The Chicken or the Egg: Brain Injury and Mental Health Problems

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Written by Nick Adams

Looking for the cause of mental health problems will take us in many different directions: a neurochemical problem, the end product of negative life experiences including trauma or a change to behavior, cognition and emotions caused by an injury to the brain? Or, perhaps there is a combination of factors which cause disruption in thinking, feeling and relating; essentially affecting all aspects of a person’s life. If we look at the statistics, approximately 25% of the people living with mental health problems have experienced a brain injury. In the population of incarcerated individuals, studies show a jump to 70% with higher numbers for women than men and brain injury is found in 80% of individuals who are homeless. Are we missing something in understanding the role of injury to the brain and its link to mental health and addiction problems, social conduct, relationships and an ability to work?

In the movie “Concussion” we see the former Pittsburgh Steeler, Mike Webster, living in his truck, hearing voices, engaging in self-damaging acts and unable to relate to his former teammate trying to reach out to him. It wasn’t until his autopsy that a problem was identified which was associated with his multiple concussions over years of playing football. And, in the movie we see the demise of his fellow players including Strelyzk, Waters, Duerson, Seau and others whose tragic suicides came when they realized they could no longer function and didn’t understand the cause. We learned from the autopsy results that they all had the same condition as Mike Webster, Chronic Traumatic Encephalopathy as it was first identified by Dr. Bennet Omalu and later by other researchers.

But football is not the only cause of the type of brain injury.  The causes of brain injury are widespread: motor vehicle accidents, falls, fights, child and domestic partner abuse, other sports injuries, high fevers, childhood accidents, ingestion of toxic substances, excessive drug and alcohol use, “black outs”, exposure to explosions in the military to name a few. In the screening of people entering into mental health facilities, usually in crisis, do we ask the right questions about their exposure to brain injury in their past? If they have a brain injury which affects memory, would they be able to answer questions accurately? Are these the individuals who have histories of crisis admissions followed by relapse?  Are they able to remember to follow-through with their discharge plans, including remembering to take medication? Does their employment fall apart? And, what about their relationships with family and friends? Is brain injury the cause of the problems, but we don’t see it because we don’t ask about it?

There are probably many more people living with the effects of brain injury than we can imagine. Certainly, there are many people who had a brain injury who live perfectly normal lives. But, there is this group of individuals with persistent mental health problems which significantly disrupts their lives and is the cause of ongoing crisis who could have brain injury as a factor to look for in assessment. We could blame them for non-compliance with treatment or medication or we could look at other factors which could be the cause of their mental health problems.

Mike Webster’s estranged wife said that she would have been more forgiving if she knew that his brain injuries were the cause of his problems. Are we asking about the brain injury before it’s too late? In mental health work we usually see people in crisis. That is not the easiest time to gain all the facts, but is an opportunity to begin asking questions: Did you ever have a brain injury? Were you ever unconscious? Were you hit in the head as a child or adult?  Did you get hurt playing sports? Were you involved in active combat in the military? Did you box, play hockey, football in any sport where you hurt your head? We need to ask these questions about past brain injuries to better understand the problems the person is experiencing and how we can best help them.

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