Brain injury and mental health 2010[1].pptx bisno

Brain Injury and Mental Health

A complex, multi-jurisdictional health & social service issue

Prepared by : Alice M. Bellavance, RPN, Executive Director, BISNO 2010

Learning Objectives

Individuals will learn about:

• Brain Injury & Mental Health symptoms• Management strategies for individuals

with neuropsychiatric challenges• BISNO’s leadership role in meeting the

complex, multi-jurisdictional presentation of this population

Brain Injury and Mental HealthCommonly seen concerns include difficulties with:

• Memory• Concentration• Sequencing• Organizing• Planning• Problem solving• Motivation• Socialization• Emotional lability• Agitation• Perseveration• Confabulation

• Memory• Concentration• Sequencing• Organizing• Planning• Problem solving• Motivation• Socialization• Emotional lability• Agitation• Perseveration• Confabulation

Brain Injury and Mental HealthCommonly seen concerns include difficulties with:

• Learning• Insight• Processing• Inflexibility• Difficulty coping with

change• Socially or sexually

inappropriate behaviour• Sleeping & eating

disorders• Or substance abuse

• Learning• Insight• Processing• Inflexibility• Difficulty coping with

change• Socially or sexually

inappropriate behaviour• Sleeping & eating

disorders• Or substance abuse

Brain Injury and Mental Health

It is often very difficult to separate Brain Injury issues from Mental Health.

It is important to:• Understand the pre-injury personality• Understand brain injury and mental

health diagnosis• Use individualized assessments,

treatment planning and strategies

Brain Injury and Mental Health

It is also important to consider the stigma surrounding a mental illness diagnosis, which can result in:

• Delay in seeking treatment• Resistance to referral from either the

individual or their family• Reluctance to be admitted to a mental health

program: by both the individual and the mental health provider

• Reluctance of community providers to consider partnerships for fear of “offloading”

Brain Injury and Mental Health

BISNO’s experience with mental health diagnosis in 19 years of service provision:

• Depression• History of abuse• Bipolar disorder• Borderline personality disorder• Concurrent disorder (MH & SA)• All have increase risk of suicide

Brain Injury and Mental Health

Suicidal behaviours are often related to:• Social isolation• Impaired self-regulation• Difficulty with mood management• Depression & despair• Stigma of mental health diagnosis• Loss of sense of self and pre-injury

health, social status & role

Brain Injury and Mental Health

• A complicating factor for acquired brain injury is when the ABI is the result of a suicide attempt

• This impacts the individual’s motivation, family relationships and engagement in treatment

Brain Injury and Mental Health

Additional variables:• Pain• Seizures• Fatigue• Poor balance & co-ordination• Perceived “malingering”• Impaired family & social supports

Brain Injury and Mental HealthSome statistics:

• 65% of applicants to BISNO had co-occurring mental health issues (often undiagnosed)

• Of the above 80% also had a co-occurring addiction (known as concurrent disorder*)

• Often this pre-injury status was precipitating factor in the injury

Brain Injury and Mental Health

*Concurrent disorder

• In a research project with our sister agency Community Head Injury Resources & Services (CHIRS) and the Centre for Addiction & Mental Health (CAMH) in Toronto, they found that:

“70% of individuals with a concurrent disorder had a history of acquired brain injury”

Brain Injury and Mental Health

• Most common post-injury MH dx is depression

• Others include: bipolar affective disorder, anxiety/panic disorder, PTSD, schizophrenia

• If addiction wasn’t pre-existing, it presents afterwards either to self-medicate depression or due to opiates prescribed to treat pain from orthopedic & soft tissue injuries sustained in MVC’s & other multiple trauma injuries

Brain Injury and Mental HealthReasons persons with an ABI access MH services:

• Many years after injury due to no dx., rehab & disenfranchisement from family, friends & community

• Require medication review, adjustment & monitoring

• Requiring pain assessment & management• Requiring assessment & treatment of other

medical issues, e.g. seizures• Requiring behavioural intervention

Brain Injury and Mental Health

Most common presenting behavioural concerns:• Verbal and/or physical aggression• Inappropriate sexualized behaviour• Suicidal ideation, para-suicidal behaviour• Elopement and related behaviours• Unsafe activities e.g. smoking

Brain Injury and Mental Health

Most common presenting cognitive concerns:

• Memory impairment resulting in significant impact on daily activity (personal care)

• Lack of motivation/initiation (known in MH circles as malingering)

Brain Injury and Mental Health

Medication management:• Antidepressants• Anti-psychotics• Mood stabilizers• Anti-seizure meds• Medications for substance withdrawal• All require monitoring

Brain Injury and Mental Health

• Supportive Strategies:• Provide calm reassurance• Counselling• Attentive eye contact• Inclusive language• Use humour (caution with concrete

thinkers)• Honest feedback

Brain Injury and Mental Health

Motivational Strategies• Establish therapeutic rapport• Encourage skill development• Utilize individual’s strengths & interests• Provide verbal praise & reinforcement• Create incentives for non-preferred

activities

Brain Injury and Mental Health

Strategies for Impulsivity & Agitation:

• Consistent approaches, scripts• Crisis plan• Knowing when to “back off”• Reframing maladaptive behaviours

Brain Injury and Mental Health

Positive Behavioural Supports:

• Meaningful activities• Replacement behaviours• Strength/interest based programming• Environmental adaptations• Age appropriate reinforcement

Brain Injury and Mental Health

Cognitive Enhancement:

• Orientation & memory aids• Routines & schedules• Appropriate time for processing• Redirection & cueing• Repetition & role-playing

Brain Injury and Mental HealthIn order to support individuals successfully

in community settings we need:

CCAC’sMulti-disciplinary teams

Mutual aid/self-help groups

Day Programs

Community Mental Health & Addiction Treatment Programs/services

Rehab service providers

Brain injuryAssociations

Police & Justice System

Hospitals

COLLABORATION

Brain Injury and Mental Health

The future:

• Fight stigmatization• Advocate for appropriate housing options• Improve collaboration between mental

health & ABI sector• Provide education to increase awareness