The Realities of Involuntary Treatment with Brain Injury

Treatment ConditionsBrain Injury
Written By Malachite Goudie-Groat
The realities of involuntary treatment with brain injury. Person with long hair facing away. Quote from the following blog post.

In September, Health Justice’s blog post written in response to political announcements on involuntary treatment in BC highlighted reasons why complex problems are not solved with quick fixes. Let’s dive into one area of complexity that is often overlooked, underdiagnosed, and medically mistreated as an intersecting factor in involuntary treatment: brain injuries.

The lack of awareness and focus on brain injuries while in involuntary treatment by medical practitioners, including those in mental health, and by policy makers and legislative decision makers undermines the care that people with brain injuries need by jeopardizing their health further and violating human rights.  

People with lived and living experience of brain injuries while in involuntary mental health and/or substance use treatment in BC have not been heard or engaged in the systemic efforts that claim to solve problems and improve the well-being of communities. At Health Justice, our work centers on elevating the voices of people that are most impacted to advocate for change and inspire collective action.  

The information shared here is from a Lived Experience Expert that has been actively involved in brain injury awareness, research, community care, advocacy in BC, and navigation of their own medical journey. The complexity and intersectionality of brain injuries are different for each person and there are a wide range of factors to consider that extends beyond our post. The following is what is missing in the care of someone with a brain injury, its impacts, and what is needed to improve care.

What is a brain injury? 

A brain injury is defined as “an alteration in brain function caused by external forces, or a reduction in oxygen supply.” A traumatic brain injury like a concussion “is a form of traumatic brain injury caused by a hard blow or jolt to the head, neck, or body that causes the head and brain to move rapidly back and forth.” (SOAR)  

Brain injuries can be caused by:  

  • physical trauma,  

  • childhood abuse,  

  • intimate partner violence,  

  • drug poisoning, 

  • hypoxia from an overdose,  

There can be a causal connection between brain injuries, mental health, and substance use but assumptions that the causes are straightforward or linear are harmful. 

“It’s important to know that so many people don’t know they have a brain injury…and when they are in the hospital under the Mental Health Act, their brain injury can be mistaken as mental distress, or the mental distress is treated without [doctors] figuring out they have a brain injury. Brain injury survivors can exhibit confusion, that leads to irritability, then anger. Brain injury survivors can be sensitive to different aspects of the hospital physical environment like sounds and lights resulting in feeling flooding and emotional overwhelm. Brain injury survivors can experience the inability to articulate thoughts, crying, slurring words, coupled with balance issues that may look inebriated to emergency services, law enforcement, and hospital people.”

— Lived Experience Expert

Symptoms of brain injuries can change daily in a person and are considered a form of hidden disability (Fraser Health). Each person’s brain injury is unique like a thumb print (VBIS ABI 101). 

Image of a brain with a heart in, a butterfly on top, and full of various depictions of nature

“The Caring Brain” by Tina Tam (2024)

What is missing in the care of someone with a brain injury in involuntary treatment and the impacts?

  • Brain injuries being underdiagnosed (Brain Injury Canada) and misunderstood is a critical issue in involuntary treatment. Some people may not be aware of being brain injured and even when there is diagnosis, treatment does not often take the brain injury into consideration.

  • When brain injuries are not addressed or acknowledged, people face multiplying unmet health needs that can lead to violent law enforcement interactions, wrongly being placed in involuntary care under the Mental Health Act and experiencing trauma that impacts long-term quality of life. The factors are magnified and significantly more harmful for people experiencing mental health and socio-economic inequities. 

  • Significant health complications can arise when the intersection of brain injuries and mental health/substance use is misunderstood or ignored in care. For example, there are certain psychiatric medications that can be harmful to people with brain injuries. (Polypharmacy in Traumatic Brain Injury)

  • A brain injured person is at higher risk of another brain injury, especially when law enforcement, emergency services, and the medical team are not aware of a brain injury and misinterpret a person’s behaviour or symptoms.

  • The hospital environment is challenging for people with brain injuries due to things like:  

    • constant noise

    • florescent lights  

    • too many people in one room 

    • forced group programs 

    • challenging dynamics with other people 

    • poor nutrition 

    • over stimulation  

    All of the above factors could cause someone with a brain injury to react in many ways that could cause additional physical injuries or can look oppositional that leads to repercussions of being over medicated and injured as a result of physical force being used.

  • Coercion in involuntary treatment can cause exposure to trauma. People with brain injuries have increased vulnerabilities in hospital environments and may feel scared into submission, foggy, and lose the ability to communicate/self-advocate.

“People getting the right type of support can get muddled. Instead of proper care, people are going through cycles where choices are not given. This can lead to long hospitalizations and further misunderstandings.”

– Lived Experience Expert 

What is needed to improve care in involuntary treatment?  

The intersectional connections of brain injuries to other physical, mental health, substance use, and social conditions needs more research, policy, legislative, and systemic focus in health, law enforcement, and social services. 

  • More awareness, diagnosis, and treatment of brain injuries. 

  • Implementation of brain injury screening (informal for law enforcement/emergency services and medical screening at intake at the hospital) (SOAR) 

  • Address the brain injury first to understand how it specifically impacts the person before trying to unpack the psychiatric problem.  

  • Prevention of drug poisoning and overdoses to reduce the chance of brain damage with harm reduction, naloxone training, and rescue breathing (Capital Daily)  

  • Awareness that people with brain injuries may also be experiencing multiple illnesses, multiple life barriers including homelessness, and that treatment effectiveness is variable (UBC) 

  • Need for a more holistic approach to care that recognizes brain injuries can look like other mental health and substance use issues. 

  • Focus on helping brain injured people unpack their confusion in treatment instead of using escalation tactics like increased medication and seclusion 

  • Create an accessible province-wide form of ID or indicator that brain injured people can use to communicate their condition that can be used when they are not able to verbalize the information. This needs to be recognized by local law enforcement and medical professionals. Similar to the following examples: 

    • Victoria Brain Injury Society (VBIS) - Service ID card that includes the person’s name, emergency contact, and information on affects of brain injury (VBIS)  

    • Nanaimo Brain Injury Society (NBIS) - Service ID card (NBIS) 

    • Headway Brain Injury Association, UK - Brain injury identity card (Headway Brain Injury Association) 

  • Improve the hospital environment with more individual rooms, areas of low stimulation, access to nature, more rest time, proper nutrition, prevention of injuries in the physical space, and more awareness of the interaction of patients.  

  • More voice and body autonomy for people and more trust in people that they know themselves best and know what need to compliment and support the work of the medical staff.  

  • Focus on the critical needs of brain injured people that help address quality of life: (UBC QOL)

    • Finding meaning in relationships;

    • Finding purpose and value;

    • Trusting a circle of care;

    • Ensuring basic needs are met;

    • Being seen and accepted;

    • Giving back and advocating;

    • Participating in everyday life.

  • Provide specifically trained disability advocates to support people with brain injury in involuntary treatment. This is someone that can speak when communication breaks down, work collaboratively with the medical staff to support them to understand  

  • Engagement of people with lived and living experiences of brain injury in the work to improve treatment under the Metal Heath Act of BC. 

Recognizing brain injuries as an intersectional factor to mental health and substance use can drastically change harmful assumptions. This has the potential to improve involuntary treatment and shift the province’s direction away from treating brain injured people using the Mental Health Act. 

Resources for further learning on brain injury: 

Malachite Goudie-Groat
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