involvement in a string of robberies – activities that struck all who knew him as completely out-of-character. He now serves as a criminal justice advocate. Stephanie Grayce suffered a serious brain injury after being involved in a car collision, and went on to graduate from Lewis and Clark with a law degree. She now sits on the board of Brain Injury Connections Northwest.

As destabilizing as his brain injuries were, Boland acknowledged that concussion protocol required by relatively new legislation likely kept the damage from being ruinous: Max's Law went into effect in 2010 and requires school districts in Oregon to implement specific concussion management guidelines -- popularly known as "recognize, remove, refer, return." Student athletes and at least one parent or caretaker must take a free online course about concussions, and referees are also required to complete training. Any student athlete that has had a concussion must get a medical release form from a health care professional before returning to training or games. The law is named after Max Condradt, a football player at Waldport High who in 2001 suffered a concussion during a game, then was allowed to play the following week.

“Because no concussion protocols existed or were being applied, he was allowed to play the following Friday when he was still concussed and he received another concussion and that led to what was known at the time as second-impact syndrome,” attorney David Kracke, a brain injury advocate-coordinator at the Center on Brain Injury Research & Training, told The Skanner. Kracke also spoke at the PCCEP forum. “(It led to) really just a terrible series of neurocognitive problems, putting him into a coma for about four months. He was permanently impaired after that.”

Attorney David Kracke, a brain injury advocate-coordinator at the Center on Brain Injury Research & Training

Kracke worked with a team of people to push Max’s Law to the finish line. In 2013, he and Dr. James Chestnutt, a sports medicine expert at OHSU who has focused on concussion management, drafted Jenna’s Law to expand Max’s Law protections to young athletes participating in sports outside of school.

More legislative support has arrived in the form of last year’s Senate Bill 420, which will create an office of brain injury resource navigation at the state’s Dept. of Human Services.

Ellis and Kracke agreed that not just the general public, but law enforcement and even the medical community, need much more education about brain injuries.

“In 2024, it is still rare for me to meet a patient for the first time that feels like they got good information (about brain injuries) in the past three to six to 12 months post-injury, from the medical community itself,” Ellis said. “It’s not just the public that needs education. The physicians don’t really get it either.”

It is hardly an obscure medical ailment: About 8.5% of the general population experience a brain injury at some point in their lives. Within the prison population, about 40% of women and 60% of men have had brain injuries – within the homeless population, it’s 40 to 50%.

“So the odds that law enforcement is going to run into brain injury are 100%,” Ellis said.

Why are brain injuries so overrepresented in marginalized populations?

“I always figure we’re all maybe two calamities away from our life falling apart,” Ellis said.

“A brain injury for a lot of people could be that one calamity that this person suffers that is enough to tear down the structure of their entire life.” 

Legal Protections

Kracke was happy when federal legislation was passed in 2022 requiring first responders to receive brain injury-specific training.

“It’s just really critical that that group understands brain injury, and especially with the first responders who are responding to injuries and transporting patients, it’s critically important that they document the signs, symptoms or behaviors consistent with a concussion in that initial documentation,” Kracke said.

“Oftentimes that is not done, and that documentation follows that patient during their medical treatment and it becomes increasingly difficult for that person to explain yes they were dizzy, confused, yes they had a headache and vision problems, yes they had ringing in their ears, they don’t remember a lot of whatever the event was.

“The first responders will oftentime show up at a scene – let’s say a car collision, which is probably the second most common way people sustain a brain injury – and they will ask the victim, the injured person, ‘Did you lose consciousness?’ That’s like me asking you, ‘Tell me what you don’t remember.’ What I’ve been advocating for is the method of determining if a person has lost consciousness that’s used by the Dept. of Defense for active duty servicemembers. They have a two-part question: ‘What’s the last thing you remember before the injury and what’s the next thing you remember after the injury?’”

Asked how law enforcement might more effectively communicate with someone who may be impacted by brain injury, Ellis said the advice was largely common-sense.

“Brain injury survivors are often very sensitive to loud noise, stress, even bright lights, commotion, crowded spaces – they can have an outsized physiological anxiety reaction to,” he told The Skanner. “So it would be great if law enforcement could engage with brain injury survivors in a calmer, quieter, less pressured fashion. Instead of raising your voice to get what you want, it’s more speaking slowly, methodically, calmly, quietly – not pushing or threatening. These are things that we train our staff to do when they’re in crisis management training.

“You want them to feel that you’re listening to them, that you’re trying to understand what’s bothering them. It’s more about engaging and asking gentle, direct questions. Simple questions – not giving two- or three-step commands, which are confusing and upsetting.”

The PCCEP event was not about finding definitive solutions, Ellis said, but addressing the issue and collaborating. It was an event that provided insight and advice beneficial to law enforcement. Unfortunately, although PCCEP invited members of Portland Police and the Multnomah County Sheriff’s office, none were present at the forum.