020 - Bridge Magazine - Mental Health - 2016

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MENTAL HEALTH

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CONTENTS

A SERIOUS CASE OF THE BLUES?

A guide to mental health disorders ............. 4 In pursuit of happiness ....................................... 6

DEPRESSION IS EXTREMELY COMMON AFTER A BRAIN INJURY

Managing stress ...................................................... 8 Friends & family to the rescue ....................... 8 Mental health – a global issue ...................... 9 Brain Injuries & gladiators ................................ 9 Managing fatigue ................................................... 9

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Young people & mental health .................... 12 Sleep, diet & lifestyle ......................................... 14 Panic attacks .......................................................... 17 Exercise for mental health ............................. 19 Drinking to your mental health? ................. 19 The economics of happiness ........................ 19 Grief & loss ............................................................. 20 Relationship Changes ....................................... 22

A JOURNEY TOWARD PRIDE WITHOUT PRIDE IN OURSELVES WE CANNOT CREATE PRIDE IN THOSE AROUND US

Co-morbidity .......................................................... 24 Mental illness – a brief history ................... 24 Always take off into the wind ...................... 25 Post-traumatic stress disorder ................... 28 The journey back ................................................. 28 Mental health for carers ................................. 30 Self-medication, alcohol & other drugs . 32 Self Harm ................................................................. 34 PTSD treatments & new research ........... 35

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BEHIND THE EXTERIOR

LIFE CHOICES & CONSEQUENCES

AT TIMES MARIA GONCET FINDS IT HARD WHEN THE WORLD REACTS TO HER OUTWARD APPEARANCE

LUCAS IS WELL QUALIFIED TO DISCUSS THIS TOPIC

Funded By

BRIDGE VOLUME 20 - FEBRUARY 2016 / ISSN 1448-9856 General Editor: Barry Morris / Contributing Editor: Jessica Irons National Development Manager: Glen Farlow

Synapse PO Box 3356 South Brisbane 4101 P: 1800 673 074 F: 61 7 3137 7452 E: info@synapse.org.au W: http://synapse.org.au

Bridge is produced by Synapse (trading name for the Brain Injury Association of Queensland). Published biannually, it welcomes contributions and news items, especially from members. Advertising rates are available on request. Synapse is dedicated to reconnecting the lives of those affected by Brain Disorders.

VISUAL DIFFICULTIES: Visit www.synapse.org.au and view the free online version which can be expanded on screen.

DISCLAIMER: While all care has been taken to ensure information is accurate, all information in this publication is only intended as a guide, and proper medical or professional support and information should be sought. Synapse will not be held responsible for any injuries or damages that arise from following the information provided. Material within does not necessarily reflect the policies of Synapse or the staff and Board of Management. References to other organisations and services do not imply an endorsement or guarantee by Synapse.

JENNIFER CULLEN CEO OF SYNAPSE

bridging THE GAP

Building services that help people reconnect...

We know that around one in five adults will be affected by some form of mental health issue every single year.

panic attacks and anxiety disorders can strike anyone at any age — it isn’t a sign of a weak character, lack of intelligence or being too emotional.

The good news is that with recent increases in funding, there are many more treatment and support options available, and an increasing understanding of what it means to live with a mental health issue.

Since a Brain Disorder will make you more vulnerable to developing a mental health disorder, this edition is all the more important.

Similar to Brain Disorders, mental health disorders are also an “Invisible Disability”, as there are often no physical signs that someone may have ongoing issues.

Luckily, the stigma of having a mental health disorder is slowly disappearing, as we realise that schizophrenia, depression,

It’s not just about finding strategies to manage existing mental health issues, it’s also working to prevent them. Getting enough sleep, eating a healthy diet, and living a balanced lifestyle are some of the keys to good health which will give you the best chance of preventing or minimising

the impacts of mental health issues.

Creating connections and building a strong support network is perhaps one of the best strategies for any mental health issue you may face… be it yours or someone you care about. Reconnecting lives underpins everything we do at Synapse, which is why we have developed a number of services to help people reconnect with their family, community and self, and to help form new connections.

Jennifer Cullen CEO of Synapse

We can help you manage your care funding.

To assist those seeking to make the most of their disability funding, be it NDIS or a private scheme, we took the initiative to develop Synapse Options.

A range of individualised services designed to take the stress out of planning, facilitating and administering disability care funding.

With our assistance you maintain control and choice over both your funding and care without any added stress... And really, isn’t that the whole point?

Connect with us at www.synapse.org.au

A GUIDE TO MENTAL HEALTH DISORDERS IT’S TIME TO DISPEL THE MYTHS SURROUNDING MENTAL ILLNESS.

Mental illness is common – around half the population will experience a mental illness at some stage of their life and about one in five people will experience some form of mental health problem each year. About one in every hundred people will develop schizophrenia at some time in their lives and up to two in every hundred will develop bipolar disorder.

The vast majority of people with mental illness are not generally violent – people being treated for a mental illness are no more violent or dangerous than the general population.

If anything, they are more likely to be the victims of violence, especially self-harm. A small subgroup of people with a mental illness may be more violent than the general population. These are likely to be people who have a history of violent behaviour, who abuse drugs or alcohol, and who are not receiving treatment or taking medication as prescribed.

Most people with mental illness receive treatment in the community – with modern medications and treatment, there is generally no reason for most people with a mental illness to be in hospital. If they are, a stay is usually for a few weeks when they are unwell . . . as with many other types of illness. There is now an emphasis on treatment in the community so that people can continue to live at home. Contrary to what is commonly believed, most people with a mental illness recover well with appropriate ongoing treatment and support.

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Schizophrenia has nothing to do with split personality – it is an illness, a medical condition which affects the normal functioning of the brain, interfering with a person’s ability to think, feel and act. Some people recover completely, and, with time, most find that their symptoms improve. People with schizophrenia find it hurtful to have their diagnosis inaccurately misrepresented as a split personality.

Let’s cover some of the basic groups of mental illness:

Anxiety Disorders?

Every year, around 14% of all adult Australians are affected by an anxiety disorder. It is a medical condition characterised by persistent, excessive worry. These can take a number of forms. Common to all of these is an anxiety so distressing, it can interfere with a person’s ability to carry out or take pleasure in day-to-day life.

A person may experience more than one anxiety disorder. Some people may also experience depression with the anxiety, or have problems with alcohol or drug abuse.

A person with an anxiety disorder will feel distressed a lot of the time for no apparent reason. An episode can be so severe it is immobilising. The person might have – persistent, excessive or unrealistic worries (generalised anxiety disorder) compulsions and obsessions which they can’t control (obsessive compulsive disorder) intense excessive worry about social situations (social anxiety disorder) panic attacks (panic disorder) an intense, irrational fear of everyday objects and situations (phobia)

Other symptoms of anxiety disorders may include a pounding heart; difficulty breathing; upset stomach; muscle tension; sweating or choking; feeling faint or shaky.

What is Depression?

Every year, around 6% of all adult Australians are affected by a depressive illness. Clinical depression is a medical condition. It significantly affects the way someone feels, causing a persistent lowering of mood. Depression is often accompanied by a range of other physical and psychological symptoms that can interfere with the way a person is able to function in their everyday life. The symptoms of depression generally react positively to treatment. Depression has a variety of symptoms and will affect everyone in different ways. Symptoms include: feeling extremely sad or tearful; disturbances to normal sleep patterns; loss of interest and motivation; feeling worthless or guilty; loss of pleasure in activities; anxiety; changes in appetite or weight; loss of sexual interest; physical aches and pains; impaired thinking or concentration.

Depression can be a reaction to a distressing situation like loss or stress (reactive depression).

Some women experience depression following the birth of a child (post-natal depression). It can be part of an illness like bipolar disorder in which the person experiences extreme moods without any reason –very high and very-excited or very low and depressed.

Delusions – a false belief held by a person which is not held by others of the same cultural background.

Depression can be unrelated to any outside cause, but associated with a chemical imbalance in the brain (endogenous depression).

Sometimes the person may be affected so much that he or she experiences the symptoms of psychosis and is unable to distinguish what is real. Children and teenagers can also become depressed. This can show itself in different ways to depression in adults, and they are best helped by a doctor who is a specialist in this area.

The causes of psychosis are not fully understood.

They are likely to be a combination of hereditary and other factors. It is probable that some people are born with a predisposition to develop this kind of illness, and that certain things — for example, stress or use of drugs such as marijuana, LSD or speed — can trigger their first episode.

What is an eating disorder?

An eating disorder is characterised by obsessive thoughts about food and body weight. This includes people who limit the amount of food they eat (anorexia nervosa), eat lots of food in a very small time and then purge (bulimia) or overeat often (compulsive overeating).

There is no single cause for eating disorders. It is thought that a number of factors are involved to varying degrees in different people, including: genetic inheritance, personal and psychological factors related to adolescence or family issues for example, and social factors such as media representation of body image.

It is difficult for researchers to give a definitive answer on prevalence, but an Australian study has shown that 8.8% of female adolescents had an eating disorder, with almost half of these also having high levels of depression or anxiety.

What is psychosis?

There is a group of illnesses which disrupt the functioning of the brain so much, they cause a condition called psychosis. When someone experiences psychosis they are unable to distinguish what is real — there is a loss of contact with reality. Most people are able to recover from an episode of psychosis.

Among symptoms doctors look for are: Confused thinking – when acutely ill, people with psychotic symptoms experience disordered thinking.

Hallucinations – the person sees, hears, feels, smells or tastes something that is not actually there, the hallucination is often of disembodied voices which no one else can hear.

About three in a hundred people will experience psychosis at some time in their lives. Most of these will be first affected in their late teens and early twenties.

What is Post-Traumatic Stress Disorder?

Post-Traumatic Stress Disorder (sometimes called PTSD) is a form of anxiety disorder. Some people develop this condition after they have experienced a traumatic event. This event might be a serious accident, physical or sexual assault, war or torture, or a natural disaster such as a bushfire or a flood. Strong reactions such as fear, horror, anger, sadness and hopelessness are natural after events like these, of course.

In most cases, these feelings will pass after the normal working-through of emotions and talking things over in your own time with family, friends or colleagues.

