As National Road Victim Month draws to a close, it is crucial to reflect on the often-overlooked psychological consequences of road traffic accidents (RTAs). Each year, 1.35 million people lose their lives in road traffic collisions globally, while at least 50 million survivors are left grappling with the aftermath of their injuries1. In the UK alone, road traffic collisions contribute to approximately 20,000 traumatic brain injury cases annually, with around 5,000 being moderate to severe2. On a global scale, this figure reaches an alarming 34 million cases each year.
Traumatic brain injuries, a type of acquired brain injury often sustained in RTAs, are not only life-changing but can also significantly impact mental wellbeing. The relationship between brain injury and mental health is complex, as both are linked to dysfunctions in the neurological pathways of the brain4. This overlap can exacerbate existing mental health conditions or give rise to new challenges, making the need for enhanced understanding and effective treatment even more pressing.
This blog will explore the mental health challenges that stem from ABIs as a result of RTAs and discuss how home-based mental health care can offer an effective, personalised approach to managing these complex issues.
Understanding traumatic acquired brain injuries from RTAs
Defining acquired brain injuries
An Acquired Brain Injury (ABI) refers to any damage to the brain that occurs after birth, with common causes including falls, tumours, strokes, and road traffic accidents (RTAs)5. There are two main types of ABIs: traumatic and non-traumatic. In the context of RTAs, traumatic brain injuries (TBIs) are of particular concern. A TBI is defined as an alteration in brain function or evidence of brain pathology caused by an external force6. The blunt force trauma often experienced during an RTA can bruise the brain, tear tissues and damage nerve cells, leading to a range of cognitive, emotional, and behavioural changes7.
Cognitively, individuals with moderate-to-severe brain injuries often face difficulties with basic thinking skills, such as with concentration and focusing on tasks, as well as learning and recalling new information. They may become easily confused, particularly when routines are disrupted or when their environment becomes too noisy or hectic8.
Emotionally and behaviourally, the impact of a TBI can be profound8. These changes may stem directly from damage in the frontal lobe, which is responsible for regulating emotion and behaviour8. Cognitive difficulties can exacerbate emotional challenges, leading to frustration and distress in situations that previously would have been manageable8. Additionally, the life changes brought on by a TBI – such as job loss, changes in family roles, and the need for supervision – can contribute to feelings of frustration, depression, and anxiety8.
Psychological impact of acquired brain injuries
The psychological effects of ABIs are wide-ranging and complex, often leading to significant mental health challenges that require professional treatment. Traumatic brain injuries (TBIs) are associated with a host of psychiatric and neurobehavioral problems9. Over the past two decades, there has been a significant increase in understanding the intricate relationship between TBIs and mental health9. As survival rates for moderate-to-severe TBIs have improved, attention has shifted to the neurobehavioral consequences of these injuries10. Even mild TBIs (mTBIs), once considered relatively benign11, are now recognised as a major cause of mental health morbidity12-13.
One of the most concerning mental health challenges following a TBI is Post-Traumatic Stress Disorder (PTSD). While it was once argued that PTSD was an uncommon impact since loss of consciousness and amnesia were thought to be protective against developing the condition14, it is now evident that this is not true. The traumatic events leading to an TBI, such as an RTA, can be emotionally scarring. Recent studies have shown that TBIs significantly increase the risk of developing PTSD9, though the exact mechanisms behind this are still being explored. Potential causes include damage to neural circuits involved in fear response15, cognitive impairments that reduce coping capacity16, or inflammatory responses following brain injury17.
Additionally, TBIs have been strongly associated with an increased risk of suicidality. Research indicates that individuals with TBIs are at a heightened risk of completed suicide, even when pre-existing risk factors – such as depression – are accounted for18-19. Moreover, the development or exacerbation of anxiety and depression is frequently observed following a brain injury20-22:
- Anxiety: A brain injury can increase the likelihood of a patient developing an anxiety disorder due to the changes in cognition, behaviour, and emotions that come with the impact of the injury on the brain’s functioning. Individuals with low self-esteem or poor coping mechanisms prior to the injury may be particularly vulnerable to anxiety disorders20. Post-injury anxiety can stem from physical damage to brain regions responsible for hormonal and behavioural regulation – such as the amygdala, hippocampus, cingulate gyrus, pituitary gland, and hypothalamus21. Other contributing factors include concerns about recovery, the effects of the injury, changes in relationships and income, and the circumstances surrounding treatment (e.g., hospitalisation or the trauma of the accident itself)21.
