Brain Injury and Mental Health        A complex, multi-jurisdictional        health & social service issuePrepared by : Al...
Learning ObjectivesIndividuals will learn about:• Brain Injury & Mental Health symptoms• Management strategies for individ...
Brain Injury and Mental Health    Commonly seen concerns include difficulties with:•   Memory                   •   Memory...
Brain Injury and Mental Health      Commonly seen concerns include difficulties with:• Learning                     • Lear...
Brain Injury and Mental Health It is often very difficult to separate Brain Injury issues from Mental Health.  It is impor...
Brain Injury and Mental Health    It is also important to consider the stigma    surrounding a mental illness diagnosis, w...
Brain Injury and Mental Health    BISNO’s experience with mental health    diagnosis in 19 years of service provision:•   ...
Brain Injury and Mental Health    Suicidal behaviours are often related to:•   Social isolation•   Impaired self-regulatio...
Brain Injury and Mental Health• A complicating factor for acquired brain  injury is when the ABI is the result of a  suici...
Brain Injury and Mental Health    Additional variables:•   Pain•   Seizures•   Fatigue•   Poor balance & co-ordination•   ...
Brain Injury and Mental Health  Some statistics:• 65% of applicants to BISNO had co-  occurring mental health issues (ofte...
Brain Injury and Mental Health              *Concurrent disorder• In a research project with our sister agency  Community ...
Brain Injury and Mental Health• Most common post-injury MH dx is  depression• Others include: bipolar affective disorder, ...
Brain Injury and Mental Health    Reasons persons with an ABI access MH    services:•   Many years after injury due to no ...
Brain Injury and Mental HealthMost common presenting behavioural concerns:• Verbal and/or physical aggression• Inappropria...
Brain Injury and Mental HealthMost common presenting cognitive concerns:• Memory impairment resulting in significant  impa...
Brain Injury and Mental Health    Medication management:•   Antidepressants•   Anti-psychotics•   Mood stabilizers•   Anti...
Brain Injury and Mental Health• Supportive Strategies:• Provide calm reassurance• Counselling• Attentive eye contact• Incl...
Brain Injury and Mental Health    Motivational Strategies•   Establish therapeutic rapport•   Encourage skill development•...
Brain Injury and Mental Health    Strategies for Impulsivity & Agitation:•   Consistent approaches, scripts•   Crisis plan...
Brain Injury and Mental Health    Positive Behavioural Supports:•   Meaningful activities•   Replacement behaviours•   Str...
Brain Injury and Mental Health    Cognitive Enhancement:•   Orientation & memory aids•   Routines & schedules•   Appropria...
Brain Injury and Mental Health        In order to support individuals successfully              in community settings we n...
Brain Injury and Mental Health The future:• Fight stigmatization• Advocate for appropriate housing options• Improve collab...
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Brain injury and mental health 2010[1].pptx bisno

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  • Mental health is a very complex issue to discuss and by sharing this slide show I hope that others will find this to be a helpful tool.
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Brain injury and mental health 2010[1].pptx bisno

  1. 1. Brain Injury and Mental Health A complex, multi-jurisdictional health & social service issuePrepared by : Alice M. Bellavance, RPN, Executive Director, BISNO 2010
  2. 2. Learning ObjectivesIndividuals 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
  3. 3. Brain Injury and Mental Health Commonly seen concerns include difficulties with:• Memory • Memory• Concentration • Concentration• Sequencing • Sequencing• Organizing • Organizing• Planning • Planning• Problem solving • Problem solving• Motivation • Motivation• Socialization • Socialization• Emotional lability • Emotional lability• Agitation • Agitation• Perseveration • Perseveration• Confabulation • Confabulation
  4. 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. 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. 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. 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. 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. 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. 10. Brain Injury and Mental Health Additional variables:• Pain• Seizures• Fatigue• Poor balance & co-ordination• Perceived “malingering”• Impaired family & social supports
  11. 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. 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. 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. 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. 15. Brain Injury and Mental HealthMost 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. 16. Brain Injury and Mental HealthMost 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. 17. Brain Injury and Mental Health Medication management:• Antidepressants• Anti-psychotics• Mood stabilizers• Anti-seizure meds• Medications for substance withdrawal• All require monitoring
  18. 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. 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. 20. Brain Injury and Mental Health Strategies for Impulsivity & Agitation:• Consistent approaches, scripts• Crisis plan• Knowing when to “back off”• Reframing maladaptive behaviours
  21. 21. Brain Injury and Mental Health Positive Behavioural Supports:• Meaningful activities• Replacement behaviours• Strength/interest based programming• Environmental adaptations• Age appropriate reinforcement
  22. 22. Brain Injury and Mental Health Cognitive Enhancement:• Orientation & memory aids• Routines & schedules• Appropriate time for processing• Redirection & cueing• Repetition & role-playing
  23. 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 SystemCommunity Mental Health & Addiction Treatment Programs/services Brain injury Rehab service Associations providers
  24. 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

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