The document discusses the complex relationship between brain injury and mental health. It notes that individuals with brain injuries commonly experience difficulties with memory, concentration, emotional regulation, and other cognitive functions. Properly assessing and treating these individuals requires understanding pre-injury history and separating brain injury issues from mental health concerns. Effective support strategies focus on medication management, counseling, motivation, and addressing problem behaviors. Collaboration between brain injury and mental health services is needed to best serve this population.
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Brain injury and mental health 2010[1].pptx bisno
1. Brain Injury and Mental Health
A complex, multi-jurisdictional
health & social service issue
Prepared by : Alice M. Bellavance, RPN, Executive Director, BISNO 2010
2. 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
4. Brain Injury and Mental Health
Commonly seen concerns include difficulties with:
• Learning • Learning
• Insight • Insight
• Processing • Processing
• Inflexibility • Inflexibility
• Difficulty coping with • Difficulty coping with
change change
• Socially or sexually • Socially or sexually
inappropriate behaviour inappropriate behaviour
• Sleeping & eating • Sleeping & eating
disorders disorders
• Or substance abuse • Or substance abuse
5. 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
6. 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”
7. 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
8. 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
9. 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
10. Brain Injury and Mental Health
Additional variables:
• Pain
• Seizures
• Fatigue
• Poor balance & co-ordination
• Perceived “malingering”
• Impaired family & social supports
11. Brain Injury and Mental Health
Some 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
12. 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”
13. 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
14. Brain Injury and Mental Health
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
15. 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
16. 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)
17. Brain Injury and Mental Health
Medication management:
• Antidepressants
• Anti-psychotics
• Mood stabilizers
• Anti-seizure meds
• Medications for substance withdrawal
• All require monitoring
18. Brain Injury and Mental Health
• Supportive Strategies:
• Provide calm reassurance
• Counselling
• Attentive eye contact
• Inclusive language
• Use humour (caution with concrete
thinkers)
• Honest feedback
19. 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
20. Brain Injury and Mental Health
Strategies for Impulsivity & Agitation:
• Consistent approaches, scripts
• Crisis plan
• Knowing when to “back off”
• Reframing maladaptive behaviours
21. Brain Injury and Mental Health
Positive Behavioural Supports:
• Meaningful activities
• Replacement behaviours
• Strength/interest based programming
• Environmental adaptations
• Age appropriate reinforcement
22. Brain Injury and Mental Health
Cognitive Enhancement:
• Orientation & memory aids
• Routines & schedules
• Appropriate time for processing
• Redirection & cueing
• Repetition & role-playing
23. Brain Injury and Mental Health
In order to support individuals successfully
in community settings we need:
Mutual aid/self-help groups
Multi-disciplinary teams
CCAC’s
Hospitals
Day Programs Police & Justice
COLLABORATION System
Community Mental Health & Addiction
Treatment Programs/services Brain injury
Rehab service Associations
providers
24. 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
