With assault the main cause of traumatic brain injuries (TBI) among Indigenous Australians, patients who are discharged from hospital may need assistance not only with getting coordinated health and social services but dealing with the psychological trauma of being victims of violence.
These were among the findings that emerged from a study into the experiences and outcomes of Indigenous Australians with TBI during the six months after their discharge from hospital. One aim of the study was to identify gaps in service for Aboriginal people and Torres Straits Islanders during this critical ‘transition period’.
Among the researchers’ recommendations was that that Indigenous people with TBI need individualised assistance from a support person, such as a nurse advocate, to better coordinate their medical and allied health care and assist them access appropriate services during their recovery.
The team included Australian Institute of Tropical Health and Medicine (AITHM) researchers Dr India Bohanna, Dr Michelle Fitts and Professor Alan Clough and the project was funded by a National Health and Medical Research Council grant.
Dr Fitts, who until recently was a project officer at the AITHM, says car crashes and falls are the main cause of TBI in the general Australian population. But admission data from Queensland and the Northern Territory, showed ‘assaults were the main cause of TBIs in the Indigenous population’. Often the injuries were due to domestic or family violence and linked to alcohol consumption.
For the qualitative study, the researchers recruited 25 Indigenous TBI patients from Townsville, Cairns Base and Royal Darwin Hospitals. They tracked down 11 patients for follow-up interviews on their experiences and rehabilitation six months after discharge.
Dr Fitts says patients who sustained their brain injury through assault ‘experienced a number of psychological issues going home. Often the perpetrator of that assault was still living in the home or in the community and so people were experiencing symptoms of psychological trauma.’ Despite criminal investigations, not all perpetrators were charged and some injured people had to make statements at the police station or attend court.
‘One of the things we realised is the need for a coordinated service approach,’ says Dr Fitts. ‘Some participants just became overwhelmed with what they had to do to engage with different services, whether to see a specialist or engage with ATODS [Alcohol, Tobacco and Other Drug Services] or see Centrelink around their disability support pension.’
Chief investigator, neuroscientist Dr Bohanna says: ‘Interventions to support Indigenous Australians after a TBI, or to prevent TBI, need to explicitly take into account the impact of domestic and family violence, and alcohol use. Understanding how these can affect recovery is very important. International research shows that providing targeted support to people who’ve suffered TBIs due to violence or alcohol can be very effective in preventing future injuries.’
She believes we need a ‘new definition of TBI rehabilitation for Indigenous Australians’ that takes into account violence and alcohol and provides holistic rehabilitation and support for accommodation, finance, criminal justice and psychological issues, as well as helping people recover physically and cognitively.
The research findings are being translated into practical improvements for Aboriginal patients. For example, Dr Bohanna says the team is working with Queensland mental health services as well as alcohol, tobacco and drug addiction services to enhance information about TBI and improve the understanding of health professionals about these issues.
At the invitation of researchers, three participants produced videos and artworks to share the experiences they faced after being discharged or leaving hospital. Dr Fitts explains the videos and artworks will ‘educate Indigenous patients admitted for TBI coming through the health system and also create opportunities for health care providers to talk to Indigenous patients about what to expect when returning home.’
One video is the story of an artist, Doug Smallwood, who has sustained several head injuries from alcohol-related falls and violence. He contributed two remarkable artworks about his feelings and experiences – including hope, anger and self-sabotage – during recovery. In one painting, Doug depicted the stages of his life as 12 decorated emu eggs, including an egg showing the damage he inflicted on himself and others through binge drinking and another showing an ambulance taking him to hospital.
For Doug, participating in the study and making the artworks ‘provided an opportunity to reflect on his life and reset his goals’, including limiting his drinking so he does not fall and trying to avoid situations where he might get injured again.
Dr Bohanna says: ‘As yet, a culturally safe, coordinated service and support model following TBI does not exist, though it is much needed to prevent people “falling through the cracks” once they return home.’
Dr India Bohanna
Dr Michelle Fitts