The Complexities of Acquired Brain Injury Care

Dr. Omar Ghaffar explored the gaps that are present in the care of patients with acquired brain injury (ABI) at the Grand Rounds presentation held on April 30 at Ontario Shores.

Acquired brain injury is damage sustained to the brain after birth. Causes of ABI range from traumatic (such as motor vehicle accidents or falls) to non-traumatic (such as stroke or infections.) Persons with ABI are at a higher risk of mental health related illness. Individuals with ABI have three times the number of mental health related hospitalizations than people suffering from mental illness without ABI. Depression is the most common mood disorder in ABI. This may be a reaction to the injury or a result of the injury - improved insight into behavioral and cognitive impairments with time may be associated with depression.

Forty-eight per cent of individuals with ABI who attempted suicide made a second attempt within one year.

“Suicide is a significant issue in ABI,” Dr. Ghaffar noted. “People who have suicide attempts need to be followed.”

Dr. Ghaffar’s presentation focused on two cases: a patient who was unable to access specialized care due to the severity of psychosis experienced after ABI as well as stigma and mistrust of mental health services (Case 1,) and a patient who could not leave specialized care due to residual psychiatric symptoms as well as cognitive impairment making discharge difficult (Case 2.) 

In Case 1, the patient had difficulty functioning in the community and had no housing options because he was not considered stable enough to live in a group home or similar setting. These factors coupled with family stigma and mistrust of mental health services left him unable to access the specialized services he needed.

In Case 2, the patient was able to access services and responded to treatment – but not completely. The residual symptoms she experienced made discharge difficult and left her unable to exit specialized services.

In both cases, Ontario Shores worked closely with Community Head Injury Resource Services (CHIRS) to determine a plan of action for each individual patient. The collaboration between the hospital and community service was fundamental in the recovery of each patient. Program development and evaluation plays an important role in the future of rehabilitating patients with ABI and mental illness. In Case 1, CHIRS was the first to engage this relationship and the patient was able to be stabilized and gradually weaned back into the community after several months. Intensive community support was required, but the outcome was positive. The patient was able to reintegrate into the community.

“We learned from our community partners, and they from us,” Dr. Ghaffar said.

Case 2 also had a successful outcome due to collaboration between the hospital and community services. The patient had her primary goal of acquiring her own apartment and living alone achieved. The NPS units’ collaboration with CHIRS enabled the service to support a patient they otherwise would have been reluctant to because of her residual psychiatric symptoms.

Based on these cases, Dr. Ghaffar believes enhanced collaboration between neuropsychiatric services and community partners is needed. This may improve health outcomes by increasing access to evidence based care while improving patient experience and value to the healthcare system. Dr. Ghaffar also noted that moving forward, it is important to better define, operationalize, and measure our therapeutic model of care in order to harmonize outcome measures with community partners.