By Paula Backen
This month is Stroke Awareness Month, an opportunity to raise awareness of the impact of a stroke and help people find the support they may need.
Every month 240 people experience a stroke. It affects individuals in a myriad of ways, depending on the severity and site of the brain damage. The long-term outcome affects each person in very different ways, sometimes more in their mobility limitations, but also in their understanding and use of speech and language.
In my experience, the first impressions of police and court professionals is based on the physical appearance and functionality of the person.
For example, I have heard many say “he looks OK to me”. However, poor understanding is often masked by the availability of context. An example of this could be a person who lives with his family and knows that when his daughter presents him with his supper every evening at the same time, he says “yes” when asked if he is hungry.
Damage from the stroke may affect language centres in the brain and therefore the ability to both understand and express language. It can also affect articulation of speech and impact the ability to read and write, make reasoned decisions and many other aspects of communication. Examples can include the ability to manage emotions, becoming more disinhibited and feel fatigued quickly.
In a criminal case, whether as a witness or defendant, the person who has suffered a stroke is usually months or years since the damage. They may have adapted to life in many aspects but are not able to function in the complex and unfamiliar circumstances of a police interview or in court.
Emotional regulation and tiredness will impact on the person’s ability to participate effectively. The intermediary can advise on best practice to ameliorate these conditions.
One of the many issues for a court hearing, is the lack of contextual clues to the words being spoken. No-one wears name badges and dress code is the same for defence and prosecution. In crown courts, the barristers have their backs to the defendant, so facial expression and body language does not augment understanding of speech.
In my experience, there is a tendency for legal professionals to assume competent understanding and many family members overestimate the person’s abilities.
One accused elderly man I was asked to assess, lived alone with daily family assistance. He sat in an armchair, in front of a TV, with a remote by his side. His family reported that he had suffered a stroke 10 years ago and “understood everything although he didn’t say much”.
Following my intermediary assessment, observed by both a police officer and his daughters, it was clear that he could not follow even simple commands or respond to requests to point to his daughter. The police decided not to proceed with the case and it was dropped.
For other people who have experienced milder strokes, it may be their ability to process complex language that is impaired, or their speech is slurred and unintelligible to strangers. I have experience of assisting such vulnerable defendants by simplifying language, using visual aids or repeating their evidence to the jury.
Without an intermediary assessment and subsequent assistance, we cannot presume that fair access to justice is achieved in these circumstances.
- Paul Backen is Chair of The Intermediary Cooperative and was a founder chair when the original members formed the organisation in 2021. She has worked with vulnerable people since 2011, particularly focussed on defendants in criminal courts, as well as with witnesses as a Registered Intermediary. Her original profession as a Speech & Language Therapist was specialising with people who experienced a range of acquired neurological disorders.