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


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


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”


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


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


• 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


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


*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”


• 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


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


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)


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


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

thinkers)• Honest feedback


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

activities


Strategies for Impulsivity & Agitation:

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


Positive Behavioural Supports:

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


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


The future:

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

health & ABI sector• Provide education to increase awareness

Health & Medicine

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