Mental health: brain injury & mental illness (dual diagnosis)
Some people may find
themselves coping not only with the effects of a brain injury, but
also a mental illness.
A mental illness can cause additional stress for the person and
their family after a brain injury. Common forms of mental illness
include depression, anxiety, and obsessive or compulsive behaviour.
A brain injury can be caused by a brain tumour, Alzheimer's
disease, traumatic brain injury, meningitis, encephalitis or
It can be very difficult obtaining support as services are
normally provided specifically for brain injury, or mental illness
- not both.
Living with a brain injury and a mental illness lead to a
very poor quality of life, particularly as there is often also a
dependence on alcohol or other drugs and contact with the criminal
justice system. Life is often a matter of simply surviving each day
with minimal to no support.
What does dual diagnosis mean?
'Dual diagnosis' is used when someone is affected by two
different conditions at one time. It can also be called
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 organization may use the term 'dual
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. Some of the most common
mental health disorders are:
- clinical depression
- bipolar disorder
- anxiety disorder
- Personality disorder
- social anxiety disorder
- substance abuse disorder
The link between mental illness & brain
A mental illness may have been present prior to brain injury. A
brain injury is also known risk factor for developing a mental
illness.1 One report indicates 42% of people as having a
dual diagnosis.2 Issues following a brain
injury that may lead to a mental illness include grief and loss,
adjustment to disability, pre-injury personality traits and
strengths, coping skills and level of social
It can also occur in the other direction. People with a mental
health disorder are at an increased risk of brain injury when
changes in cognitive abilities include reaction time, alertness and
increased risk of self-harm.
Dual diagnosis issues
The effects of brain injury and mental illness can look very
similar, so misdiagnosis is possible if there are no clear medical
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.
The brain injury itself can cause symptoms similar to syndromes
such as psychosis and dementia, which can increase chance of
A mental illness can affect the rehabilitation process due to low
motivation and creating unhelpful coping mechanisms and a negative
A mental health disorder can increase risks associated with a brain
injury, including social isolation, family breakdown, unemployment,
aggression and risk of exploitation.4
Treatment & support
Dual-diagnosis situations require additional support and a
holistic approach, which may include medication, psychological
therapy, and programs focusing on social skills/living skills
The first step is to get an appropriate assessment by a
qualified specialist, such as a neuropsychologist or
psychiatrist. There should be a care plan upon discharge
outlining supports and services in the community to prevent
relapse. Case management should be provided to co-ordinate any
mental health and brain injury services.
It is not uncommon for people with a dual diagnosis
to access support - mental health services will say they need a
brain injury service, but the brain injury services say they should
go to a mental health service. You may like to seek
the support of an advocate to resolve this lack of support for dual
How can family help?
Signs that a mental illness may be developing following brain
- A gradual decline in ability to perform everyday tasks
- Decline in ability to cope with every day stressors
- Increased behavioural issues e.g. anger, frustration,
- Exaggeration of the effects of the acquired brain injury.
Seek advice from an appropriate professional or service for a
suspected mental illness. Read about mental illness and brain
disorders such as traumatic brain injury. Contact your local Brain
Injury Association for more information and local supports.
Steps needed to plug gaps in service
At the policy level, no government agency takes responsibility
for this group of people. This plays out at the service level where
people with a dual diagnosis are bounced back and forth between the
disability, health and homelessness sectors. The following
recommendation would go a long way to plugging the gaps in service
- Dual diagnosis recognized by governments at the policy
- Psychiatric and disability groups in partnership with a focus
on the client
- Training on dual diagnosis is required within mental health
- Neuropsychiatric services within mental health services
- Crisis teams experienced in dual diagnosis
- Screening for brain injury within the criminal justice
- A 24 hour dual diagnosis crisis team is needed.
References and further information
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.
2 Van Reekum, R., Bolago, I., Finlayson, M. A. J. (1996).
Psychiatric disorders after traumatic brain injury. Brain Injury,
10, 319 - 328.
Australian Institute of Health and Welfare. (2007). Bulletin 55:
Disability In Australia: acquired brain injury. Retrieved 18
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.
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/docs/FaCSIA%20-%20ABI%20-%20Mental%20illness%20Dual%20DisabilityPaper-%202007_final.pdf