11.9 Take home messages

Mental health & mental illness & TBI

Mental health is an integral and essential component of health.
We define mental illness as a person having particular symptoms or behaviour that represents certain types of illnesses that psychiatrists or psychologists may diagnose.

Factors affecting the risk of psychiatric illness after a TBI include:
  • Pre injury characteristics
  • The injury
  • The setting: the social and service context.
The brain and psychiatric illness

The key determinant, of whether or not a person is at risk for psychiatric illness appears to be the location of the lesion at the time of the injury.

Severity of a TBI

Two ways to measure the severity of a TBI are

Glasgow Coma Score
Period of posttraumatic amnesia (PTA).

Types of mental health problems after a TBI

a) Depression
b) Psychosis
c) Anxiety
d) Behaviour & personality change

Diagnostic challenges include challenges related to:

a) Person with TBI
b) Inherent in the disease
c) Social environment
d) Psychiatry and services

Management challenges include challenges related to

a) Person with TBI
b) Medical services
c) Family
d) Rehabilitation team

For example common diagnostic and management challenges for a person with mental health problems and TBI are:

The person with TBI can give you their past history quite clearly but they can not tell what they have done for the past month. The person with TBI can have difficulties with regard to

a) the generativity of speech and/or
b) the comprehensibility of speech.

Often following brain injury a person's attention span may only be minutes to maybe 15 to 20 minutes at most, psychiatric assessments take time. The person with TBI's lack of ability to see that they can have emotions and that their behaviour can be influenced by their emotions.

The person with TBI not expressing distressed emotions but rather developing physical symptoms.

Examples of management challenges that arise from the person’s family are:

Level of expressed emotion
Families hidden agendas impacting on diagnosis and management
Cultural differences for male/female roles parent/child roles
Carers who take care of people with brain injury can get their own mental health problems, this can make it much harder for the carer to actually care