On June 28, 2016, Amy Daniel from Bridges: Northern Kentucky Brain Injury Support Group spoke about the relationship between Traumatic Brain Injury (TBI) and mental disorders. TBI can lead to mood, personality and behavioral changes. Individuals suffering from TBI are also at a higher risk of experiencing psychiatric problems such as depression and anxiety and are at a higher risk of inflicting acts of violence, abuse and neglect. Unfortunately, mental health intervention is often lacking in long-term treatment for TBI and vice versa. To combat this problem, Bridges and NAMI NKY (National Alliance on Mental Illness) advocate an understanding that TBI is serious. Diagnosis and determination of medical treatment should include psychiatric evaluation. Follow through and follow up of treatment is also vital. For more information about TBI and Bridges, visit http://www.bridgesnky.org/.

1. Amy Daniel, RN, MSN, CNOR
Support Group Facilitator
Phone: 513-265-5889
danielamy@fuse.net
Brain Injury and Mental Illness :
Symptom Overlap

2. What is aTraumatic Brain Injury
• TBI is aWorldwide Health Problem “Silent Epidemic” (limited knowledge
about the issue and its symptoms.
• Greater than 1.4millionTBI’s occur each year with 50,000 fatalities and the
remaining treated and released with varying levels of disability.
• In excess of 5.3 million people live suffering long term disabilities fromTBI.
• AcquiredTBI is caused by falls, traumas, traffic accidents, violence,
drownings, overdose, unsuccessful suicide attempts, strokes etc.

3. Symptom Overlap:
TBI DisruptsThought Processes
• Attention problems (concentration, tracking, filtering)
• Memory impairment
• Conceptual disorganization
• Altered causal or logical reasoning
• Executive dysfunction (e.g., planning, organizing, prioritizing,
• staying on-task/ focus and attention

4. Symptom Overlap:TBI Can Lead to
Personality and Affective Changes
• Mood changes, including depression, anger, mania, or decreased control of
emotions/behavior
• Affective blunting or lability
• Paranoia, hallucinations
• Unusual beliefs or delusions/ misunderstanding of social cues
• Psychiatric Disorder rates for incidence and prevalence is higher postTBI
than in the general population. (Schwarzbold et al.)

5. Psychiatric Problems Increase
Risk of Brain Injury/ Reinjury
• Vassalo et al. (2007) studied psychiatric risk factors forABI in a sample of
3766 non referred community dwelling US veterans.
• Depressed persons were at 2 ½ times greater risk of brain injury.
• Persons with anxiety and conduct disorders were at 60% greater risk ofTBI.

6. Violence, Abuse and Neglect afterTBI
(Reichard et al, 2007)
• If this small (N=9) qualitative study is accurate, this is a significant problem
• BI survivors vulnerable to violence and neglect for number of reasons
• Reports of abuse by persons with brain injury often discounted
• Participants suggested strategies for prevention: support systems, anger
management skills, prevention of drug and alcohol abuse, public education
regardingTBI.

7. Lack of Mental Health intervention withTBI
leads to a Big Problem, with a Broad Impact
• Increased Medicaid expenditures for persons with both BI and mental illness
(Wei et al. 2005).
• More than 40% of homeless hospital admissions with schizophrenia-like
symptoms had history ofTBI (Silver &McKinnon, 1993).
• Of 15 death row inmates, all had history of severe brain injury and 9 had
recurrent psychoses preceding incarceration (Lewis et al. 1986).

8. Treatment Models and
Approaches

9. Treatment Models:
The BIG Band-Aid with HOLES
• Brain Injury: Rehabilitation through skills re building and compensatory
strategies largely do not incorporate Mental illness treatment.
• Crisis (Band-aid) is early in treatment only with pediatric and adultTBI
survivors.
• Mental Illness: Habilitation, skills building long term are difficult to access
• Alliance (It takes a village…) (100%Access)

10. Treatment Strategies
• Physical crisis management skills in the community/ law enforcementTBI
education
• Support groups (BRIDGESNKY)
• Support the natural supports/ caregiver mental health services.
• An ounce of follow-up is worth a pound of crisis intervention.
• Psychiatric consultation is a key component

11. Importance of Psychiatric/Mental Health
Intervention
• Understanding of brain injury critical: Diagnosis and determination of cause
guides medical treatment and should include psychiatric treatment.
• Potential causes of mental health sequela withTBI:
• Posttraumatic seizure/ Migraines
• Untreated Depression/ Mania.
• Ongoing or past substance abuse.
• Schizophrenia-like disorder.
• Determine Medication management most effective in context of
psychotherapeutic support with consideration of TBI.

12. What Is Needed?
• We need specialists with skills in several areas:TBI, mental illness, substance
abuse.
• It takes a village: structure, supports and ongoing follow-up.
• A village with resources does a better job than one without.
• Political advocacy as part of the process at Local, State and Federal level.
• A coalition of brain injury, substance abuse, and mental health advocates
speaking in one voice.

13. Thank you for your interest in helping
Brain Injury Survivors! Like mine.
Friday, March 31, 2017
11th Annual NKY TBI Conference
Applicable Strategies for TBI Recovery
Receptions Conference Center, Erlanger KY
Contact: Julie Fronk
julie@bridgesnky.org
text/phone: (859) 802-4077
Visit: bridgesnky.org