- SELF STUDY MODULES
- 1. Intro to TBI
- 2. Communication
- 3. Skills for independence
- 4. Cognitive changes
- 5. Behaviour changes
- 6. Sexuality
- 7. Case management (BIR)
- 8. No longer available
- 9. Mobility & motor control
- 10. Mental health & TBI:
an introduction - 11. Mental health problems
and TBI: diagnosis
& management - 12. Working with Families
after Traumatic Injury:
An Introduction - 13. Goal setting
- 11.0 Aims
- 11.0A Take the PRE-Test
- 11.1 Mental health & mental illness & TBI
- 11.2 Factors affecting the risk of psychiatric illness after a TBI
- 11.3 The brain and psychiatric illness
- 11.4 Severity of a TBI
- 11.5 Types of mental health problems after a TBI
- a) Mood disorders
- b) Psychotic disorders
- c) Anxiety
- d) Personality
- 11.6 Sam : case study
- 11.7 Diagnostic challenges:
- a) Person with TBI
- b) Inherent in the disease
- c) Social environment
- d) Psychiatry and services
- 11.8 Management challenges
- a) Person with TBI
- b) Medical services
- c) Family
- d) Rehabilitation team
- 11.9 Take home messages
- 11.10 Resources
- 11.11 Take the POST-test
11.7c Social environment: Families & culture
i) social environment
Families
Families have an important role in terms of helping us with managing the patients. They often have the most significant burden of care.
Families also influence diagnosis in a number of other ways.
Relationships as clues to pre-morbid status
If the family is absent or distancing that might provide us with a clue to what the person's pre-morbid status was like, but it also may produce a significant challenge in diagnosis because we do not have anyone who is with that person for hours in a day who can tell us what they are doing, how they are different, what they are like most of the time. Their absence will provide a real problem for management.
Family dynamics will also influence the ability to make an adequate assessment
Pre-existing family dynamics will also influence the ability to make an adequate assessment. In some cultures and communities the male has a very particular role . If there are only female members in the family there can be a real issue for those female members feeling comfortable talking about their husband's or father's behaviour. These pre-existing dynamics will have a strong influence in relation to what they report or do not report.
Families can have hidden agendas
Families can have significant hidden agendas. Particularly in the case of anxiety disorders a spouse or family member may not want to talk about their relative's agoraphobia because the agoraphobia serves a purpose, it reduces their independence and autonomy. The family might like the fact that this person is now much more home bound and more containable in relation to their behaviour.
Shame
While those of us who work in the area of traumatic brain injury or in the area of mental health recognise that brain injury and mental health causes changes in behaviour, that they are illnesses that warrant and deserve treatment, often a family member will be very ashamed of how their loved one is behaving and therefore not disclose or reveal what is going on. This is often the case with wives who are ashamed of how their partner may be behaving and limit the amount of information that they give.
ii) Questions
Answer these questions:
Are the following true or false:
If the family is absent or distancing that could provide us with a clue to what the person's pre-morbid status was like.
If a person with mental illness and TBI is living by themselves that fact will create a significant problem for management.
