By Dr Keith G Jenkins (1), Megan Trigg (2) and Shireen Omar (3)
For ‘food for thought’, or perhaps simply validating some of your own observations, we are sharing some reflections on the changing nature of the circumstances of acquired brain injury (ABI) as seen at St Andrew’s.
Accepted wisdom around acquired brain injury in the UK has for some time been that the biggest population groups experiencing an ABI are young males around 18-24, as a result of road traffic accidents and other forms of accidental or deliberate (e.g. assault) injury; and older adults as a result of falls and stroke.
However, possibly due to the highly specialist nature of our neurobehavioural rehabilitation services at Kemsley, St Andrew’s, and what also appears to be a change in how ABIs occur in our patient cohort, our experience is diverging from this accepted wisdom, creating new challenges for innovative treatment and prevention.
Attempted suicide by hanging appears to be a significant causal factor in an increase in people admitted for neurobehavioural rehabilitation following hypoxic brain injury.
Official statistics suggest an underlying cause, hanging is the most common cause of death by suicide and this has been an increasing trend since 2001 (ONS; Suicides in England and Wales 2023 registrations).
Suggesting that we are likely to see an increasing number of hypoxic brain injuries from failed attempts in line with this.
Indeed, the overall suicide rate too has also been increasing since 2007, following falling rates from 1981 to 2006, with more brain injured survivors likely as a result.
Have you also noticed that recovery and progress for people with hypoxic injury is often more difficult than for other types of brain injury?
Another change that we have noticed in brain injuries for our time is the increasing trend for substance misuse to play a key role in either acquiring a brain injury and/or in struggling to cope afterwards.
In the US, studies examining traumatic brain injury (TBI) model systems data revealed that over 50 per cent of patients treated for TBI were intoxicated at the time of injury.
Regarding UK alcohol use, since peaking in the mid-2000s, consumption has fallen steadily, especially among young people.
Average adult consumption is about 9.7 litres of pure alcohol per year (18 units a week) and around 20 per cent of the population don’t drink at all, an increasing figure among young people in particular.
However, we continue to see the impact of chronic or acute substance misuse or alcohol abuse contributing to the brain injuring incident.
In the UK, for the year ending March 2023, an estimated 9.5 per cent of people aged 16 to 59 years and 17.6 per cent of people aged 16 to 24 years reported drug use in the past 12 months (ONS; Drug misuse in England and Wales: year ending March 2023), overdose and altered mind state contributing to a range of ABI scenarios.
Given the above, are we really ready for brain injuries of our time?
I’d suggest not, until we have effective intervention for substance misuse that can cope with acquired cognitive impairment and personality change; education and awareness raising that reduces substance use in general; and a truly effective suicide preventative social fabric.
Established as the first specialist neurobehavioural unit in the UK, Kemsley has been supporting people with brain injury and complex cognitive, physical and psychological needs for over 45 years.
To find out more visit: stah.org/brain-injury
(1) Dr Keith G Jenkins, Lead Psychologist in the Neuropsychiatry Division of St Andrew’s Healthcare and Chair of Headway
East Northants and the Northamptonshire Acquired Brain Injury Forum
(2) Megan Trigg (Bournemouth University), Honorary Assistant Psychologist, St Andrew’s Healthcare
(3) Shireen Omar (University of Kent), Honorary Assistant Psychologist, St Andrew’s Healthcare
