As a physiotherapist working in one of the province’s leading neurological rehabilitation centres, I have witnessed the mental health effects of COVID-19 on some of my clients with traumatic brain injury. In the spirit of Bell Let’s Talk Day, I wanted to share the perspectives of some of my clients (with their permission) with our readers in the hopes that it might help someone.

Since the first pandemic lockdown in Canada last March, many of my clients who were previously suffering from a mild to moderate traumatic brain injury have reported an increase in issues regarding psychosocial health, mental health, stress, anxiety, and just overall not feeling well. They also shared that the unpredictability and uncertainty of the pandemic situation is the root cause.

A year into the pandemic, we now have access to research that links the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown with an increased risk of mental health problems and exacerbated health inequalities. In one study, preliminary findings suggest increased adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders.[i]

Traumatic Brain Injury and Mental Health

People who sustain a brain injury are at an increased risk of experiencing mental illness. Some of the short- and long-term effects of brain injury are related to mental health, and can include anxiety, depression, aggression, and impulsivity.[ii]

The psychiatric consequences of brain injury are influenced by pre-injury status, co-occurring disorders, injury-related factors, and pre- and post-injury environmental factors, among other potential influences.[iii]

It is not difficult to imagine how social isolation, loss of income, loneliness, inactivity, limited access to basic services, decreased family and social support, food insecurity, or increased access to online gambling, alcohol and other substances might be contributing factors to an increase in mental health issues in this population.

What we also see as physiotherapists is that as our clients’ symptomology becomes further exacerbated, it reveals itself in physical manners as well. In other words, the client is reporting decreased quality of sleep, increased self reported pain, decreased muscular endurance or cardiovascular endurance, with no physical change or explanation.

That is because mental health and physical health are fundamentally linked. In fact, people with mental health issues are at higher risk of developing chronic physical conditions and vice versa.[iv] For this reason, physiotherapists have an important role to play in mental health care for our clients.

You may also enjoy reading: Brain Injury: Prevention & Treatment

The Physiotherapists Role in Mental Health Care

As physiotherapists, it is important to recognize that we are not mental health experts. However, due to the nature of our job, specifically in working with clients who have had traumatic brain injuries or other life altering injuries, we often treat clients who are experiencing mental health issues. It is therefore essential that we understand how to recognize the signs, show support and point them towards experts or resources that can help.

One of the more common messages I’m hearing from my clients with TBI is they’re not feeling mentally well. More specifically, not being able to see their family and friends or get back to the things they used to love doing is really having a real impact on their life. And, although they can be making some good physical gains in physical therapy sessions in clinic, it does, in effect, dampen a portion of physical health goal setting.

For instance, one of my client’s goals for the winter was to get back to playing winter sports such as snowboarding or cross-country skiing. With lockdown orders in effect and many winter sports facilities temporarily closed and/or operating at a reduced capacity, these goals are suddenly harder if not impossible to achieve. This lack of tangible goals outside the clinic can limit the client’s perception of how well they’re doing in clinic.

The first thing any physiotherapist working with someone who has had previous traumatic brain injury needs to understand is that the client is at an even higher risk of developing mental health issues during this time. The second thing need to know is how we can help our clients and stay within our scope of practice.

As a physiotherapist, I think one of the most important things we can do is just talk to our clients, and have that regular touchpoint to make ourselves more aware of their situation. For this at-risk population, finding areas where they require additional support in clinic and in the community is critical.

You may also enjoy reading: My Traumatic Brain Injury Road to Recovery

A couple of simple ways that I make this a priority is by scheduling my sessions in a way that gives me the first five to seven minutes in a session just to talk with clients that I know are at risk, or have conveyed to me that their mental health is not good. Giving us that buffer time really helps with how the remainder of the session unfolds, but also it helps me take notes in case I need to take further action.

