Recently I had the privilege of conversing with the parents of an Afghanistan war veteran who tragically lost his life in a shooting encounter with Tulsa police. In many of the early media reports, the parents recognized that the police officer was only doing his job to protect the neighborhood. His mother also acknowledged that her son suffered a serious brain injury while he served and revealed that her son would share his feelings that something was wrong with him that he could not explain. Memory loss and willingness to share their experiences are key indicators of brain injury. Reluctance to talk about the events and reliving the excruciating details of events are significant traits to Post-traumatic Stress Disorder (PTSD). Yet once again the initial reports sensationalized PTSD and the lack of mental health services in the VA as the most presenting problem for this veteran. This scenario is not exclusive to veterans with brain injury or mental health challenges.
The denial and disavowing of brain injury in the media and medical profession is becoming a deadly epidemic. Webster’s Dictionary defines Denial as: 1.) refusal to satisfy a request or desire; 2.) a: refusal to admit the truth or reality (as of a statement or charge); b: refusal to acknowledge a person or a thing. Webster’s defines the word Disavow as: to say that you are not responsible for (something): to deny that you know about or are involved in (something) and: to refuse to acknowledge or accept. Having worked with brain injury patients in both the military and civilian medical models, all too often, mental health issues are being utilized to overshadow the real root causes and appropriate treatment. A major flaw is the refusal by medical professionals and insurance conglomerates, to acknowledge that acquired and traumatic brain injuries are chronic events with the probabilities of life-long physical and mental health consequences. Like cancer, a patient can move into a state of remission with treatment, but the possibilities of a recurrence may still remain for their lifetime. With brain injuries, the realities of delayed onsets of physiological, behavioral and memory issues, and early onset dementia or Alzheimer’s, are often ping-ponged through the insurance game of bouncing the problem between the well crafted labyrinths of the separate medical and mental silo’s created by the Managed Care Model. In the meantime, the burden is placed on the ill prepared family to address multi-faceted medical and behavioral complications of the brain injury.
As the process of coping with emerging issues beyond brain injury unfolds, the family becomes exhausted by the charade of requesting medical assistance and the reality that they are unprepared to handle the complications of brain injury sets in. Friends begin to detach for many of the same reasons. In many cases, this normal looking person’s brain injury induced issues with unrecognized physiological responses, cognitive disconnects and societal boundaries are disavowed, leading to social isolation. As the bridges burn for the brain injured person, the task of managing a person with cognitive and behavioral deficits are passed on to homeless shelters, low cost housing opportunities, understaffed nursing homes, and, too often, prisons. Having personally worked counseling clients with substance abuse and co-occurring mental health issues in prisons, homeless shelters and prison reentry, I would estimate that over 85% of my patients reported experiencing at least one brain altering event in their life. There are emerging stories of over-crowded jails and the rising costs of incarceration due to higher mental health care needs of this population. How many of those imprisoned have had a brain injury event? What was their treatment plan and when did it end? The more interesting numbers are with the states reporting declines in health care costs per prisoner. Are they on to new treatment alternatives or following the trends of “Denial and Disavowing”?
It is reported that 1.7 million people in the United States experience a traumatic brain injury (TBI) each year. Seventy five percent of the injuries reported are deemed to be mild TBI’s with an average lifetime cost of $85,000. The remaining injuries are rated as moderate to severe at estimated average lifetime costs of over $2 million. The average state prison costs for incarceration in 2011 were $31,286, with reported county jail costs at $110 a day or higher, making that yearly average approximately $40,000. When a brain injured offender is released from prison, the lifetime costs for care remain. Who gets rewarded at the taxpayers’ expense? Where do the burdens of care fall after incarceration?
What is most troubling are the moments when law enforcement officers are forced to end the misery in encounters some label “Suicide by Cop”. Police officers are trained to “Protect and Serve”. When and why has brain injury treatment planning become an added responsibility? What criteria will be developed to divert police officers experiencing PTSD from being forced into situations that end in deadly fallouts deemed by medical and insurance entities as denied and disavowed? What are the other areas in which society and taxpayers are left with the costs of managing brain injury?