Transcript Brain Injury and Mental Health

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 Health
Commonly seen concerns include difficulties with:
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Memory
Concentration
Sequencing
Organizing
Planning
Problem solving
Motivation
Socialization
Emotional lability
Agitation
Perseveration
Confabulation
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Memory
Concentration
Sequencing
Organizing
Planning
Problem solving
Motivation
Socialization
Emotional lability
Agitation
Perseveration
Confabulation
Brain Injury and Mental Health
Commonly seen concerns include difficulties with:
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Learning
Insight
Processing
Inflexibility
Difficulty coping with
change
• Socially or sexually
inappropriate behaviour
• Sleeping & eating
disorders
• Or substance abuse
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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
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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
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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
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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
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Additional variables:
Pain
Seizures
Fatigue
Poor balance & co-ordination
Perceived “malingering”
Impaired family & social supports
Brain Injury and Mental Health
Some statistics:
• 65% of applicants to BISNO had cooccurring mental health issues (often
undiagnosed)
• Of the above 80% also had a cooccurring 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 Health
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Reasons 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
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Medication management:
Antidepressants
Anti-psychotics
Mood stabilizers
Anti-seizure meds
Medications for substance withdrawal
All require monitoring
Brain Injury and Mental Health
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Supportive Strategies:
Provide calm reassurance
Counselling
Attentive eye contact
Inclusive language
Use humour (caution with concrete
thinkers)
• Honest feedback
Brain Injury and Mental Health
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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:
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Consistent approaches, scripts
Crisis plan
Knowing when to “back off”
Reframing maladaptive behaviours
Brain Injury and Mental Health
Positive Behavioural Supports:
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Meaningful activities
Replacement behaviours
Strength/interest based programming
Environmental adaptations
Age appropriate reinforcement
Brain Injury and Mental Health
Cognitive Enhancement:
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Orientation & memory aids
Routines & schedules
Appropriate time for processing
Redirection & cueing
Repetition & role-playing
Brain Injury and Mental Health
In order to support individuals successfully
in community settings we need:
Mutual aid/self-help groups
CCAC’s
Multi-disciplinary teams
Hospitals
Day Programs
COLLABORATION
Community Mental Health & Addiction
Treatment Programs/services
Rehab service
providers
Police & Justice
System
Brain injury
Associations
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