When these feelings are intensely distressing and go on for more than four weeks, however, it is important to ask for help from a doctor or other health professional, as they may be symptoms of a more persistent condition such as PTSD. About 25% of people who are exposed to traumatic events develop PTSD. As well as being very upsetting, the symptoms interfere with the person’s ability to carry on their everyday life, work and relationships. Treatment helps deal with the symptoms so that people are able to get on with their life again.

This information is reproduced with permission from SANE Australia, an organization aiming to help all Australians affected by mental illness in leading a better life. We highly recommend SANE Australia’s website for plenty of great resources. SANE Australia pursues its mission through three key areas of activity: support, training, and education.

WEBSITE: www.sane.org SANE HELPLINE NUMBER: 1800 18 SANE (7263) FORUMS ADDRESS: saneforms.org

IN PURSUIT OF HAPPINESS WHY SOME PAIN HELPS US FEEL PLEASURE

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The idea that we can achieve happiness by maximizing pleasure and minimizing pain is both intuitive and popular. The truth is, however, very different. Pleasure alone cannot make us happy.

Take Christina Onassis, the daughter of shipping tycoon Aristotle Onassis. She inherited wealth beyond imagination and spent it on extravagant pleasures in an attempt to alleviate her unhappiness. She died at 37 and her biography, tellingly subtitled All the Pain Money Can Buy, recounts a life full of mind-boggling extravagance that contributed to her suffering.

Aldous Huxley recognized the possibility that endless pleasure may actually lead to dystopian societies in his 1932 novel Brave New World.

Although the idea of endless pleasure seems idyllic, the reality is often very different.

We need pain to provide a contrast for pleasure; without pain life becomes dull, boring and downright undesirable. Like a chocoholic in a chocolate shop, we soon forget what it was that made our desires so desirable in the first place.

Emerging evidence suggests that pain may actually enhance the pleasure and happiness we derive from life. As my colleagues and I recently outlined in the journal Personality and Social Psychology Review, pain promotes pleasure and keeps us connected to the world around us.

Pain builds pleasure An excellent example of how pain may enhance pleasure is the experience commonly referred to as “the runners high”. After intense physical exertion, runners experience a sense of euphoria that has been linked to the production of opioids, a neurochemical that is also released in response to pain.

Other work has shown that experiencing relief from pain not only increases our feelings of happiness but also reduces our feelings of sadness. Pain may not be a pleasurable experience itself, but it builds our pleasure in ways that pleasure alone simply cannot achieve.

Pain may also make us feel more justified in rewarding ourselves with pleasant experiences.

Just think how many people indulge themselves a little after a trip to the gym.

My colleagues and I tested this possibility by asking people to hold their hand in a bucket of ice-water and then offered them the choice of either a Caramello Koala or a florescent highlighter to take with them as a gift.

Participants who did not experience any pain

chose the highlighter 74% of the time. But those who had pain only chose it 40% of the time – they were more likely to take the chocolate. Pain, it seems, can make chocolate guilt-free!

Pain connects us to our world People are constantly seeking new ways to clear their minds and connect with their immediate experiences. Just think of the popularity of mindfulness and mediation exercises, both of which aim to bring us in touch with our direct experience of the world.

There is good reason to believe pain may be effective in achieving this same goal. Why? Because pain captures our attention.

Imagine dropping a large book on your toe mid conversation. Would you finish the conversation or attend to your toe? Pain drags us into the moment and after pain we are more alert and attuned to our sensory environment – less caught up in our thoughts about yesterday or tomorrow.

My colleagues and I recently tested whether this effect of pain may also have some benefits. We asked people to eat a Tim Tam chocolate biscuit after holding their hand in a bucket of ice-cold water for as long as they could. We found that people who experienced pain before eating the Tim Tam enjoyed it more than those who did not have pain.

In two follow-up studies, we showed that pain increases the intensity of a range of different tastes and reduces people’s threshold for detecting different flavours. One reason people enjoyed the Tim Tam more after pain was because it actually tasted better – the flavour they experienced was more intense and they were more sensitive to it.

Our findings shed light on why a Gatorade tastes so much better after a long hard run, why a cold beer is more pleasant after a day of hard labour, and why a hot chocolate is more enjoyable after coming in from the cold.

Pain literally brings us in touch with our immediate sensory experience of the world, allowing for the possibility that pleasures can become more pleasant and more intense.

helped clean up after the 2011 Brisbane floods or the sense of community spirit that developed in New York in response to 911.

Painful ceremonies have been used throughout history to create cooperation and cohesion within groups of people. A recent study examining one such ritual – the kavadi in Mauritius – found that participants who experienced pain were more likely to donate money to a community cause, as were those who had simply observed the ceremony. The experience of pain, or simply observing others in pain, made people more generous.

Building on this work, my colleagues and I had people experience pain in groups. Across three studies, again, participants either immersed their hand in ice-water and held a squat position for as long as they could, or ate very hot raw chilies.

We compared these experiences to a no-pain control condition and found pain increased cooperation within the group. After sharing pain, people felt more bonded together and were also more cooperative in an economic game: they were more likely to take personal risks to benefit the group as a whole.

A different side of pain Pain is commonly associated with illness, injury or harm. Often we don’t see pain until it is associated with a problem and in these cases pain may have few benefits at all. Yet, we also experience pain in a range of common and healthy activities.

Consider the recent ALS (amyotrophic lateral sclerosis) ice-bucket challenge. By dousing ourselves in ice water we were able to raise unprecedented support for a good cause.

Understanding that pain can have a range of positive consequences is not only important for better understanding pain, but may also help us manage pain when it does become a problem.

Framing pain as a positive, rather than negative, increases neurochemical responses that help us better manage pain.

Brock Bastian (ARC Future Fellow, School of Psychology at UNSW Australia) published this

Pain bond us with others

article under the Creative Commons Licence at

Anyone who has experienced a significant disaster will know that these events bring people together. Consider the 55,000 volunteers who

www.theconversation.com

MANAGING STRESS

Slow breathing techniques Proper breathing habits are essential for good mental and physical health. First, a person needs to focus upon their breathing pattern.

They need to identify whether they breathe mainly through the chest or through their stomach. Short, shallow and rapid breaths from the upper chest should be avoided. The aim is to breathe deeply and slowly through the nose.

A person should feel greater movement in the stomach than the chest as they inhale and exhale. Practice breathing exercises everyday. Learn to apply slow breathing as needed e.g. when feeling stressed, angry or anxious.

Visualization

Progressive muscle relaxation

Use your imagination (e.g. pleasant daydreams or memories) to will yourself into a relaxed state. Start by getting comfortable, scanning your body for tension and relaxing the muscles. Select a favourite place which is real or imagined.

A person learns to identify muscle groups and the difference

Focus your imagination using all five senses, then use affirmations such as repeating ‘I am letting go of tension’; or ‘I am feeling peaceful’.

Practice using visualization three times a day for a few minutes or longer. Eventually, with practice you can use visualization in everyday situations when feeling uptight.

Its effectiveness requires evaluation! Note the physical, mental and behavioural signs of stress each time and try different strategies and see which works better.

between tension and relaxation in the muscles. Focus on the four main muscle groups: 1 Hands, forearms and biceps 2 Head, face, throat and shoulders 3 Chest, stomach and lower back 4 Thighs, buttocks, calves and feet.

Tense muscles for five to seven seconds then relax for 10 to fifteen seconds.

It should only take a week or so to master with two 15 minute sessions per day.

FRIENDS & FAMILY TO THE RESCUE While medication and therapies can be very effective treatments for mental health disorders, one of the best preventive approaches is family and friends. Family connections, and knowing that you are important to others, is a powerful antidote to the blues!

But we may lose friendships after a Brain Injury, particularly if we have trouble with social skills, emotional control, behaviour, memory and empathy. The good news is that our social skills are learnt, not instinctive, so we can relearn them if our self-awareness is intact.

A skilled therapist can work with you to relearn these skills — check with your Brain Injury Association for professionals in your area.

Here are some tips if you are unable to access a social skills trainer: Enlist the help of family and friends you trust to give you honest feedback Join a peer support group if there is one in your area Focus on listening and asking (appropriate) questions — people love a good listener!

WHAT IS COGNITIVE BEHAVIOURAL THERAPY? Cognitive behavioral therapy (CBT) is a popular therapy that has proven very effective with dysfunctional emotions, behaviours and cognitions through a goal-oriented, systematic procedure. CBT does

not delve into past issues but focusses on the ‘here and now’. It has a strong emphasis on looking at unhealthy thought patterns and replacing them with more appropriate ones. There has been a high degree of success with CBT as a treatment for anxiety disorders, depression, obsessive compulsive disorder and post-traumatic stress disorder. CBT is most commonly provided by psychologists.

MENTAL HEALTH - A GLOBAL ISSUE Mental disorders are found in every culture and country around the world and affect roughly one in three Early detection and people, but the quality and degree of support treatment can make available varies wildly. Research not only needs to a massive difference and look into causes and treatments, but how to deliver yet these are still serious treatment in countries that can’t afford expensive problems in first world services or highly qualified professionals. countries – they are even There is also a need for broader solutions beyond just medications, with problems like depression being treated by promoting exercise, healthy eating, education, public awareness and reducing stigma.

more neglected in other parts of the world.

Medications are increasingly being seen in a new light too. For example, medications for schizophrenia have usually just aimed to minimise psychotic symptoms, but have affected cognitive and motor functioning. There is now an emphasis on cognitive and physical health as well because the side-effects of many medications can seriously affect quality of life.

Early detection and treatment can make a massive difference and yet these are still serious problems in first world countries – they are even more neglected in other parts of the world.

The future should see closer links between mental health research and neuroscience, with the latter providing more insights into areas such as genetics and cognition.

BRAIN INJURIES & GLADIATORS An unearthed cemetery in Turkey revealed gladiator remains and offered a unique opportunity to further explore theories on how gladiators fought, sustained head injuries, and the types of weapons used. The evidence used has come from analysing cranial bones.

11 individuals exhibit a total of 16 well-healed antemortal cranial traumata, with five showing multiple trauma. This is a surprisingly high frequency of deadly head injuries, taking into account that most of the gladiator types wore helmets.