- Depression22: depression is another common mental health issue following an ABI, with about half of individuals with TBIs experiencing depression within the first year post-injury, and up to two-thirds affected within seven years. Depression may also arise from damage to brain regions that regulate emotions, as well as changes in neurotransmitter levels. Additionally, depression can result from the struggle to adapt to new or ongoing disabilities, losses, or changes in family and societal roles during and after recovery. Individuals with a genetic predisposition, personal or family history, or other pre-injury influences may face an elevated risk of depression.
Importance of early intervention
Recognising and addressing the psychological impacts of an ABI early is crucial for improving long-term outcomes. Early intervention can help mitigate the severity of mental health challenges and support the individual’s recovery process. Healthcare professionals and families should be vigilant for signs of psychological distress in ABI patients, such as mood swings, irritability, difficulty concentrating, and changes in sleep or eating patterns.
Early treatment, including both medical and psychological support, can significantly improve the quality of life for those affected by ABIs and prevent the escalation of mental health issues.
Challenges in traditional mental health treatment for ABI-related mental health conditions
Traditional in-clinic mental health care presents several limitations for individuals grappling with mental health conditions stemming from ABIs. One of the foremost challenges is accessibility. For many ABI survivors, commuting to therapy sessions is not merely an inconvenience but a significant hurdle. The journey often necessitates travel by car, which can trigger severe anxiety or PTSD symptoms, especially in those whose injuries resulted from RTAs. The very act of getting into a vehicle could evoke traumatic memories, making consistent attendance at in-clinic sessions daunting. Furthermore, traditional therapy settings may lack the controlled environment necessary to manage the multifaceted symptoms of ABIs. The unfamiliarity and potential overstimulation of clinic environments can hinder therapeutic progress, emphasising the need for more adaptable treatment approaches.
The ripple effects of ABI-induced mental health challenges extend beyond the individual, profoundly impacting families and support systems. Caregivers often find themselves navigating uncharted territories of emotional and psychological strain. Recognising the pivotal role families play in recovery is essential. Involving family members in the treatment process not only alleviates caregiver burden but also enhances patient outcomes. For example, a 2014 study involving over 200 veterans with serious mental health challenges found that increased family participation led to reduced symptom severity and expedited recovery23.
The psychological benefits of a supportive home environment are well-documented. For instance, family involvement has been shown to lessen residual psychotic symptoms in patients with schizophrenia and aid in early detection of relapse warning signs24-25. In cases of depression, early family intervention can mitigate the severity of depressive episodes26. Moreover, sustained family engagement can lead to fewer relapses, prolonged periods between episodes, and improved adherence to personalised mental health care plans23, 27-30.
These insights underscore the necessity for a multidisciplinary approach to mental health, one that integrates home-based mental health care and actively involves family support to address the unique challenges faced by emotional support for brain injury survivors.
Benefits of at-home mental health care for those living with ABI-induced mental health challenges
Home-based mental health care offers significant advantages for high-profile or discerning, high-net-worth individuals, particularly those grappling with mental health challenges stemming from traumatic ABIs. The privacy and discretion afforded by home-based care are crucial for those in the public eye, allowing them to receive the support they need without the risk of public exposure. Moreover, the comfort and familiarity of being treated in a patient’s own home around their family support network can greatly enhance the therapeutic process, creating a safe environment where patients feel more at ease and receptive to treatment. This personalised mental health care approach allows for tailored treatment plans that align with each individual’s unique needs and lifestyle, ensuring optimal outcomes in a secure and private setting.
Integrative mental health care approach that addresses the whole person are also essential in this therapeutic model. This means combining traditional therapies, such as Cognitive Behavioural Therapy (CBT), with complementary practices like mindfulness, meditation, and physical health routines, including good nutrition and sleep hygiene. This whole person approach ensures that all aspects of the individual’s wellbeing are considered, supporting not just the reduction of symptoms but also the enhancement of overall quality of life. By integrating these therapies, a multidisciplinary approach to mental health treatment can be offered, fostering resilience and promotes sustainable recovery for those living with ABI mental health challenges.
Tailoring home-based mental health care for ABI-induced mental health challenges
Creating a customised care plan
Every individual living with mental health challenges stemming from ABIs requires a personalised approach to treatment. Given the complexity of ABI-induced mental health treatment, especially when such injuries are the result of traumatic events, it’s crucial that care plans are tailored to address the specific needs of each patient. Each case can vary dramatically, not only in the physical manifestations of the brain injury but also in the psychological and emotional responses. For instance, a patient may be dealing with survivor’s guilt, PTSD, and even family bereavement alongside their ABI symptoms. Therefore, a customised care plan must focus on treating the underlying causes of these challenges, rather than just addressing the surface-level symptoms. By developing personalised mental health care plans, all aspects of patient wellbeing are considered, leading to more effective recovery strategies.
