Mental Health and ABI

General Information

• An individual has a significantly greater chance of developing a diagnosable mental illness after sustaining an acquired brain injury (ABI)^1,2
• The risk is elevated for a number of reasons such as: issues with grief and loss, adjustment to disability, direct effects of brain injury (e.g., cognitive, emotional and behavioural changes), pre-injury personality traits and strengths, pre-injury social functioning, coping skills and level of support system³
• A mental illness may have been present prior to the ABI or it may have developed following the brain injury
• Some of the common mental health problems following an ABI are:
  • depression
  • anxiety
  • psychosis
  • personality disorder
  • substance abuse disorder
• Symptoms of ABI and mental illness can overlap and it can be difficult to determine whether the issues are the result of an ABI or the mental illness
• Mental health problems can hinder rehabilitation outcomes making it very important to get these symptoms well managed as soon as possible

Treatment

• The first step is to get an appropriate assessment by a qualified specialist, such as neuropsychologist or psychiatrist
• Case management should be provided to coordinate any mental health and ABI services that the person will receive
• Continued follow up is an essential component to the client’s well-being. Individuals with an ABI often require additional support and consideration
• Support should be holistic and take into account the needs associated with the ABI, as well as the mental illness
• Treatment for both ABI and mental health may include medication, psychological therapy, and/or individualized programing in such areas as social/life skills
• Collaboration between mental health and ABI services is of the utmost importance
• Education on ABI to mental health staff is very important

References
¹Hibbard MR, Uysal S, Kepler K, Bogdany J , Silver J. Axis 1 psychopathology in individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation, 1998;13, 24-39.
² Koponen S, Taiminen T, Portin R, Himanen L. Axis 1 and 11 psychiatric disorders after traumatic brain injury: a 30 year follow-up study. The American Journal of Psychiatry, 2002; 159: 1315-1321.
³Victoria. Acquired Brain Injury and Mental Illness: Protocol between mental health and other services. Melbourne: Metropolitan Health and Aged Care Services Divn, Dept of Human Services, 2004.
⁴Synapse. Reconnecting Lives – Get the Facts. Retrieved January 18, 2015, from
https://synapse.org.au/information-services/mental-health-brain-injury-mental-illness-(dual-diagnosis).aspx

Resources

Adjusting to life after brain injury can be stressful as survivors may be coping with many losses which may include loss of self-identity, their job, their friends, their community and sometimes their family. There are no quick and easy answers but service providers can start by providing education and counselling to the individual and their families. Below is a list of resources which service providers, families, and survivors can refer to for more information.

• Intro to ABI – Mental Health and ABI - This is a module from the ABI Partnership's Introduction to Acquired Brain Injury series which is designed to provide a basic level of knowledge for health care workers and other service providers, ABI survivors, caregivers, and anyone else interested in learning more about the effects of brain injury. Strategies to help guide survivors and families through the lifelong process of adapting to and/or recovering from their injury are provided. In this module you will hear an 18-minute presentation from Tyla Young, RPN on Mental Health and ABI.

• Mental Health and ABI Information Sheets - These information sheets have been adapted with permission from ABIOS-Acquired Brain Injury Outreach Service in the State of Queensland. They are great resources for service providers, families, and survivors. Feel free to print and distribute them for educational purposes.
  • Adjustment, Grief and Loss after Brain Injury
  • Anxiety and Brain Injury
  • Depression, Suicide and Brain Injury
  • Depression and Brain Injury
  • Psychosis and Brain Injury

Saskatchewan Services

• Saskatchewan Mental Health and Addiction Services - on this page of the Government of Saskatchewan’s website you will see a link titled, Find Mental Health and Addictions Services in My Community, providing a comprehensive listing, alphabetically by community, of Addiction and Mental Health Services and Agencies in Saskatchewan.
• 811 HealthLine provides mental health and addictions support. HealthLine’s registered psychiatric nurses and social workers can offer crisis counseling and strategies to help you manage your situation or give you information about resources in your community.
• https://www.onlinetherapyuser.ca/ - The Online Therapy Unit for Service, Education, and Research (USER) offers adults living in Saskatchewan free Online Cognitive Behaviour Therapy (CBT) for depression, anxiety, and or pain. Online CBT involves reviewing educational material online and corresponding with a therapist over a secure messaging system. The approach is found to be effective and is a convenient way to receive care.

Adapting Your Service for Persons with Acquired Brain Injury (ABI)
 

If you are a professional who is new to working with ABI survivors and/or would like to increase your success with survivors, there are a number of on-line resources that can help you adapt your treatment to better serve this population.

• Suggestions for Professionals - Programs and services often need to be adapted to accommodate disability arising from an ABI. This two page document offers many simple, yet effective accommodations.

• Accommodating the Symptoms of TBI web-based training module. The Ohio Valley Center for Brain Injury Prevention and Rehabilitation offers a number of on-demand modules regarding Traumatic Brain Injury. These modules are free, or can be purchased for continuing education credits. In their module, Accommodating the Symptoms of TBI, you will learn to recognize the common symptoms of TBI and how to incorporate compensatory strategies into your treatment practices. These simple, yet effective strategies will help you increase the odds of treatment success. A booklet accompanies this training.
   
• Five Strategies for Adapting Psychological Interventions for those with Brain Injuries - There is a growing body of evidence indicating that people with brain injuries can benefit from cognitive behaviour therapy (CBT) and other psychological interventions. In conducting their randomized control trial of therapies to treat anxiety and depression in TBI populations, Dr. Wong and colleagues encountered some challenges, particularly in those with severe cognitive impairment. Based on their experiences from the trial, five strategies are offered for optimizing CBT for brain injury populations.