People who have suffered brain injuries do no belong in psychiatric hospitals

ON behalf of Headway, the national association for Acquired Brain Injury (ABI), I would like to express my disappointment at the apparent mismanagement of funds in relation to the care of brain-injured patients in the public health system as highlighted in your report headlined ‘Security bill for patient heading for €1 million’ (September 13).

The report highlighted the cost of keeping a single man in his 30s under constant secure supervision in the acute psychiatric unit at Ennis general hospital.

This raises two issues that require immediate attention and action on behalf of the HSE and Government.

Firstly, the fact that this man’s difficulties seem to stem from a traumatic brain injury in 1999 would suggest his placement in a psychiatric unit was wholly inappropriate to his organic care needs. For this, the blame cannot be apportioned to the professionals involved in this man’s primary and ongoing care, but to the complete lack of foresight in the health service that has led to the current dearth of essential rehabilitation units equipped to deal with challenging behaviour in the aftermath of brain injury.

There is an acute and definite distinction between ABI and psychiatric disorders/mental health issues and though the two are very often interlinked, the approach taken to the treatment and rehabilitation of ABI is significantly different to the management of psychiatric illnesses.

Unfortunately, because there is often no alternative, adults with traumatic and acquired brain injuries are frequently transferred to psychiatric and secure residential units insufficiently prepared to manage the specific behavioural, cognitive, emotional and physiological after effects of brain trauma. The plasticity of the brain means that specific neurobehavioural techniques and practices are required in the management of challenging behaviour post-ABI; this requires specialised training and psychological intervention, something that cannot be expected of the already massively overstretched mental health and psychiatric services in this country.

To align mental health patients with ABI patients is to misunderstand and therefore run the risk of mistreating the complex and distinct difficulties of both.

A greater awareness of ABI is required from the Government so that funding can be channelled into providing the correct neurobehavioural facilities required adequately to meet the needs of the vastly increasing numbers of brain injury patients filling Irish hospital beds each year.

This brings us to the second point – the need to correct the appalling lack of foresight and the management of health funding which has thus far seen almost €1 million spent on keeping a single patient under lock and key for the past two years. If this figure relates to security alone, the cost of maintaining this man in the current environment is far higher.

Apart from the quality of life issues there are numerous ways in which this funding could be more creatively used with a coalition of specialists to achieve better outcomes for all, particularly the person in question.

There are many people with ABI languishing in secure wards and nursing homes throughout the country because of lack of knowledge of the complexity of brain injury and the specialist services that exist. The need for more rehabilitation centres like the National Rehabilitation Hospital in Dun Laoghaire and the need for new, long-term residential neurobehavioural units across the country grows ever more pressing with each year. Estimated figures suggest that there are currently around 30,000 adults living with ABI in Ireland now. Of this figure, only a fraction have at some stage since their injury received specialist rehabilitative care or are currently linked in with existing brain injury services. There are many people who have not yet been recognised by the system as having a brain injury and this poses a significant challenge for the person, family or carers and, ultimately, society.

This is a situation that can no longer be ignored and brain injury patients should no longer be marginalised. Action is required to correct the current unworkable system and replace it with a strong rehabilitative care model equipped to meet the needs of all types of ABI patients at every stage along the recovery process.

Kieran Loughran

CEO

Headway

Manor Street Business Park

Dublin 7