Role of multidisciplinary teams
Effective home-based mental health care for ABI-induced conditions hinges on a multidisciplinary approach to mental health. This involves a coordinated effort from a diverse team of professionals – including psychiatrists, therapists, holistic practitioners, nutritionists, and mental health support workers. By combining expertise from various disciplines, providers can offer comprehensive care that addresses the full spectrum of mental health challenges faced by ABI survivors. This team-based approach to ABI treatment ensures that all areas of a patient’s life are supported; from emotional, spiritual and psychological wellbeing to physical health and nutrition.
Emotional and practical support
Providing robust emotional support for brain injury survivors and their families is fundamental to fostering long-term recovery. In addition to professional interventions, practical support at home is essential for helping patients regain their independence and navigate daily challenges. Creating such an environment that promotes sustained recovery and enhances overall quality of life requires reducing the stigma associated with mental health conditions and offering continuous, compassionate care.
Comprehensive ABI-induced mental health treatment at-home
The effective and sustainable treatment of ABI-induced mental health conditions present complex and multifaceted challenges. Throughout this blog, we’ve explored the profound psychological impact of ABIs, the limitations of traditional treatment approaches, and the significant benefits of home-based mental health care. By adopting integrative mental health therapies and creating personalised mental health care plans, we can better address these unique needs, fostering resilience and long-term recovery.
For healthcare professionals, it is crucial to consider the advantages of home-based mental health care for patients facing these challenges.
Find out more about Orchestrate Health’s comprehensive, multidisciplinary approach to mental health can provide the tailored support your patients need. Visit our website or contact us to learn more about our specialised services.
References
- World Health Organization, Global status report on road safety 2018
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914876/
- https://pubmed.ncbi.nlm.nih.gov/29701556/
- https://www.headway.org.uk/about-brain-injury/individuals/brain-injury-and-me/mental-health-and-brain-injury/
- https://www.headway.org.uk/about-brain-injury/individuals/types-of-brain-injury/
- https://www.biausa.org/brain-injury/about-brain-injury/nbiic/what-is-the-difference-between-an-acquired-brain-injury-and-a-traumatic-brain-injury
- https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
- https://msktc.org/tbi/factsheets/understanding-tbi-part-2-brain-injury-impact-individuals-functioning
- https://www.sciencedirect.com/science/article/pii/S0006322321016413#bib6
- https://www.tandfonline.com/doi/pdf/10.3109/02699059009026156
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562956/
- https://www.psychiatrist.com/jcp/military-sports-related-mild-traumatic-brain-injury-clinical-presentation-management-long-term-consequences/
- https://jamanetwork.com/journals/jama/article-abstract/2757430
- https://www.tandfonline.com/doi/abs/10.3109/02699059509005780
- https://psychiatryonline.org/doi/full/10.1176/appi.ajp.2009.08101604
- ResearchGate, Disentangling Mild Traumatic Brain Injury and Stress Reactions
- https://www.tandfonline.com/doi/abs/10.3109/02699052.2013.873821
- https://academic.oup.com/aje/article/186/6/668/3863002
- https://journals.lww.com/headtraumarehab/abstract/2021/01000/risk_factors_for_suicidal_ideation_following_mild.11.aspx
- https://www.health.qld.gov.au/__data/assets/pdf_file/0027/435357/anxiety_abi_mh.pdf
- https://www.headway.org.uk/media/12016/anxiety-after-brain-injury-publication.pdf
- https://msktc.org/tbi/factsheets/depression-after-traumatic-brain-injury
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8801858/
- Cambridge Core, Behavioural Family Management in Schizophrenia
- https://jamanetwork.com/journals/jamapsychiatry/article-abstract/481583
- https://www.tandfonline.com/doi/abs/10.3109/09638239209034511
- https://www.tandfonline.com/doi/abs/10.1080/10973439908408388
- Cambridge Core, The Salford Family Intervention Project
- https://www.sciencedirect.com/science/article/abs/pii/S0006322300009318
- https://journals.lww.com/psychopharmacology/abstract/2011/02000/the_role_of_the_family_and_improvement_in.15.aspx
