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Treatment Considerations for TBI and Suicide by Charles Watson


Posted on March 1, 2021

“It built up over a long period of time...problems that have been brewing over the last 20 or 30 years just finally kind of all added up together and you know, just kind of exploded...” (TBI Survivor) 

Some people may complain of poor concentration, poor sleep patterns, agitation, and mood swings. They are diagnosed with bipolar disorder or ADHD (attention deficit hyperactivity disorder). However, the medications did not work as expected; the stimulant makes them more aggressive, and the mood stabilizer, sleepier. 

On careful investigation, the underlying cause lies in the history- brain injury that happened years back. It can be a mild injury, an ABI, or multiple concussions, usually due to sports or a closed head injury.

All neurological symptoms disappear within a week. But a quarter of them will suffer from chronic mental health issues. Studies suggest that this may be due to specific abnormal communication in brain regions that control cognition and emotions or progressive neurodegenerative disease.

Post-TBI individuals are 81% more likely to experience chronic suicidal ideation or behavior than those without a history of brain injury.

Suicide and TBI sufferer 

“The worst feeling is like there’s nowhere else to go or nothing else to try” (TBI survivor).

Suicidal thoughts can be precipitated by loneliness, lack of support and connection, social anxiety, holiday times, employment or job issues, and bad news about prognosis.

If you are considering suicide, you should know that you are not alone and that many people consider it at some point. It is important to understand that it is not easy to deal with physical and mental issues, but this crisis will also pass. Be open about your problems because your family members, friends, and doctors know how you feel and can help you. 

Effective Communication Techniques:

A combination of techniques can be used to convey support:

  • Active listening –nodding and responses like okay, sure
  • Meaningful eye contact and supportive body language
  • Asking permission: I want to help you; let me hear you out.
  • Understanding what the person is feeling: I can see you’re upset 
  • Understanding the content: it seems you need to take up a hobby to keep yourself busy
  • Summarizing and paraphrasing: ‘At the moment, you are feeling overwhelmed. 

Do not use these techniques when offering support to people in distress:

  • Inappropriate use of facts: ‘you’ll very soon recover from your brain injury.’
  • Disrespect the person’s feelings: ‘come on, it must not hurt that bad.’
  • False reassurance: ‘don’t worry; everything will be fine.’
  • Confrontation: ‘learn to accept the fact that you’ll never be normal again.’
  • Probing or intrusive questioning: ‘why do you think you’re unable to keep a job?’

Critical intervention strategies:

These strategies are usually for individuals with a high risk of suicide to increase feelings of being emotionally supported.

  • Explore the person’s perception of crisis
  • Establish rapport: I am here to listen to you and support you.
  • Remove the potential means of suicide where possible
  • Develop an action plan and increase options available to the person and people available to help
  • Monitor their emotional state and devise a follow-up plan
  • Keep the person involved in small and meaningful activities around the home and garden.
  • Encourage the person to devise a plan, which includes resources and support for the immediate future

Being close to or working with someone at a high risk of suicide can be very stressful. It is important relatives, friends, and caregivers seek professional help and take care of their emotional well-being.