Medicine has historically treated physical and mental health as two very separate entities. While this is changing, we are only just starting to understand the power of the connection between our body and our mind. Research shows strong links between mental health and a wide range of physical factors, such as gut health and exercise. And those of us working with individuals who have experienced a life changing injury regularly see the impact mental health has on physical rehabilitation – both positive and negative.
Of course, mental health issues are all too common. With around 1 in 4 people in the UK experiencing a mental health problem every year, it’s possible that someone with a catastrophic injury faced mental health challenges before their accident. However, even if someone has no pre-existing condition, a life changing injury is likely to have an impact on their mental health. This can range from feelings of overwhelming distress, confusion, anger, fear, hopelessness, anxiety and depression or the development of phobias, panic disorder, catastrophisation or post-traumatic stress disorder (PTSD).
All of this is vital background knowledge for any case manager. Because mental health inevitably impacts ongoing physical rehabilitation, mental health support is an important element of nearly all our rehabilitation programmes.
From a Breakthrough Case Management perspective, our rehabilitation programmes will almost always bring in a qualified psychologist. Mental health is important, and we work with a team of talented psychologists who we match with a client depending on their requirements and their injury/situation.
There may be a wide range of issues we need to recognise and then work with. Whether it’s a fear of cars, crowds or the workplace, it all affects day to day quality of life. Our goal is to always support and guide individuals and their families who have experienced a catastrophic injury, to improve their quality of life and help them realise their full potential.
Mental health support should always be considered as part of a holistic approach to rehabilitation. And we work collaboratively with the entire multi-disciplinary team, to understand the challenges our clients are facing and deliver the support they need to move beyond them. There’s a lot going on for someone who has experienced a life changing injury, which might include anything from sleep problems and financial difficulties to relationship issues. We understand that when we ask someone to be motivated and push themselves physically it’s going to be even harder if they aren’t feeling well mentally.
Importantly, it doesn’t need to be a mental health crisis or severe depression to require attention and action. Feeling overwhelmed and fearful is understandable after a traumatic injury, this can lead to lower motivation, reduced engagement or a wish to isolate. All of which can delay or impact the success of physical rehabilitation.
We see clients who sometimes feel the effort required may not be worth it. This might be because the gains don’t seem big enough, the status quo feels more comfortable, or they are frightened they will injure themselves further. They can withdraw, feel helpless and become anxious – and again it’s all completely understandable. But staying in that place limits potential. We’re here to help our clients take back control and look towards a more positive future.
So, what can we do when a client is experiencing a mental health issue, or just feeling stuck? The psychologist’s role in the multi-disciplinary team is vital, to identify the problem and develop a plan to address it. But every member of the team needs to be involved if a client is going to reach their goals, whether that’s getting themselves out of bed in the morning or walking a mile.
Our case managers work with each individual to find out exactly what they need to reach their goals and then bring together the best possible team to support them. This might involve a personal trainer, occupational therapist, neuro-physiotherapist and psychologist for example. They will also identify any other issues that might be interacting to affect ongoing rehabilitation – such as sleep, appetite or medication – and organise professional or financial help to address them.
Even before establishing a team, the starting point is to set realistic SMART goals broken down into achievable milestones. Ones that a client can get behind and truly believe they are able to achieve. And these goals need to be backed up by trust – in the case manager, team and whole rehabilitation process. Developing this trust starts with the very first time we meet a client, where we start to build their confidence in our professional expertise and experience. We always listen in these meetings and never lecture, as it’s so important to us that a client doesn’t feel judged.
Sometimes when we first visit someone they feel let down. They haven’t got what they need at this point and can find it hard to trust that things can be different with a new approach. We’re here to help, provide support and be positive – while remaining honest. We will never make unrealistic promises about what can be achieved and that’s one of the most important ways we build trust.
An example here is a client with severe PTSD following an accident which was profoundly limiting her quality of life and ability to do things outside the home. We appointed a psychologist to develop a robust mental health support programme using a range of appropriate interventions to help her find a way forward. Throughout this process her Breakthrough case manager was always there when she needed someone to talk to and to ask questions if she was feeling uncertain.
As well as appropriate medication to help in the short term, we worked with her on a long-term programme of gradual exposure. Re-introducing the things she found challenging at a very slow pace. This involved going into a shop with a support worker, leaving quickly, and then building up the time she spent in store before finally making a purchase. The support worker also travelled on the bus with her for just one stop until she felt more confident taking longer journeys and eventually traveling alone.
Another client developed vehophobia and amaxophobia (fear of travelling by car or driving a car) following a road traffic accident. The trusted relationship with her Breakthrough case manager led to us taking the first journeys together. We gradually reintroduced her to other people driving, initially with the case manager accompanying in the car. Eventually our client was able to make shorter and then longer journeys with others and then by herself.
When someone has been traumatised, rehabilitation can take a long time and it is understandably not always easy. But with a plan and the right support it is possible to overcome obstacles that might have previously felt insurmountable.
Interestingly, resilience is based on experience and people often cope better when they have already lived through something uncomfortable or challenging they can relate back to. The more people push themselves forward and see the benefits of the work they put in, the more resilient they become.
A positive attitude is also important. At Breakthrough Case Management, we are naturally optimistic, and this optimism alongside our tenacity and positive attitude supports our clients. It’s not about giving people false hope – we never promise that everything is going to be all right when it isn’t. But it is about working together to find out what is possible, setting realistic goals and making the best of what a client has at their disposal to reach those goals.
The physical, mental and practical challenges our clients face are inextricably linked. We know we can support their mental health, and in turn physical rehabilitation, by taking some of the anxiety away. This might be something as simple as organising the bills or sorting out basic house maintenance. These practicalities are peripheral to the main problem, but they are often the straw that breaks the camel’s back.
We are here to help and ensure our clients feel cared for physically and mentally. Because effective physical rehabilitation isn’t possible without good mental health support.