In addition to having that dialogue, we need to familiarize ourselves with the signs of anxiety, stress or depression. While listening to the client talk about their fears about their own health or the health of their loved ones, pay specific attention to language around any physical changes in their sleeping, nutritional intake, or if they’ve shared that they have increased use of any substances. These are all things to take note of and consider whether additional support from mental health experts or resources need to be part of the overall approach to a client’s treatment plan.

Access to Mental Health Services & Resources

A lot of our clients who do rely on publicly funded services for peer support, or emotional or psychological support, have had access to these services limited or disrupted during this time. We try to help our clients connect with others services, including virtual mental health supports or our online mindfulness training and resources, and free or very low-cost resources that the government has developed like these below:

Tips for managing mental health:

WELLNESS TOGETHER CANADA MENTAL HEALTH PORTAL– Government of Canada

RESOURCE HUB: MENTAL HEALTH AND WELLNESS DURING THE COVID-19 PANDEMIC– Mental Health Commission of Canada

TIPS TO SUPPORT MENTAL HEALTH DURING THE COVID-19 PANDEMIC– The Canadian Mental Health Association

HOW TO LOOK OUT FOR OUR MENTAL HEALTH DURING COVID-19– Jack.org

MENTAL HEALTH AND COVID-19– The Centre for Addiction and Mental Health

TAKING CARE OF MENTAL HEALTH DURING COVID-19– Canadian Red Cross

MENTAL HEALTH AND CULTURAL SUPPORTS FOR INDIGENOUS CANADIANS– First Nations Health Authority (British Columbia focused)

MULTICULTURAL MENTAL HEALTH RESOURCES RELATED TO COVID-19– Multicultural Mental Health Resource Centre

WELLCAN DIGITAL RESOURCE HUB– Morneau Shepell

Managing anxiety, stress and panic:

COPING WITH STRESS AND ANXIETY– The Centre for Addiction and Mental Health

MANAGING ANXIETY THAT TURNS TO PANIC (VIDEO)– Dr. Joti Samra (MyWorkplace Health)

7 TIPS FOR MANAGING ANXIETY AND WORRY ABOUT CORONAVIRUS (VIDEO)– Dr. Joti Samra (MyWorkplace Health)

CORONAVIRUS: MANAGING STRESS AND ANXIETY– The Canadian Mental Health Association Kelowna

COPING WITH ANXIETY DURING STRESSFUL TIMES– Calgary Counselling Centre (Alberta focused)

End the Stigma Around Mental Health & Brain Injury

Sadly, there still exists a stigma around mental health and brain injury. Internal or invisible symptoms are often misunderstood and disregarded by others. That is why it is so important for us to be a part of the discussion and try to make a difference in the mental health care and outcomes of people with traumatic brain injuries.

Some tips for physiotherapists and other healthcare providers in treating people with brain injury include:

  • Make sure that the language we use is not judgmental.
  • Try to educate yourself as much as we can.
  • Give the client time to respond and not rush them through their responses.
  • Build in that time to talk about mental health and illness, and even by providing empathetic and supportive listening can go a long way.

I hope this article gives you a glimpse of how a physiotherapist, or even your massage therapist or exercise professionals can help people with mental health, while working specifically on your physical health and physical goals.

References

[i] How mental health care should change as a consequence of the COVID-19 pandemic

[ii] J. R. Fann, A. Leonetti, K. Jaffe, W. J. Katon, P. Cummings, and R. S. Thompson, “Psychiatric illness and subsequent traumatic brain injury: A case control study,” J. Neurol. Neurosurg. Psychiatry, vol. 72, no. 5, pp. 615–620, 2002.

[iii] Understanding the link between mental health and brain injury, ABI Research Lab

[iv] Connection Between Mental and Physical Health, CMHA

Written by

Hoong Phang
Hoong PhangClinic Manager & Physiotherapist
Hoong holds a Bachelor Honours Health Sciences from the University of Western Ontario (2008). He has also completed a Master of Science in Health and Exercise Psychology (2010) from McMaster University, and Master of Physiotherapy (2012) from McMaster University. Hoong is currently published in the academic journals “Disability and Rehabilitation” and “Spinal Cord.”

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