A possible explanation could be the frequently reported deathblow technique used by the hammer-carrying death god “Dis Pater”. At least one injury per known type of offensive weapon could be identified, as well as evidence for the most popular, the gladiator trident, which was found to be represented by one perimortem and two antemortem injuries.

Overall, the reportedly very strict nature of combat rules for gladiator fights could be confirmed by the absence of multiple perimortal traumatised individuals, showing a lack of the excessive violence commonly observed on medieval battle ground victims.

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MANAGING FATIGUE Fatigue is an almost universal issue after a Brain Injury – it is different to the yawning and sleepy feeling of normal fatigue.

This type fogs the mind, drains all energy, dampens movement and sleep may do little to reduce it.

Learn where your limits are from experience. Even when you feel energetic, take your usual breaks or naps, as overdoing it can lead to feeling exhausted for several days. Schedule pleasant relaxing activities where needed – listening to music, watching TV or reading if these are not tiring. Make sure you eat properly, sleep well and avoid all drugs including alcohol, nicotine and caffeine.

Adynamia, or lack of motivation, often goes hand-in-hand with fatigue. Task analysis is one possible strategy where tasks are broken into individual sequenced steps and formed into a checklist.

Each step is then ticked as it is completed. In this way beginning, completing and following through on a task is much easier.

This reduces fatigue as it minimises the need to plan, organise, decide, prioritise, remember and put things in sequence. These are only some of the cognitive issues required to say, cook an omelette. The person with adynamia can be exhausted by these tasks before they’ve even opened the kitchen door!

Task analysis re-establishes the routines in our activities of daily living. With the use of checklists and lots of practice it can eventually make a great improvement in terms of drive and motivation.

A SERIOUS CASE OF THE BLUES? DEPRESSION IS EXTREMELY COMMON AFTER A BRAIN INJURY – HERE ARE SOME TIPS TO KEEP THE BLACK DOG AT BAY

Depression is a mood state in which you may feel low, down, negative and generally unhappy about yourself, the world and your future. Two reliable symptoms of depression are feelings of worthlessness and hopelessness.

These symptoms of depression may range from mild, in which a person may still be able to function in day-to-day life but generally feel low, to severe and debilitating depression.

Common symptoms Sadness, despair, flat emotional reactions and increased irritability Sense of hopelessness and pessimistic beliefs Behaviour patterns such as reduced

attention to physical appearance, social withdrawal and loss of motivation Poor sleep, appetite changes, and tiredness.

For a person with a Brain Injury, other signs of depression may include: A gradual decline in ability to perform everyday tasks Less ability to cope with everyday stressors Increased irritability and behavioural issues such as anger, frustration, and agitation.

Depression can exaggerate the effects of a

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Brain Injury and interfere with rehabilitation, so it is important that the family is aware of these symptoms. The good news is that once it is detected, depression is manageable and treatable with the support of family, carers and professionals. It is normal to experience periods of despair after a Brain Injury, but treatment is needed when it becomes severe or long lasting.

Depression after a Brain Injury There can be multiple triggers or causes of depression after a Brain Injury. One obvious cause is the significant loss and changes to

THOUGHT CHALLENGING This involves modifying your inaccurate and upsetting thoughts, which are common in depression. Upsetting thoughts are replaced with constructive explanations and more rational thoughts. You can keep a diary to monitor and assess your negative thoughts. These entries can include the time, situation, triggers, the thoughts that arose, and the feelings and actions that resulted. This may help you to become aware of patterns in your thinking, which may be destructive and negative. Here are some examples of negative thought process: Positive events attributed to external factors, such as an accident or luck (e.g. “I’m hopeless at work, I’m just lucky the boss doesn’t pay attention and see all my mistakes”) Negative events attributed to personal characteristics/faults (e.g. “I didn’t get that job because the interviewer could see I’m not a nice person”).

Next time something positive happens that you were involved in, make sure you give yourself a pat on the back and let yourself know what a good job you did!

physical, cognitive, social and lifestyle aspects of life. Depression can occur at any stage, from the acute hospital stage to many years later.

Depression in the early stages can be a sign that the patient is becoming aware of deficits caused by the Brain Injury. This is actually a promising sign in the rehabilitation process, as it means some level of self-awareness is returning, which is needed to identify and work on these deficits.

Depression can occur after discharge when life is resumed back in the community. The rate of recovery often starts to slow after the first six months, and there can be a growing realization of how much daily life has changed.

In fact, depression is almost always going to occur at some point in the recovery process.

Assessing depression

To be considered for this scheme you need to be referred by your GP, a psychiatrist or a paediatrician. You may need to book a longer session with a GP, as they will need to complete a detailed mental health assessment before considering a referral.

Types of treatment include cognitive behavioural therapy and antidepressant medication.

Personal strategies for coping Here are some simple but highly effective strategies: Get adequate sleep Listen to your favourite music Avoid drugs and alcohol Work on a personal project or hobby Mental stimulation (which is also great for cognitive rehabilitation) Schedule activities and make short-term plans

Clinical psychologists and neuropsychologists are experts in the assessment and treatment of mental disorders. Diagnosing depression can be complicated and easily misdiagnosed following a Brain Injury due to the overlap in symptoms.

For example, fatigue, irritability, poor motivation, slow information processing and changes in appetite are all symptoms of depression and a Brain Injury. A professional well acquainted with Brain Disorders is needed to assess post-injury depression.

Other useful approaches include thought challenging, peer support and exercise.

Professional treatments

Peer support

Professional treatment is advisable when depression becomes a problem. A person assessed as having a mental health problem can be referred by a GP to a registered psychologist under a Mental Health Care Plan. This means a person can receive a rebate on the cost of psychological treatment by a psychologist.

Don’t underestimate the importance of social contact for your mental health, especially fighting off depression. Social contact, and in particular peer support, can have a dramatic effect. Your local Brain Injury Association or mental health association can put you in touch with peer support groups for Brain Injury or depression.

Exercise Research indicates that exercise can assist with all but the most severe cases of depression.

Even 10 minutes of walking per day is good for your mood. If you are currently recovering from physical injury or physical deficits as a result of a Brain Injury, discuss any exercise program with your GP or rehabilitation team.

Suicide risk In cases of severe depression, it is important that family and friends look for any signs of a possible suicide attempt. If any suicidal thoughts are present it is important to encourage the person to seek help from a GP or psychologist.

If there has been a previous suicide attempt, look for the warning signs that occurred before, and immediately suggest professional treatment if they reappear.

Eat a nutrient-rich diet (e.g. Omega-3 can help with depression)

Warning signs to look for include:

At the end of each day write in a diary five things you are grateful for

I had died” or making threats of suicide

Use positive self-talk (e.g. “I can cope”, “I can manage this”)

Statements like “It would have been better if Suddenly and unexpectedly becoming

cheerful after a long period of depression (which may indicate a decision to use suicide as a solution) Having a plan for suicide, and the means to

achieve it.

The existence of an achievable suicide plan must be taken seriously. All suicidal comments need to be heeded, but having a plan and the means to achieve it is a sign that professional support is urgently needed. If the situation is critical, ring 000.

BLUE GENES? There is overwhelming evidence that many mental health disorders are due in large part to the genes we inherit from our parents. This is why it is common to see depression, anxiety or schizophrenia forming common threads down the generations. David Lykken from the University of Minnesota did a long-term study on twins and concluded that 50% of our mental health is derived from our genes.

Published in 1996, his paper reported that circumstances like income, marital status, religion and education contribute only about 8% to one’s overall well-being. He believes the other 42% is made up of what he called “life’s slings and arrows.”

Does this mean we are largely programmed to feel and think the way we do, so why bother fighting our depressive, anxious or paranoid nature? Far from it, although it does explain why it is hard work to change the way we think and feel!

YOUNG PEOPLE & MENTAL HEALTH YOUNG PEOPLE CAN GO THROUGH MANY DIFFERENT CHANGES AS THEY GROW UP

IMPORTANT THINGS TO REMEMBER ABOUT YOUNG PEOPLE Young people need a sense of belonging, connectedness to their family (whatever they say!), friends and community, and to make a meaningful contribution.

Firm and consistent boundaries are essential, but try to involve the young person in negotiating acceptable ‘rules’. A balance between self-responsibility and support helps a ‘child’ grow to an ‘adult’.

Young people need to do things differently from their parents and become individuals in their own right. Teenagers and young adults often question everything their families say and do. Try to stay confident in yourself, but also be open to learning.

Mistakes happen. Use mistakes – whether by you or the young person – to learn and keep moving forward. Having some conflict and then repairing the relationship is more important than avoiding doing anything because you fear upsetting the young person.

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Raising sensitive issues and working to resolve problems that arise along the way can be challenging. It can often be hard as a parent to know the difference between normal behaviour, such as occasional moodiness and irritability, and an emerging mental health problem.

If a young person develops a mental health problem it is important that they get help early. This artricle will help you better understand mental health and what you can do to support young people who might be going through a tough time.

Mental health problems in young people Mental health is about being able to work and study to your full potential, cope with day-to-day life stresses, be involved in your community, and live your life in a free and satisfying way. A young person who has good mental health has good emotional and social wellbeing and the capacity to cope with change and challenges.

Feeling down, tense, angry, anxious or moody are all normal emotions for young people, but when these feelings persist for long periods of time, or if they begin to interfere with their daily life, they may be part of a mental health problem.

Mental health problems can affect their feelings, thoughts and actions, and can affect their ability to function in their everyday activities, whether at school, at work, or in relationships.

If you feel you know a young person whose mental health is getting in the way of their daily life, it is important to let them know you are there to support them.

Most parents can tell when something is out of the ordinary, but there are also signs that suggest a young person might be experiencing a mental health problem. These are new, noticeable and persistent changes in the young person, lasting at least a few weeks, including: Not enjoying, or not wanting to be involved in things that they would normally enjoy

What affects a young person’s mental health?

There is no one “cause” for mental health concerns. Instead, it seems that a number of overlapping factors may increase the risk of developing a mental health problem. These can include: Biological factors - family history of mental health problems Adverse early life experiences - including abuse, neglect, death or a significant loss or trauma Individual psychological factors - including self-esteem, coping skills or thinking style Current circumstances - for example, stress from work or school, money problems or difficult personal relationships Serious illness or physical injury Drug and alcohol use and experimentation.

How can I help?

