Brain Injury & Multiple Disadvantage
A blog by Anna Tickle, Clinical Psychologist:
Take a moment to appreciate your brain. That 3.3lbs of matter and those billions of neurons allow you to do a lot of things without even being consciously aware. It is normal to take your brain for granted and often only when something goes wrong do we realise just how amazing brains are.
Brain injury results from a lack of oxygen and / or blood to the brain. It can be caused before birth, but is more often 'Acquired Brain Injury' (ABI, also known as Traumatic Brain Injury, or TBI) as a result of physical injury to the head or unconsciousness. There is increasing evidence that individuals who are homeless and / or involved in offending have ABI more commonly than other people. Studies of people who were homeless and had experienced brain injury showed 50 – 70% were injured before becoming homeless.
There is good research evidence that ABI increases the risk of offending and homelessness. People experiencing multiple disadvantage are likely to have higher risk of ABI because of their exposure to causes. For example: domestic violence often places victims at risk due to multiple assaults to the head or strangulation; excessive alcohol and substance misuse can damage the brain directly but also indirectly through falls, overdoses or interpersonal violence; suicide attempts can lead to brain injury; and untreated physical health problems such as asthma, epilepsy or infections can lead to unconsciousness.
Brain injury can have a wide range of consequences, from very mild and brief changes right up to severe and life-long changes. While most people with mild brain injury recovery fully within six months, a minority suffer ongoing changes, which can include physical changes (e.g. with senses or bodily functions), thinking and memory problems, changes in personality and mood, and behavioural changes. These could include difficulties concentrating, feeling motivated to do things, or controlling frustration and anger. Understandably, such changes can lead to mental health problems and difficulties maintaining relationships, jobs, housing and independence. They might also increase the likelihood of people using substances to try to cope, which may impair recovery and increase further risk.
If you work in frontline homeless or offending services, screening for ABI is straightforward – you can ask somebody 'Have you ever had an injury to the head which knocked you out or at least left you dazed, confused and disoriented?' You can also ask if they have ever had a serious illness, infection or overdose that left them unconscious.
You might also complete this 11-question tool with somebody, which is free to download: https://www.thedtgroup.org/foundation/brain-injury-screening-index This cannot diagnose a brain injury, but could support a referral via a G.P. to a specialist.
Referrals to a specialist organisation such as Headway may also help: https://www.headway.org.uk/ A social care referral / assessment may also be useful if an individual is clearly unable to meet their basic needs. More information can be found at the Disabilities Trust and Headway websites and at these sites: