Intersectionality With Brain Injury
Brain injury can create mental health problems in children, youth and adults and it can worsen pre-existing issues, even with a concussion level injury (mild). A mild injury does not necessarily mean a mild outcome. As high as 75% of the people looking for mental health and substance use treatment also have a brain injury. Six months to one year following a brain injury, one third will experience a mental health problem and that number will grow over time. “People with brain injury of any severity have 2 to 4 times the risk of attempting or having a death by suicide.”
Common mental health issues following brain injury in childhood include “depression, anxiety, personality changes, psychosis/paranoia, secondary attention deficit/hyperactivity disorder, oppositional defiant disorder, post-traumatic stress disorder and mania/hypomania.”1 Adults with brain injury are more likely than those without an injury to experience “mood disorders, anxiety disorders, psychotic disorders and substance abuse disorders,1 as well as personality changes, decreased self-awareness, suicidality and socially inappropriate behavior.
People with brain injuries often have cognitive and physical changes in addition to the mental health changes listed above. Cognitive changes can include decreased attention, memory, self-awareness (including awareness of changes and their impact), judgment, decision-making and reasoning, as well as increased impulsivity. They can have difficulty picking up on social cues and may act inappropriately. Sometimes symptoms are unseen and therefore untreated. Sometimes symptoms are seen but misattributed to other things, like lack of interest in treatment or purposeful non-adherence.
People seeking mental health treatment should be screened for a lifetime history of brain injury and provided with accommodations that fit their symptoms. Voluntary cognitive screening may also be offered.
Administration for Community Living’s Behavioral Health Guide: Considerations for Best Practices for Children, Youth, and Adults with TBI contains, among other useful information, evidence-based MH treatments for people with brain injury.