How to find help If you are worried about the health and safety of a young person: Talk openly and honestly with them, and let them know that you are concerned Reassure them that you will be there for them, and ask what they need from you Let them know that there is lots of help available – they will be able to talk to health professionals if this is what they prefer Help find an appropriate service, such as a headspace centre (headspace.org.au) and support them in attending Ask direct questions if you are concerned about suicide (e.g. have you been thinking about death? Have you thought about ending your life?)

Help the person build a support network.

When someone in your family has a mental health problem: Keep communication open, show empathy and don’t rush into judgements Be available without being intrusive or ‘pushy’ Spend time with the person. Take an interest in their activities, and encourage them to talk about what’s happening in their life Take the person’s feelings seriously Encourage and support friendships Encourage activities that promote mental health, such as exercise, good eating, regular sleep, and doing things the person enjoys Give positive feedback.

Let the person know that you love them. They may not always admit it, but this is likely to be very important to them.

Look after yourself as well. Get some support by talking to people, and seek professional help for yourself if you need it.

Looking after yourself It is important that as you care for someone that you also look at what you need to remain fit and healthy. Being at your best means that you can offer greater patience and a more considered approach as to how you can help.

Parents and carers of young people can often neglect their own needs and not know where to get information and support for themselves.

The Carer Information Pack produced by the Commonwealth Carer Resource Centre contains fact sheets that provide information to support carers.

Changes in appetite or sleeping patterns Being easily irritated or angry for no reason Finding that their performance at school, TAFE, university or work is not as good as it should be or as it once was Involving themselves in risky behaviour that they would usually avoid, like taking drugs or drinking too much alcohol Issues with their concentration Seeming unusually stressed, worried, down or crying for no reason Expressing negative, distressing, bizarre or unusual thoughts.

ABOUT HEADSPACE headspace is the National Youth Mental Health Foundation, established and funded by the Commonwealth Government of Australia in 2006. The primary focus is the mental health and wellbeing of all Australians, and especially support for young people who are going through a tough time. There are more than 70 centres around Australia which can provide young Australians with: There is also a wealth of General health, mental health and counselling information and services Education, employment and other services for parents and carers and Alcohol and other drug services. professionals who work with young people. Visit www. headspace.org.au for more information.

SLEEP, DIET & LIFESTYLE THE FOUNDATIONS OF HEALTHY LIVING

When faced with stressful life events our bodies tend to react in ways that often create chemical and behavioural changes which lead to problems with sleep. When under pressure and coping with difficult circumstances we also often neglect to maintain a healthy diet and balanced lifestyle.

It is amazing how often people who are in the midst of coping with stressful situations and experiencing some anxiety or depression forget to manage their sleep, diet and lifestyle appropriately. Sleep, diet and lifestyle are critical areas which can either help or hinder a person’s ability to cope.

Sleep Sleep is one of the most vital and critical behaviours necessary for human survival. Much research has shown that when humans are denied sleep for long periods of time they can suffer major psychological and physical problems which, if prolonged, can cause irreversible damage. I’m sure most of us can remember a time where not enough sleep made us irritable and difficult and made concentrating on things at work or with family quite hard at times.

Many people with psychological difficulties find their condition improved significantly after their sleep pattern was restored. Research has shown that an improved sleep pattern can assist in the recovery from depression.

Tips for a good night’s sleep Go to bed when you are sleepy and get up at the same time every morning. Try to avoid sleeping in longer trying to make up for “lost sleep” as this will alter your sleep/wake cycle. Avoid taking naps during the day.

Do not lie in bed worrying about issues. Write things down and make time during the day for problem-solving. If you can’t sleep then, after about 10 minutes, get up and engage in a healthy relaxing activity such as listening to your favourite music, and practicing breathing and

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relaxation techniques. Return to bed when you feel sleepy again.

Avoid the use of alcohol, cigarettes and caffeine products such tea, coffee, and cola soft drinks after about 4pm. Avoid having more than two to three caffeine drinks during the day. Regular exercise during the day can improve sleeping patterns.

Diet Diet is another important aspect of coping with life successfully. Eating a balanced diet, getting appropriate nutrition and limiting bad foods and substances can help prevent burnout and assist in recovering from difficult life problems, as well as improve our ability to maintain our physical health and fight off disease and infection.

Research has well established the link between

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nutrition, diet and physical illness. More recently research has shown the effect of a poor diet (e.g. excessive consumption of caffeine (tea/coffee), alcohol, simple sugars and other food products) on stress problems such as depression, anxiety, stress, and problems with mood, attention and concentration.

Tips for a balanced healthy diet Make sure you eat regular meals at planned times during each day. Avoid skipping meals or neglecting to eat during busy periods.

Even if you have lost your appetite try not to disrupt your normal eating pattern. Still sit down to eat your breakfast, for example, at your regular time even if you just have a nibble as your body will still be experiencing its normal routine which is important to maintain.

lots of fruits, vegetables, breads, cereals, grains and seafood moderate amounts of chicken, lean meat, nuts, eggs and dairy products very little sugar, fat, alcohol and salt.

When shopping for food, buy foods consistent with your dietary goals. Limit the amount of “junk” food - if you don’t buy it you won’t eat it.

Avoid grocery shopping when you are hungry.

If you do choose to lose or gain weight ALWAYS seek professional advice and support to ensure your plan will work and you will not adversely affect your health. Enjoy eating - make it a fun and pleasurable activity each day.

Lifestyle

Avoid snacking excessively between meals and avoid unhealthy snacks. Plan ahead to make sure you have plenty of healthy foods available to eat when you feel like having morning or afternoon tea (you may need to try a few healthy foods to find some you really like).

Not only do we need to eat well and get enough sleep. We also need to exercise regularly and do activities that keep our bodies fit and healthy.

Research has shown that exercise can assist in helping people cope with depression and also has been shown to be important in regulating sleep/wake cycles, and helping anxious or stressed people with sleeping problems improve their sleep.

Avoid consuming more than two to three caffeine drinks (e.g. tea and coffee) each day and never after 4pm. Learn more about healthy diets from experts. Remember, generally speaking in a healthy diet you should eat:

Lifestyle is also about activities we engage in.

Do we organise routine in our lives to assist in regular meals and times for rest or are things less predictable placing strain on our body’s ability to cope?

Are we too busy or not busy enough? Being too busy creates vulnerability to burnout. Not being busy enough can make us worry about problems excessively and become less focused and potentially leaves us with less meaningful activity and a lack of meaning and purpose to life.

Tips on balancing your lifestyle Plan regular times each day for exercise. Use lunch breaks to go for walks and get some time outdoors. Generally speaking healthy adults need at least one hour’s energetic exercise each week. Ideally plan for at least three sessions of 20 minutes energetic physical activity per week.

Develop interests and hobbies consistent with improving fitness and lifestyle. Take an interest in active sports and hobbies which allow active time in the outdoors.

Learn more about nutrition and cooking.

Enhance your culinary skills - hold dinner parties with friends.

Develop friends whom you can share interests with. Remember you may need to develop a range of friends who may appreciate different aspects of who you are. Diverse friendships allow for a variety of experiences and a broad social base for you to grow and develop across all areas of you life.

A JOURNEY TOWARD PRIDE WITHOUT PRIDE IN OURSELVES WE CANNOT CREATE PRIDE IN THOSE AROUND US, SAYS LEAH HOBSON

For people with disabilities, the transition from a childhood where you’re cared for, nurtured and perceived as “cute”, to the harsh realities of adulthood can be difficult to navigate. Leah Hobson unpacks the contradictions we face on the journey to becoming who we really are.

I’ve had this theory for a while that if you’re disabled, you take a lot longer to become whatever it is you are - whether that’s a wage slave, a queer person, an artist, or all of the above - than most people. While many others take a few cathartic years in their early to mid twenties to figure it all out, that’s the time when people with disability are grappling with multiple problems alongside the kind of identity questions that plague us all.

When you are no longer cute If you’ve spent your whole life – or even a significant chunk of it – as visibly disabled, by the time you’re in your twenties you’ve had to deal

with being stared at, called names, and told you were “brave” and “special”. You’ve been ostracized through both shame and celebration. It’s no wonder you’re confused and possibly angry.

provider websites: the most prominent pictures

Then suddenly, when you’re no longer cute, another element rears its head. It’s possible for you to be invisible. Lots of services cut out when you’re eighteen. People who supported you at school and at home are suddenly no longer there. Agencies that may have used your image as a struggling but hopeful youth to raise funds for services (or top heavy management structures) are not interested because you are no longer part of the most fiscally viable demographic. (Go and look at a few service

sympathy and fundraising, to an awkward social

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will be of young children.)

There are many ways to handle the sharp transition from being an object of bullying, misfit better left unseen, bundled away from the inspiring headlines about overcoming stuff. You could be burdened with a massive sense of self entitlement. You could have the world’s biggest chip on your shoulder, like I did. You might be in complete denial, waving the ‘normal’ flag at all the ‘normal’ parades.

But whichever road you take, some things are certain. For one thing, it’s unlikely that you come

out of the vastly contradictory experiences of a disabled childhood with a sense of self worth about your disability.

No win situations You’re thrust into the harsh daylight of a world that doesn’t know what to do with you, and it’s no wonder you find it hard to face yourself. Where children with disability are both celebrated and shamed without any regard for the internal schisms this creates, adults with disability also face no-win social memes.

Some of these are starkly contradictory. For example, if you’re on a pension you’re a bludger or an object of pity, but if you’re trying to work you’re clearly less efficient and able than other applicants. If you want to cure yourself, there must be something wrong with you. If you don’t want to cure yourself, there must be something wrong with you too. If you love your disability it’s weird that you’re happy about it. If you hate your disability, there’s no way you can be happy about it, ever.

there are lots of people who do lots of good things that help lots of people with disability in useful ways. But there are also schools that refuse entry to ‘difficult’ children. There are judges who let off parents who kill their disabled charges because it must be so hard. There are people who smile quietly as they drop money into the rattled tins but don’t stop to think about whether the charity they’ve just donated to puts people with disability in charge of their own lives.

And if you dare to question those things as I have here, you are unreasonably angry. And if you’re not unreasonably angry, then you must be happy, therefore everything must be okay!

