brain injury and mental health a complex, multi-jurisdictional health & social service issue...
TRANSCRIPT
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Brain Injury and Mental Health
A complex, multi-jurisdictional health & social service issue
Prepared by : Alice M. Bellavance, RPN, Executive Director, BISNO 2010
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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
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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
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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
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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
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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”
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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
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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
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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
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Brain Injury and Mental Health
Additional variables:• Pain• Seizures• Fatigue• Poor balance & co-ordination• Perceived “malingering”• Impaired family & social supports
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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
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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”
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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
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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
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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
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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)
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Brain Injury and Mental Health
Medication management:• Antidepressants• Anti-psychotics• Mood stabilizers• Anti-seizure meds• Medications for substance withdrawal• All require monitoring
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Brain Injury and Mental Health
• Supportive Strategies:• Provide calm reassurance• Counselling• Attentive eye contact• Inclusive language• Use humour (caution with concrete
thinkers)• Honest feedback
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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
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Brain Injury and Mental Health
Strategies for Impulsivity & Agitation:
• Consistent approaches, scripts• Crisis plan• Knowing when to “back off”• Reframing maladaptive behaviours
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Brain Injury and Mental Health
Positive Behavioural Supports:
• Meaningful activities• Replacement behaviours• Strength/interest based programming• Environmental adaptations• Age appropriate reinforcement
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Brain Injury and Mental Health
Cognitive Enhancement:
• Orientation & memory aids• Routines & schedules• Appropriate time for processing• Redirection & cueing• Repetition & role-playing
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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
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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