by Rolf B. Gainer, Ph.D.
We know that a brain injury can set a person’s life into turmoil in terms of disruption to their pre-injury social relationships and status, cause depression and create feelings of worthlessness. All too often I have heard the person with a brain injury say: “I wish I died in the accident” or “I wish I didn’t have to live this way”. These are not idle statements, but feelings and thoughts which we need to take seriously as indicators of suicide risk. Often the psychological problems and social isolation associated with a brain injury become barriers to accessing needed care and treatment which increases the risk for suicidal thinking progressing to a suicide attempt.
Brain Injury can set the stage for the onset of suicidal thinking and attempts. The “Perfect Storm” for the onset of suicide for the person with a brain injury develops from a confluence of negative feelings, poor problem solving skills, self-directed anger, thinking about “the end” and impulsive behaviors. Additional factors include: substance abuse; isolation from others; a history of abuse and/or trauma; a history of domestic violence as a victim or perpetrator and a perception of loss of personal status in terms of relationships with family, friends and in the community.
The risk factors are highest among males, those with a history of previous suicidal thinking or attempts, a family history of suicide and current substance abuse problems. Once a person has attempted suicide, their risk for a second attempt increases significantly and can extend for years in some cases. For the person with a brain injury, their impulse control problems, poor self-regulation and Executive Deficits can help a person formulate a plan to harm themselves. The studies related to brain injury and the onset of mental health issues indicate that the potential for depression exists at high rate and extends throughout the person’s life. Other conditions such as PTSD as well as other physical disability can contribute to the negative risk factors which underlie suicidal thinking and behavior.
The management of suicide risks requires a pro-active response to the identification of problems and the establishment of effective safety nets. A collaborative effort is needed between rehabilitation professionals, the mental health community, the family, the client and others in the support network to create and maintain safety. It is highly important to assess the person’s risk for suicide. This assessment should include a thorough clinical assessment which may include an assessment tool such as the Suicide Probability Scale which supports ongoing re-testing. The degree to which impulsive behaviours factor into the risk analysis becomes important in preventing harm. In the assessments we have learned that the rehabilitation staff and family members can help “fill in the blanks” with information important to assess the person’s risk potential. We also caution clinicians not to “contract for safety” with the person and instead work to create a safety net involving family and friends around the person who is expressing self-harm to prevent a negative event from escalating.
As we approach the holiday season let’s remember that mental health issues can surface and with them an increased risk for depression, substance abuse and self-harm. The prevention of self-harm requires intervention at the first indicators and follow-through with medication, psychotherapy and ongoing support.