Combined, all these things make it inevitable that many people with disability become cornered and tired and silenced. From then on, it’s a matter of applying common sense; people who are cornered and tired and silenced are often riddled with self doubt or self hatred. It takes time and a conscious effort of will to overcome those things.

Who am I?

Becoming a better society

Owning your capacity as a human being, your autonomy about what happens to your disabled body or mind and above all, your happiness, becomes a huge struggle. It takes energy to fight these external, invisible demons. And that’s on top of the energy it takes to live an everyday disabled life, where getting dressed might cost you an hour, or reading a book for twenty minutes might mean you can’t think straight for the next twenty. “Who am I?” becomes a question that sits on the back burner while you get through one day, and then the next.

Only then can you think about being a manager or a mother or a bisexual adventurer or a van Gogh in the making. We are losing a swathe of people who could be brilliant to sleepy decades of constricted thought. And while we as individuals with disability are disadvantaged by our lost years, so is our community. Without pride in ourselves we cannot create pride in those around us. We are too busy chasing down the invisible barriers, the things never quite said.

Are we really pro-disability?

All of this takes place in a society where part of the reason that disability is so invisible is because it’s utterly uncontroversial to be pro-disability.

Everyone is pro-disability, aren’t they? Nobody would want to hurt people in wheelchairs, people with guide dogs or guide dogs in wheelchairs.

Would they? All you have to do to prove your pro-disability credentials is give to a charity that helps the disabled, or talk about how lovely your next door neighbour or niece is. . . you know, the one who is always happy because they have an intellectual disability.

PANIC ATTACKS

Like becoming that person with multiple labels, goals and ambitions, becoming a better society for people with disability is not a one-shot process. It’s going to take a long time and a lot of thought.

The first step is to recognise all our contradictions, traumas and mistakes.

The second step is to stop hating them.

The author Leah Hobson is a policy wonk, Labrador wrangler and wine drinker, usually in that order. This article featured on the Ramp Up website at www.abc.net.au/rampup on the 11th June 2014.

In reality, our society is only pro-disability until you scratch the surface. Don’t get me wrong,

RAMP UP - WWW.ABC.NET.AU/RAMPUP Ramp Up is a website which featured as an online destination for news, discussion, debate and humour for everyone in Australia’s disability communities. While Ramp Up is now discontinued, the website remains at www.abc.net.au/rampup/ as an important resource. Ramp Up was produced by the ABC with the assistance of the Department of Families, Housing, Community Services and Indigenous Affairs.

Panic attacks are a possible outcome if a person experiences higher levels of anxiety. A small number of these people will go on to develop panic disorder, whereby panic attacks are intense and occur frequently. If left untreated, panic disorder can be a debilitating condition, severely restricting the quality of life of the sufferer.

Panic attacks can occur at any time, repeatedly and without warning. Mostly they last for a few minutes, but on occasion may last for an hour or more.

In between attacks the sufferer often feels intense anxiety, worrying when and where the next one will strike.

Panic attacks are accompanied by the unpleasant physical symptoms of anxiety including heart palpitations, hyperventilation, muscle pain, dizziness and sweating, along with the fear that the attack will lead to death or a total loss of control.

Why panic attacks occur Panic attacks are just extreme versions of normal bodily responses to danger.

Adrenaline being released into the blood stream causes the heart to beat faster and the breathing rate to increase in order to supply major muscles with more oxygen.

Treatments There are a number of treatments for panic attacks with research showing cognitive behavioural therapy to be best practice. Some people choose to combine a number of treatment options. These can include cognitive behavioural therapy (CBT), medication, complementary therapies (herbs, vitamins and homeopathy), exercise and relaxation techniques.

BEHIND THE EXTERIOR AT TIMES MARCIA GONCET FINDS IT HARD WHEN THE WORLD REACTS TO HER OUTWARD APPEARANCE I love children, however they don’t always love me back. This was not always the case, in fact, they used to like me. However, I now sit in a wheelchair due to a massive stroke and everyone’s reaction to me is different.

For a start, I speak very loudly, I don’t mean to, but it makes it is easier to understand myself. In turn, children think I am angry and they get scared and run away. I have dyspraxia, a weakening of my vocal cords, so I sound very different to the naked ear, and can be hard to understand.

Sometimes, it is not easy to accept my fate, and I get very depressed. I was once a kindergarten teacher and children loved me. On a good day, I think they are only children not used to a loud person in a wheelchair, but on a bad day, I can get depressed, even teary.

The other day, I went to my children’s school for an open day. I explained to my daughter’s teacher I wanted to bring cupcakes for the kids as it was my way to break the ice as the children were scared of me. As soon as I said it, the teacher felt bad, then I felt bad, then the tears started. I had to flee the scene of the crime quickly so the children wouldn’t see me crying.

My psychologist often says I have to develop a thick skin, and my husband agrees, but I feel like shouting “That’s easy to say but you aren’t in my skin!” I don’t shout, as I’d only look crazy. I’m not crazy, just a little peculiar after the stroke.

My reactions are very confronting for some adults, let alone a child. For example, in conversations I won’t remember a word due to memory problems. However, all of a sudden it pops into my head and I tend to shout the word out minutes later in the conversation.

Last week, we were staying in a lovely unit on the beach with spectacular views and fantastic weather. However, I felt sad as I wanted to play cricket with my children and feel the sand on my feet and collect seashells with the kids. Instead, I was looking at them from afar.

The big problem is I’m legally blind. I can’t see very well, so I just imagined them. It’s hard to accept there are so many things you can’t do anymore.

Today, my husband kindly made pancakes for all of us. Normally, he cuts food for me, but I decided to cut my own pancake. The pancake flew off my plate, to much hysterical laughter. I joined in the laughter, and for one moment at least I felt an affinity with my children.

I shouldn’t take life so seriously, but sometimes I just do. It is my life after all.

I recently went to see my father in Spain who is unwell. My family had to employ a live-in assistant for me, but Spanish was not her first language and communication was hard. One of Khadija’s jobs was keeping me occupied so she would just plonk me in front of the TV. It was an unpleasant trip. The time difference meant going to the toilet in the middle of the night. I tried to remember Khadija’s name, then tried to wake her from her very sound sleep. I felt all alone in the world, and thought I would actually have an accident in bed.

Khadija would treat me one way when we were alone, and much better if my family was around. I can sympathize with those babies whose working mothers leave them alone in day care, oblivious to what goes on in their children’s lives. At least I’m a grown up, I have a voice, and I can defend myself. I told my siblings how I was being treated but our hands were tied.

I was only in Spain for four weeks, there wasn’t much we could really do.

When you are in a vulnerable position you encounter all kinds of people – many are kind-hearted and some less so. People like Khadija can be insensitive, even callous, but I’m learning to deal with people in complex situations. No one should be treated as a second class citizen, regardless of having a disability or not, so I choose to surround myself with those who are kind-hearted.

EXERCISE FOR MENTAL HEALTH Exercise had a big boost as a way to fight depression when some studies indicated it was as effective as antidepressant medications. While those findings are now under question, there is no doubt that exercise can play a key role in our overall mental health. Why? Feel-good biochemical brain processes include plasma b-endorphin, norepinephrine and serotonin. Exercise releases these, especially if prolonged and intense.

If you do make a commitment to exercise remember to look at your diet as well!

Regular exercise and physical fitness are increasingly being portrayed as hallmarks of the successful lifestyle. Our self-esteem can plummet after a Brain Injury, so exercise is an easy, healthy way to feel better about ourselves. Having a sense of control over your health can also promote feeling more in control of your life. And finally, there are plenty of exercises that involve social interaction (e.g. a running group) which can counter the sense of isolation common after a Brain Injury, or if you are a carer.

THE ECONOMICS OF HAPPINESS

DRINKING TO YOUR MENTAL HEALTH? Alcohol and other drugs may enhance our lives when used in moderation and with due care, but their use definitely needs to be carefully considered after a Brain Injury.

Any difficulty in thinking clearly and managing one’s emotions and behaviour can lead to dependence on alcohol or other drugs.

In turn, drugs usually impair these abilities even more, so a vicious cycle can result. Cognitive deficits are only worsened, as well as behaviours with impulsivity, risktaking, and difficulties in monitoring one’s emotions and behaviour. Having a Brain Injury and a mental health disorder would present a very strong case for avoiding alcohol in the long term. At the absolute minimum rehabilitation specialists would advise on avoiding alcohol for the first year during recovery, then very carefully monitoring its effect if when recommencing its use in low doses.

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Economists often equate the good life with wealth, but while richer nations tend to be happier than poorer nations, this difference seems to disappear once GDP/ capita reaches US$15,000 a year. Some economists have been coming up with happiness equations like Wit = α + βxit + εit, where W is the reported wellbeing of individual i at time t, and x is a vector of known variables such as socio-demographic and socioeconomic factors.

The idea that happiness is important to a society is not new. Thomas Jefferson put the pursuit of happiness on the same level as life and liberty in the United States. Jeremy Bentham, an English philosopher, said public policy should attempt to maximize happiness, hence his ‘hedonic calculus’. The king of Bhutan created the first Gross National Happiness index as he was concerned about the problems arising when focussed on economic growth alone. Thailand started a similar in index in 2006, assessing criteria like security, good governance, social justice and education. Australia, Canada, China, France and the UK are also coming up with their own happiness index.

GRIEF & LOSS GRIEF IS THE EMOTIONAL PAIN THAT WE FEEL WHEN WE LOSE SOMETHING OR SOMEONE WE VALUE. IT IS A NATURAL AND NORMAL REACTION. DEATH IS ONE SUCH LOSS, BUT ILLNESS ALSO BRINGS THE EXPERIENCE OF LOSS FOR THE PERSON WITH THE CONDITION AND FOR THEIR CARER.

There is no single way to grieve, no clear set of “steps” in a grieving process.

Friends often don’t know how best to support you and grief can sometimes stretch relationships to breaking point. The most important thing is that people are allowed (and allow themselves) to grieve in their own way, in their own time.

For the carer & family Families almost always experience grief over the loss of the life they had before. Grief may be felt over the changes in the person you care for or in confronting their imminent death. Many carers feel they can’t admit, even to themselves, how terrible they feel.

Diagnosis: this often brings shock and confusion. You may be so focussed on the

person that you have little time for your own feelings or reactions. Your relationship with the person may be changing, and your own needs may be neglected.

