Mental Health Care Following Brain Injury

What most people know about brain injuries is what they see in movies and on TV programs, which is almost always inaccurate. People don’t wake up from a brain injury, walk out of a hospital and get on with their lives without any repercussions. In reality, cognition and mental health are often impacted by a brain injury, and the treatment and recovery process can be complicated and long.

In fact, an estimated 5.3 million Americans live with a brain injury-related disability involving physical and/or mental health. A brain injury can impact thoughts, feelings and action, and it increases the risk for a host of mental health and neurobehavioral disorders, including anxiety, post-traumatic stress disorder (PTSD), depression and substance abuse.

Those with brain injuries often experience mood or behavior changes that are evident right after the injury as they are undergoing rehabilitation in an inpatient or outpatient setting. But not all symptoms show up immediately. In fact, 1 in 5 people may experience mental health symptoms up to six months after a traumatic brain injury (TBI).

For those with a mild brain injury, cognitive and behavioral changes may be temporary. However, a patient with a more serious TBI that caused bruising, bleeding and other physical damage should be followed for an extended period to watch for new symptoms.

Common Symptoms

Brain injuries may cause personality changes, such as acting impulsive, irritable, unstable and apathetic. It is not unusual for patients to be more explosive and aggressive than before the injury. Patients also can be more withdrawn and quieter, and fluctuate between being reserved and boisterous.

Common cognitive, behavioral and mental symptoms include:

• Memory or concentration problems
• Confusion or disorientation
• Mood swings or changes
• Agitation and combativeness
• Behavior regulation problems
• Sleeping more or difficulty sleeping
• Feelings of depression, anxiety and/or anger

Treatment and Recovery

In addition to physicians, nurses and physical, occupational and speech-language pathologists, an important member of the brain injury treatment team is the neuropsychologist, who supports the patient’s mental health. Neuropsychologists specialize in how brain function relates to neurological and physical function. They work with patients and their families to help face diagnoses, conditions and disabilities.

For example, when a patient undergoes inpatient care at Good Shepherd Rehabilitation Hospital, a neuropsychologist helps the patient and family understand the injury and changes experienced. A neuropsychologist supports the patient in processing feelings about the injury and recovery, and provides a realistic look at what the future may hold.

During inpatient treatment, a neuropsychologist works one-on-one with patients to process trauma and address coping skills, manage anxiety, address feelings and solve sleep issues. Imagery, meditation techniques and exercise are used often.

“It is sometimes hard for patients and their families to know what life is going to look like following a brain injury,” said Kaitlin P. Fiedler, PsyD, clinical supervisor and training director for Good Shepherd Psychology Group. “Neuropsychologists help them address their feelings and fears, and support their grief for cognitive and physical losses and changes. We offer encouragement and strategies to help them move into the future.”

The Family’s Role

Because brain injuries impact families and not just patients,  neuropsychologists discuss expectations and roles with patients and loved ones. Neuropsychologists prepare families for when patients go home and explain the importance of family support for daily routines (e.g., getting up at the same time each day), exercising, eating well, taking medication consistently and doing assigned cognitive activities. Many patients whose recovery progresses well have family members who are highly involved.

Transition to Outpatient

When patients are ready to be discharged to home and transition to outpatient treatment, neuropsychologists work with patients’ care team and set up outpatient care, such as counseling, psychotherapy and substance abuse treatment (if necessary). Neuropsychologists follow patients as they return to work, school or any life setting, and recommend accommodations or additional treatments to further aid patients’ progress.

Impact on Caregivers

When a person with a brain injury returns home, family members often are the main caregivers. Despite good intentions, caregivers may end up feeling anxious, burdened, angry or depressed.

Mental health care of caregivers goes beyond developing self-resilience. They often need ongoing information and resources, emotional and social outlets, and psychological support to remain healthy and mentally capable of supporting their loved ones.

Support Groups

To encourage self-care, Good Shepherd Rehabilitation’s Caregiver Support Group provides presentations or discussions focused on the caregiver, including stress management, processing emotions and coping, financial/life planning and local resources. Meetings are held virtually at 6 p.m. on the third Tuesday of each month. Check Good Shepherd’s events calendar for upcoming meetings.

In addition, Good Shepherd hosts the Lehigh Valley Head Trauma Support Group for adults with brain injuries, their families and friends, medical and rehabilitation professionals and all people working to promote better understanding, treatment and quality of life for people with brain injuries. Meeting are held at 6:30 p.m. on the third Thursday of each month at Good Shepherd’s Hyland Center for Health & Technology in Allentown. Check Good Shepherd’s events calendar for upcoming meetings.

For more information on Good Shepherd’s comprehensive brain injury rehabilitation services, call 1.888.44.REHAB (73422) or contact us online.