Dual Diagnosis - ABI and Mental Illness Fact Sheet
Apart from the many cognitive effects of an Acquired Brain Injury a person can find themselves struggling with a mental illness. A mental illness can cause additional stress for the person and their family living with Acquired Brain Injury. Forms of mental illness include Depression, Generalised Anxiety Disorder, and OCD.
- What does dual-diagnosis mean?
- How does a dual-diagnosis of mental illness & ABI develop?
- Issues Associated with Dual Diagnosis: ABI and Mental Health
- Treatments and Support
- How can family help
- Issues of support in Australia
What does dual-diagnosis mean?
Unless a person comes from a psychology or health background, the term dual-diagnosis may be unfamiliar. The term ‘dual-diagnosis,’ is generally used when someone is affected by two different conditions at one time. Other related terms include ‘co-morbidity’, ‘co-existing disorders’ or ‘dual-disability.’ The terms used may depend on the country and professional background of a person, For example, a psychiatrist or health professional may commonly use the terms co-morbidity or dual-diagnosis, whereas someone from disability organisation may use the term ‘dual disability.’
A dual diagnosis of mental illness and acquired brain injury means a person has both a diagnosable mental illness and Acquired Brain Injury.
Types of mental illness include:
- Clinical depression
- Schizophrenia
- Bi – polar
- Anxiety disorder
- Personality Disorder
- Social Anxiety Disorder
- Substance Abuse Disorder
For a mental health condition to be diagnosed as a disorder, the condition needs to be of such severity that it interferes with a person’s cognitive, emotional or social abilities (or a combination of these). One of two classification tools may be used to diagnose a mental illness, these include the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, text revised (DSM-IV-TR) and International Classification of Diseases – Tenth Edition (ICD- 10).
There are other combinations of disability that can be classified as a dual-diagnosis. These include co- occurring mental health and substance abuse and spinal cord injury and acquired brain injury.
- In a survey conducted in 2003, of those aged under 65 with an ABI around 42% had psychiatric disability.
How does a dual-diagnosis of mental illness & ABI develop?
A mental illness may have been present prior to a Traumatic or Acquired Brain Injury or it may have developed following a brain injury. Traumatic Brain Injury or Acquired Brain Injury is a risk factor for the development of a mental illness [1]. According to a report released by the Australian Institute of Health and Welfare, as high as 42% of people aged below 65 with ABI report also having a psychiatric disability [2]. Following ABI, people are at a higher risk of developing mental health conditions such as adjustment disorders, depression, anxiety and drug and alcohol addictions. The risk is elevated for a number of reasons some include issues with grief and loss, adjustment to disability, pre-injury personality traits and strengths, coping skills and level of social support [3].
It also works in the other direction. People with a mental health disorder are found to be at an increased risk of Acquired Brain Injury due to changes in cognitive abilities including reaction time, alertness and increased risk of self-harm which may lead to intentional and un-intentional accidents resulting in brain injury.
Issues Associated with Dual Diagnosis: ABI and Mental Health
- Problems associated with a person’s ABI can be heightened by the presence of a mental illness. A mental illness in itself can affect skills in memory, attention and planning.
- Symptoms of brain injury and mental health can overlap and it can be difficult to determine upon presentation, whether difficulties experienced are the result of an ABI or brain injury.
- The brain injury itself can cause symptoms similar to syndromes such as psychosis and dementia, which can increase chance of mis-diagnosis.
- A mental illness can jeopardise the rehabilitation process, by effecting motivation and creating unhelpful coping mechanisms and negative mind set.
- A mental health disorder can exacerbate risks associated with an ABI including social isolation, family breakdown, unemployment, aggression and risk of exploitation [4].
Treatments and Supports
A person with a dual-diagnosis of brain injury and mental illness requires additional support and consideration. Support should be holistic and consider all the needs of the person, include needs associated with the acquired brain injury. Treatment for a mental health condition should be part of the support received for the effects of an Acquired Brain Injury.
Many of the same treatments used for a mental illness can be utilised when a person has an Acquired Brain Injury. Treatments include medication, psychological therapy, and programs focusing on social skills/living skills re-training.
- The first step is to get an appropriate assessment by a qualified specialist, such as a neuropsychologist or psychiatrist.
- A person with an ABI and Psychiatric illness should have a care plan in place if being discharged from a hospital facility that outlines the supports and services to assist the person back in the community. This is important for preventing relapse and re-admission into a psychiatric facility.
- Case Management should be provided to co-ordinate any mental health and ABI services the person it to be receiving.
- Continued follow up and support from a mental health professional, such as a psychiatrist, clinical psychologist or neuropsychologist is important to monitor progress.
How can family help?
If you suspect a mental health issue, it is important to seek advice from an appropriate professional or service. A mental illness often creates additional stress and can worsen the symptoms of Acquired Brain Injury and jeopardise rehabilitation. Once a mental illness has been detected and appropriately assessed, mental illness is highly treatable.
It is important for family members to educate themselves as much as possible on mental illness and acquired brain injury. This helps create a greater understanding of the condition and assist with providing and seeking the appropriate support for your loved one. Contact your local Brain Injury Association for more information.
Issues of support in Australia
People with both an acquired brain injury and mental illness are a vulnerable group. It is not uncommon for people with both conditions to experience difficulties with accessing services. People with an ABI, who have developed a mental illness, may be denied access to mental health services and programs. It is not uncommon for people with ABI and mental illness to be told that because they have an ABI they are best supported by disability services. Some people may go back and forward between the two service sectors. You may like to seek the support of an advocate if this becomes an issue.
A lack of awareness and understanding of acquired brain injury exists in some mental health services. The presentation of ABI and mental health look very similar, so acquired brain injury can be vulnerable to mis-diagnosis if there are no clear medical records. For an overview of the issues faced by members of the community with a dual diagnosis you might like to read the Report on ABI and mental health released by Brain Injury Australia [4].
References
[1] Hibbard, M.R., Uysal, S., Kepler, K., Bogdany, J., & Silver, J. (1998). Axis I Psychopathology in Individuals with Traumatic Brain Injury. Head Trauma Rehabilitation, 13, 24-39.
Van Reekum, R., Bolago, I., Finlayson, M. A. J. (1996). Psychiatric disorders after traumatic brain injury. Brain Injury, 10, 319 – 328.
[2] Australian Institute of Health and Welfare. (2007). Bulletin 55: Disability In Australia: acquired brain injury. Retrieved 18 August, 2009, from http://www.aihw.gov.au/publications/aus/bulletin55/bulletin55.pdf
[3] Victorian Government Department of Human Services. (2004). Acquired Brain Injury and Mental Illness: Protocol between mental health and other services. Retrieved 18 August, 2009, from http://www.health.vic.gov.au/mentalhealth/abi/abiprotocolpaper.pdf
[4] Brain Injury Australia. (2007). Complexities of co-morbidity (acquired brain injury and mental illness) and the intersection between the health and community services systems. Retrieved, 18 August, 2009, from
http://www.braininjuryaustralia.org.au/reports_factsheets/FaCSIA%20-%20ABI%20-%20Mental%20illness%20Dual%20DisabilityPaper-%202007_final.pdf
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