Loss of independence, freedom, time for yourself, pursuing things you enjoyed, and employment.

Too close for comfort: a carer looking after a parent may find their roles reversed – carer becomes parent – which can be awkward and difficult to come to terms with on both sides.

Losing a sense of normality and future, loss of dreams, goals and plans.

Caring for a spouse: this often means taking over their responsibilities in the relationship. In both cases, you may be losing your greatest source of comfort and support.

Loss of religious faith.

Carers speak of loss in many ways: Loss of the person you once knew, the things you did together, sharing good times.

Lack of intimacy and closeness.

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Loss of communication and mutual support.

Loss of predictability, control, and financial security.

Feeling stuck – small setbacks can trigger grief.

Where the condition is clearly progressive, you may feel you can’t start to move on until the person’s death, yet even to think like that opens up more grief and guilt. It can be a very drawnout process.

Feelings People react in many different ways and at different times. It’s important to remember that these are all normal reactions to serious loss.

You are not falling apart, cracking up or failing to cope. Feelings like these listed below may come over you in waves, often without warning. They are part of the process of adjusting to the changes.

Denial and shock – “Not us/me!”, it hasn’t happened, it can’t be true.

Anger and resentment – “Why us/me?” It’s someone else’s fault, blame the doctor, blame God. You may feel sorrow, numb, miserable and many other negative emotions.

Guilt – at your anger, because you couldn’t prevent the illness, because it didn’t happen to you or because you no longer feel the same about the person. Despair at the words “no cure”.

Depression, sadness, sorrow, helplessness hopelessness – feeling you can’t cope, it’s not worth it, there’s nothing to live for, a continued grief with no end in sight.

Anxiety or panic – over the intensity of your feelings, about your future, about the present.

Self-doubt and blame – a sense of inadequacy, insecurity, “I’m doing a rotten job”, “It’s my fault”.

Reactions These feelings may cause people to behave and react in all sorts of ways. Each person’s response is unique, but carers have described: Tension, crying, fatigue, exhaustion Sleeping problems Changed eating habits Poor concentration, memory and motivation Difficulty making decisions Poor health e.g. headaches, stomach aches Refusing help Withdrawing from social outings.

Preparing for death We all know we are going to die, yet in our society, we tend not to think about death or to prepare ourselves for it. Watching a person you love slowly approach death as they move, perhaps, from home to hostel to a nursing home, can therefore become a painful and confronting process for carers. But by thinking about how

you might feel and doing some preparation, you can make this process a little easier.

Acknowledging death: for many people, the grief is there long in advance. It may start when the person is diagnosed, or before, and continue throughout their illness. Some people may begin grieving only after their family member dies.

Grief is unique: there are no rules about how to grieve – what you do, how long you are sad, when you stop crying – each of us deals with this in our own way. Do not expect those around you – family members or friends – to behave or feel as you do. We all react differently. Just be yourself and allow yourself to grieve in your own time, in your own way, whether that is publicly or privately, but do grieve.

Before or after death: talk about your thoughts, feelings and memories – it helps to sharpen memories, to remember the good times and the bad. Accept offers of support – this can help you to express your feelings, to reflect and to talk it out.

Professional help: if you can’t seem to come to terms with the loss or if after several months you are not sleeping, not eating properly and are sad much of the time, seek professional help. A trained grief counsellor can make a difference.

Moving on: for many people, caring has defined their lives for so long that life beyond it can seem a challenge. There are usually decisions you can make and actions you can start that will help you move toward a new future.

Try planning things you might do now, or in a few weeks, months or further down the track. These might include finding someone to help sort out a large house and financial affairs, thinking about friendships you would like to rekindle, looking into TAFE courses, volunteering, employment or community work, or planning a break.

There is a time to move on that comes when you are ready, but occasionally, a person needs the help of a good counsellor to get there.

Reproduced from “Those who care” by Brainlink, a Victorian-based service that is dedicated to improving the quality of life of people affected by acquired disorders of the brain, by providing support to their families and carers. Visit their site at www.brainlink.org.au

MANAGING GRIEF Ignoring grief won’t make it go away, but there are certain approaches that might help you to find a path through it and to adjust to your losses.

Recognise your feelings: Become aware of the feelings you have and learn to recognise why you have those feelings. Keep a diary if necessary.

Help yourself: Adopt a problemsolving approach. What can you do to help deal with these feelings or to defuse them?

Care for yourself: It’s essential that you take care of your own needs as well as those of the person you care for. Acknowledge to yourself that you are grieving – it’s OK to grieve.

Talk it out: Find someone you can talk to, perhaps a friend who will listen without giving advice. Consider seeing a grief counsellor who can give you skilled help in dealing not only with your own grief, but with that of the person you care for.

Find hope: You need hope. With hope, there is a future. While one part of you needs to acknowledge the difficulties you face, there is always something to hope for, however small or large it may be – don’t let anyone talk you out of it. It might be an event, it might be a relationship or the knowledge that this time, too, will pass.

Other strategies that carers have found helpful include: Seek respite care Actively try to maintain a positive state of mind Faith in a higher spirit or religion Keep informed and know what to expect in the future Treat yourself – to the movies, shopping with a friend, buying yourself something special Avoid isolation Hold on to a sense of humour Keep a journal to write down fears, hopes, concerns, joys Joining a carers’ support group Nurturing activities like yoga and tai chi

GRIEF & LOSS FOR THE PERSON WITH A BRAIN INJURY Our own grief will be paralleled in the person you are caring for. Consider some of the losses they are dealing with: loss of the ability to move about easily, to work, to play, perhaps even the ability to communicate. There is loss of their authority and place in the family, loss of decisionmaking abilities, family security and predictability, loss of self-esteem, religious faith, privacy and dignity. When we are well, we have a sense of invulnerability that somehow the bad things in life will pass us by. Chronic or progressive illness shatters this sense and brings grief that anticipates losses yet to come – loss of control, of family support and the fear of further illness and of becoming a burden. For those with an inherited condition, there may be the added fear that their children may face the same experience.

RELATIONSHIP CHANGES AFTER A BRAIN INJURY THE IMPACT OF A BRAIN INJURY HAS OFTEN BEEN LIKENED TO THROWING A PEBBLE IN A POND - THE INFLUENCES REACH OUT TO PARTNERS, FRIENDS, FAMILY, CARERS, WORK COLLEAGUES AND THE WIDER COMMUNITY.

As a partner or carer, the issues you face will vary according to the stages of the recovery process, and each stage will bring its own joys, challenges, hopes and needs. Old coping methods may remain helpful for some but others will find new methods need to be developed.

The hospital & rehabilitation stages If the Brain Injury is life-threatening then no one wants to leave the hospital - everyone’s focus is on the patient. Your own needs right now hardly seem to matter. Your friends want to help; this is the time to let them by taking care of the house, children, car-pooling, shopping, and so forth.

Beyond attending to day-to-day tasks, some may want to offer emotional support as well.

You may have conflicting feelings about this.

Your good friends will understand and be there for your needs, whatever they are. You might find it helpful to name one or two of them as coordinators. They can return phone calls for you, offer apologies and thanks to others, and do whatever else needs to be done.

During the rehabilitation stage, the patient is medically safe and has been moved to a

rehabilitation centre. At this point, you can relax a bit and start to put order back into your world.

You may feel exhausted and out-of-sorts - this is part of the natural letdown of the initial trauma.

You may not feel like talking to, or being with, your friends right now. You may be pre-occupied by your own concerns. This is a perfectly natural reaction even if it feels disconcerting to you. Ask your friends for their patience and grant yourself the same. You may find more comfort being with other families in the rehabilitation unit who are going through what you are, than being with your old friends.

The return back home The person with a Brain Injury moves back into family life and begins to renegotiate his or her social world. You, as care giver, begin to redefine your world as well. Your friendship needs will

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change again. Depending on the severity of the injury, you may find it difficult to leave your loved one and go out. You may want a friend or two to visit, but even that may feel like it is too much because of the extra work that now goes on in your world.

Some friends may be comfortable with what has happened, and with the difference they observe in your loved one - and perhaps in you.

One of the first ways to address their fears or discomforts may be to educate these friends about the injury. With information, they can become more comfortable with the situation.

You may feel isolated, and even jealous of your friends’ happiness. You might want to find support groups and other carers, who are dealing with the same issues. You do need to go out, take time for yourself and start making your life a priority.

IN THE LONG TERM The family: One of the common issues that families face is their son or daughter with an injury returning to the family home despite having lived away from home prior to the injury. For the person with the injury this can represent a huge loss of independence and self-reliance.

Everyone’s lives can change significantly.

Future plans may be put on hold, there may be dramatic personality and behavioural changes after the Brain Injury such aggression, rapid changes in mood, self-centredness, impulsivity, sexual and social disinhibition, poor motivation and lack of empathy. Friends of the family often distance themselves over time when there are behavioural issues.

Partners: The rate of marital and relationship breakdown is very high following a Brain Injury. The pressures can be immense: running of the house, becoming the sole wage earner, making most of the decisions, and providing support to the person with the injury. Finances may become a major concern due to medical bills and loss of income. A change in the sexual relationship of a couple can also be a very distressing and sensitive issue e.g. either a decrease or increase in sexual drive.

Children: A child may have to come to terms with why their parent has changed so dramatically after coming home from hospital - why their parent needs care, walks or talks strangely, never remembers anything, gets upset so easily, and why they no longer want to play with them.

Children may display increased acting-out behaviours, emotional problems, or relationship difficulties. Negative parenting performance such as yelling, ignoring or being impatient by both injured and uninjured parents is reported in most families. Most non-injured parents report substantial depression, which correlated significantly with negative behaviour in children.

Friends: A very common statement made by people with a Brain Injury is ‘you find out who your real friends are’ after the accident. Unfortunately, friends can disappear at the time when the person most needs their support. It is also common for people who have spent a long time in hospital to feel that they have missed out on a lot of experiences with their friends and that they now have trouble relating to their friends and sharing their interests.

Supportive friends learn to adjust their expectations of the person with the injury and seek new activities for spending time together e.g. watching a game of sport instead of going to a nightclub. Alternatively, the person may wish to meet other people with a Brain Injury by joining a specialized group rehabilitation program or a less structured Brain Injury social group.

CO-MORBIDITY WHEN A BRAIN INJURY AND A MENTAL DISORDER OVERLAP Mental illness can occur at the same time as an Acquired Brain Injury and is known as a dual diagnosis or co-morbidity. A mental disorder may have been present prior to an acquired or traumatic Brain Injury, or there may have been a history of mental illness prior to acquiring a Brain Injury.

A mental disorder can lead to Brain Injury Certain mental disorders can increae the chances of acquiring a Brain Injury, especially if there is: Impulsivity and risk-taking behaviour Drug use as self-medication Tendency toward violent behaviour Attempted suicide.

Brain Injury can lead to a mental disorder Psychiatric and emotional problems are common after a Brain Injury, of which depression is the most common. There is debate as to whether depression is a normal phase in adjusting to life changes after a Brain Injury, or if it’s a long-term disorder. Various anxiety disorders have been reported, including post-traumatic stress disorder and obsessive compulsive disorder. Bipolar disorders and schizophrenia do not seem to be linked strongly with Brain Injury.

Which is which?

Separating the symptoms of a mental illness and a Brain Injury is a difficult task. The symptoms can be extremely similar, causing problems for diagnoses and therefore access to appropriate treatment.

Signs that a mental illness may be developing after a Brain Injury include: A gradual decline in ability to perform everyday tasks Decline in ability to cope with everyday stressors Increased irritability and behavioural issues (e.g. anger, frustration, agitation) Exaggeration of the Brain Injury’s effects.

Management & treatment Given this co-morbidity, regular psychological assessments should be an important part of rehabilitation. Family members should be made aware of the risks and how to identify a possible mental disorder. Early identification of depression should be a priority to maintain quality of life, and minimise the chance of suicide attempts.

Various anxiety disorders have been reported, including post-traumatic stress disorder and obsessive compulsive disorder.

Rehabilitation, medical and support services have often been slow to recognise how frequently there is co-morbidity, and at times it has resulted in people being refused treatment e.g. a Brain Injury support service may say they don’t handle mental disorders, while a mental health service may say they aren’t equipped to deal with the complications of a Brain Injury.

MENTAL ILLNESS – A BRIEF HISTORY The Greeks coined terms for melancholy, hysteria and phobia over 2000 years ago.

In the Middle Ages, Christian Europe saw mental illness as a mixture of the satanic, divine and humoral, while the more advanced Islamic world was developing psychiatric theories and treatments (their first psychiatric hospitals built in the eighth century!).

The early modern period in Europe saw a mixture of madhouses, witch-hunts and imprisonment for mental illness.

The 18th century saw mental illness treated increasingly as a physical problem, with more humane treatments being proposed.

Insane asylums were all the rage in the 19th century, and the second half of the 20th century finally saw the dramatic impact of medications and a move toward keeping people in the community instead of institutions if possible.

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ALWAYS TAKE OFF INTO THE WIND EVAN’S FIGHT TO NOT ONLY SURVIVE BUT ACHIEVE A LIFELONG DREAM In May of 2008 I went for a motorbike ride with my girlfriend on the back as a passenger. We were involved in a road accident in which she passed away at the scene. Given the tyre marks over my clothing, I had been driven over and dragged beneath a car for somewhere between 30 to 40m.

Exercise during rehab I am a massive advocate of exercise as a means of rehabilitation – not just for the physical side of things, but also for the cognitive aspect.

Exercise increases blood flow around the body at a faster rate (in line with the pulse rate) and effectively forces oxygenated blood to the brain at a higher rate. I also view study as a means of rehabilitation, as the brain is just like a muscle – if you don’t use it, you lose it.

So, after five years of work where I had systematically progressed my way through the company, and six and a half years post-accident, I applied to UTAS and Par Avion to become a commercial pilot. It was a risk, but also a life-long dream of mine which initially I thought I’d never achieve. Like all challenges faced up to that point, I addressed each issue one-by-one, with the first being to pass a medical test.

No witnesses came forward who could have provided an accurate description of what happened – however it appears a third vehicle was involved which had been driving on the wrong side of the road. There was no drinking, drugs, or speed involved by me – I was just in the wrong place at the wrong time.

Massive injuries The injuries I sustained were varied. I had massive orthopaedic injuries, including spinal injuries, right wrist and leg, and some of the worst pelvic injuries that Royal North Shore Hospital had ever seen in someone who survived. I lost a lot of bowel, half a lung, and am an incomplete paraplegic.

I was airlifted to hospital and spent five weeks in a coma and six and a half weeks on life support – my family were advised that when I woke the chances were I’d never recognise them, and be dependent upon them for the remainder of my life. It’s fair to say I wasn’t very well.

I was in post-traumatic amnesia for 67 days, and spent several months at Royal Rehab in the Brain Injury Unit. Even in rehab my family would bring me books to read and documentaries to watch in order to stimulate my brain. Personally, I believe it worked.

After leaving rehab (and completing the last of my 46 major operations) my family encouraged me to return to university, albeit under the care of the disability and support unit, to complete the last three subjects of my degrees. I had only three weeks to go when the accident occurred – however I could no longer study three subjects at once, especially as I had recently returned to the workforce (as a further means of cognitive stimulation). I required substantial assistance from the university. That said, after 18 months I finally completed my university studies, and in April of 2011 I graduated with a Bachelor of Business (Accounting) and a Bachelor of Laws. I must confess, even I was pretty chuffed with that result myself!

For me, there was no point in just becoming a private pilot – I wanted to go the whole way, and if I was going to do something I would do it correctly. This meant achieving the required health to pass a Class 1 CASA medical, the highest CASA medical examination. It even involves your eyes having drops in them to dilate the pupils so the retina can be examined under a microscope. It’s incredibly in-depth, but in October 2014 I passed! This was quite possibly the most joyous moment of my life up until that point.

My partner (Mandy) and I made the decision to move to Tasmania, and she has believed in me and supported me the entire way. We took a huge gamble and moved to Hobart without jobs, but have made things work out for the best ever since.

Mandy has also stayed committed to my physical recovery, and continues to push me to get out and hike as much as possible. This hiking not only increases my physical strength (which my right hip especially requires), but I believe it helps ‘feed’ my brain as I alluded to earlier.

Since coming to Tasmania I have completed 90% of my private pilot’s license qualification. Because of the challenge my Brain Injury presents to memory and concentration functions, the theory exam was always going to be my biggest hurdle and this week I passed the CASA three and a half hour theory test. Yee haa! My goals are coming ever closer.

Determination & not giving up In summary, I just wanted to share my story because I know only too well, first hand, just how tough a Brain Injury can be. I want to let others know that with a serious amount of determination, actually getting off the couch, and spending the time and effort working towards things, I have been able to obtain some very remarkable results. It IS possible, it just takes work.

And, whilst there have definitely been days where I have questioned myself, doubted my abilities, felt that it was all too hard and I wasn’t going anywhere, (honestly, I’d be lying if I said otherwise), I always remember, ‘a plane always takes off into the wind’.

LIFE CHOICES & CONSEQUENCES LUCAS IS WELL QUALIFIED TO DISCUSS THIS TOPIC AFTER CLINICALLY DYING MULTIPLE TIMES

You know when sometimes you wake up and you aren’t sure where you are or how you got there? Well one day in 2005, when I woke up the last thing I remembered was – nothing. I had no memory of my entire life. I didn’t know my name, I didn’t recognise my own family and I couldn’t remember how to talk, read, eat or even go to the bathroom.

In the relatively short time I’ve been around I’ve been involved in two major road accidents that were so severe I’ve actually been declared clinically dead on multiple occasions. I’m now a road safety advocate and life choice ambassador.

My previous life In my life before my accident I was never really a focused student; school was more about having fun with my mates. All in all, life was fun. I was an active young man into football, indoor cricket, kite surfing and music.

Like a lot of young drivers my confidence grew to dangerous levels and I drove like the invincible young man I thought I was. I continuously pushed the limits, driving under the influence, and taking more risks because I was bullet proof.

I managed to lose my licence twice but never stopped driving – that is until I crashed into an electricity pole.

injuries. I shattered my skull in five places and was immediately comatose. Just like that my brain was bleeding and I was dying.

My first accident

I was rushed to hospital and underwent countless emergency operations. The only thing keeping me alive was the breathing machine, committed doctors and a will to live. I was declared clinically dead several times. After over two weeks in Intensive Care, my brain had stopped swelling, the bleeding was only a trickle and I began to wake up. But I wasn’t the same, and I never would be. I didn’t know anything or anybody.

I had no memory, limited body function and I had lost half my right-side vision in both eyes.

I also had double vision from the head injury.

I had to slowly relearn how to eat, walk, talk, communicate, be hygienic and go to the toilet.

It was Friday night and after having plenty to drink, a few cones and at least one ecstasy tablet, my three mates and I decided to drive to a party. A friend’s girlfriend was absolutely insistent that I should not drive – she even took my keys off me. I didn’t listen to her, Somehow I convinced her that I wasn’t going to drive – Tim was. As we walked to the car I grabbed the keys off him and jumped into the driver’s seat.

With no inhibitions and no seat belts on, we raced off at 120 km/h in a 70 km/h zone. I swerved off the road head-on into a power pole.

My three mates in the car sustained extensive

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ADVERSITY, REHABILITATION & ATTITUDE We all deal with adversity and hardship in life but it is at these times where we can see our biggest growth as people. There may be times you feel like the only one, but it is what you learn from these challenges and how you deal with the setbacks that will shape you into the person you will be. The fundamentals of dealing with hardship are very similar. You must first accept the changes and challenges in your life, because it is only then you can move forward and grow into the magnificent person you are destined to be!

Recovery I was then transferred to BIRU (Brain Injury rehabilitation unit) where I spent six months learning how to read, cook, clean and be hygienic, along with brain rehab exercises. I finally returned home, but my memory was a white board – literally. I also use my phone as a reminder for my daily tasks. Twelve months after my accident it was important for me to take life on so with my father’s support we decided that I would do a carpentry course at a TAFE college.

It didn’t matter what I did but it was important to take the next step – I needed to continue to grow and widen my vision of the ever-expanding world, because that is the only way we can grow!

“It was extremely tough and challenging” but I just kept pushing on with a positive attitude and giving it my all. It is important to have a vision, a goal and something that you are working towards because without a vision we can get lost and walk around aimlessly.

I then got a job doing casual labouring at my father’s construction site. I was now in the big bad world dealing with hardened men who had no idea about my past or disabilities. I did need assistance, and at times someone to basically hold my hand through particular tasks. One of my strengths was that I knew my limitations and accepted that I needed help, so I wasn’t afraid to ask! I would always work hard and efficiently

as I could, but there were times I made mistakes and because of the environment I was in I was treated quite harshly. But from each experience I gained the necessary wisdom that would help me continually grow and learn for future challenges. Staying positive is the key to a joyful future!

My first attempt into the work force didn’t work out, I wasn’t quite ready for it so I left. Six months later with the love and support of my father I was encouraged back to work. This time I was mentally ready to take it on and I did.

Rehab never ends

Attitude is everything – you must continue to look on the bright side of life. It’s fundamentally important to surround yourself with a great support network of people. You need to walk your journey with others so that you have someone to fall back on, which brings positivity into your life. I can’t underestimate how important it is to have a positive frame of mind, so make sure your continually growing in your attitude – that is going to define your future.

Remember don’t overwhelm yourself by taking on too much, just one task at a time if you are able, and your future is bright!

with positive and loving people because you are a reflection of your environment. You can find these people at church, community groups or

Rehabilitation is a massive part of my life, it is ongoing and forever. You must embrace the challenges with a positive and uplifting attitude because we are capable of an amazing future no matter what the setbacks.

sporting clubs. Don’t overwhelm yourself, it is

I now travel the country telling my story. I hope that I can influence and educate people about the importance of life choices and the necessity in supporting your mates in making the right choices – on and off the road.

Lucas is a road safety advocate and a life choice ambassador who has twice survived the unsurvivable. As a representative of the Paraplegic Benefit Fund (P.B.F) and having also worked with road safety education he was called in to be a spokesman on behalf of the Youth Advocacy Centre. Lucas now travels around the country discussing the importance of life choices and how one risky decision can change the course of a life. As Lucas says “If I can help just one person believe, achieve and dream a little bigger then I have served the community well”. Visit his website at www. lucasmerrick.com

A vision for the future I am a dreamer, a visionary, and I believe we are all capable of amazing things – so dream and create a vision for yourself. I believe the greatest gift we can give ourselves is to give to others as it creates joy. It is important to surround yourself

important to just take on one challenge at a time.

Attitude is everything so keep dreaming and don’t be afraid to aim for the stars.

POST-TRAUMATIC STRESS DISORDER Post Traumatic Stress Disorder (PTSD) is an anxiety disorder wih symptoms such as hypervigilance, being easily startled, and sensitivity to loud noise. It can occur after a traumatic event that causes a mild to moderate Brain Injury, in which some of the traumatic event may be remembered.

However, new research suggests PTSD can occur even where there is no memory of the events.

Other symptoms include nightmares, difficulty sleeping, a racing heartbeat, shortness of breath, dizziness, sweating, panic and avoiding situations or thoughts related to the event.

A person experiencing both Post-Traumatic Stress and effects of a Traumatic Brain Injury requires a high level of understanding and support. Due to the unpleasant feelings a person may avoid various situations which act as reminders of the trauma or avoid thoughts and feelings associated with the event. As the person continues to avoid these feelings and situations, it is easy to maintain the idea that it is unsafe to think about or be in such situations. As a result a person may become restricted from various activities and maintain high levels of anxiety.

Both Post-Traumatic Stress Disorder and mild Brain Injury are prone to misdiagnosis.

This is largely due to the similarity of symptoms in Brain Injury and PTSD. The sleeping disorders, irritability, depression and emotional problems that can be due to a mild Brain Injury can be misdiagnosed as an effect of PTSD. This may also occur in reverse, leading to inappropriate treatments.

After horrific accidents, a person with Traumatic Brain Injury may have no signs of PTSD because they have no memories of the actual accident-often their earliest memories are of being in rehabilitation weeks later. However, it is important that any suspicions of PTSD be checked thoroughly by professionals with an understanding of Traumatic Brain Injury.

Treatment for Post Traumatic Stress Disorder Treating and recovering from PTSD is often a gradual process. It is a process of healing and gradually coming to terms with the traumatic event and this can take time. It’s about learning to cope with the thoughts and feelings associated with the event and continue with life without these thoughts or feelings of the event interfering with daily life. Below are some common forms of treatment for PTSD. It is preferable that therapy be sought by a psychologist or psychiatrist with an understanding of traumatic Brain Injury.

This way a program may be tailored to your specific needs. Contact your Brain Injury Association for options in your area.

THE JOURNEY BACK LOUISA REID’S ONGOING RECOVERY AFTER A STROKE Two years ago I had a suspected ear ache checked and it turned out to be two aneurysms in my brain.

I did some research on aneurysms then joined a support group on Facebook. A year later I went into surgery on just one aneurysm, thinking it would go well, a few days in hospital, and then return home.

In the Intensive Care Unit I couldn’t really hear or understand what the staff were saying. After a week they put me in a wheelchair and took me to the Brain Injury Rehabilitation Unit which was a locked ward.

Don’t take life too seriously.

You will never get out of it alive.

Elbert Hubbard

I couldn’t understand what was happening. I cried. I waited. The next day I packed my things and waited by the locked door.

Someone opened the door, not suspecting that I wanted to escape, and I made it out. I was stopped outside but I cried and refused to move back, I refused to allow any staff lead me into the locked area.

My doctor rang my daughter, who, in an hour, arrived to talk to me. She explained to me what was happening – I had a stroke during my operation and had to come to the rehabilitation ward. My daughter walked back inside with me and kept me company for a while.

In the days ahead, I found the staff were too busy helping other patients with things like wheelchairs and bed chairs to provide much in the way of support. The other patients had quite severe Brain Injuries, but I never saw myself in the same situation although I was very frustrated – I couldn’t talk properly, I couldn’t use my laptop, I’d repeat my own words then realise I wasn’t speaking in English. I had a speech pathologist, a music therapist, a physio and an occupational therapist. Slowly I saw things more positively as I learned to talk again, though I had to stop and think so often when trying to talk.

People need to understand how an aneurysm – or any kind of Brain Injury – can drastically change the lives of so many. I was reading that up to five percent of strokes are caused by ruptured aneurysms, although mine was unruptured but led to a stroke during surgery.

Finding a support group on Facebook has been wonderful as a source of support and information, and I now enjoy helping out in an administrative role. I have made a goal of posting up some useful information every day which also helps with my language problems. I also work two mornings at an art gallery as a volunteer.

I can now accept that the aneurysm and stroke are just part of my life. I’ve struggled with depression which has hit the bottom very recently, the result of me living alone with no visitors and very few friends.

I am working very hard to pull myself back up.

Just before I discovered the aneurysms I completed a graduate diploma to complement my job of seven years, but I can’t work now because of my memory problems. It’s very upsetting that I can’t work anywhere, but having hit the bottom of my depression I can think ahead – I now know all of these wonderful support services.

People can face very difficult lives after aneurysms, strokes and other types of Brain Injury. I am determined to make so many people aware of how much a Brain Injury can change their lives, or that of their partner, family members or friends.

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It’s tough enough being a carer without having to become an accountant too.

We understand. We can help with it all, or just a little.

With the introduction of the National Disability Insurance Scheme (NDIS) comes a new era of control and choice for those Australians living with a disability requiring care.

With this new found control also comes the responsibility to ensure that the outcome of your care is to your benefit and can be sustained financially. A situation that will require compliant administration and reporting.

Whilst we applaud those with a disability finally gaining more control over their lives, we feel that the burden of such administrative responsibilities can only add to the difficulties they already endure throughout their lives.

Our work in assisting those with a Brain Disorder to reconnect their lives has provided us with the insight, expertise and resources to make managing the care of those with a disability easier, whilst maintaining an unwavering focus on quality outcomes.

To assist those seeking to make the most of their disability funding, be it NDIS or a private scheme, we took the initiative to develop Synapse Options.

A range of individualised services designed to take the stress out of planning, facilitating and administering disability care funding.

Let’s get you connected... synapse.org.au

You choose whatever service, or services you require, whether they be planning through to financial administration, to a more physical need like accommodation. And we do the rest.

With our assistance you maintain control and choice over both your funding and care without any added stress ...

And really, isn’t that the whole point?

Managing Stress A simple technique for reducing stress is to listen to and follow the instructions of a recorded relaxation CD. The recording is designed around you taking time out in a comfortable place, turning your thoughts to different parts of the body and releasing tension whilst soothing tired muscles. Relaxation CDs are cheap and can be utilized in the home with little disruption to your lifestyle. These are available for free through phoning the Commonwealth Respite and Carelink Centre on 1800 200 422 or Carer Advisory Service on 1800 242 636.

Stress can also be greatly reduced by staying organized. This can be difficult when situations arise with your care recipient; however a basic scheduling of your day may assist you to remain calm and in control. Keeping a daily planner, simple list, diary or scheduled alarms (on most mobile phones) will help you in your daily routine.

Writing down appointments, medication times, dosages and meal breaks may help. Always remember to be realistic and flexible in your schedule. Reducing stress is your goal – not adding to it.

Our counselors at Carers Queensland also run fantastic programs state wide for stress reduction such as the self esteem group, assertiveness programs, art therapy, writing, self-awareness, therapeutic intervention, rest and relaxation group, women and men’s therapy.

Just call the Carer Advisory Service on 1800 242 636 for a counselling referral.

Having ‘me’ time ‘Me’ time is one of the best respite experiences you can have as a carer. So much of your energy is spent meeting the needs of another that you may easily neglect your own needs. It doesn’t take a lot of time or money to spend time on you.

Here are some easy suggestions: Have a cup of coffee or tea in your favorite cup.

Watch a TV show or DVD. Have a comfortable chair of your own to sit on indoors or outdoors.

Play your favorite music.

Read a magazine, book or browse websites.

Have a small project to work on in your shed.

Do something creative.

Spend time in the garden.

Play solitaire on the computer or with a deck of cards.

Lay down for a rest.

Nutrition and exercise Recent research shows that most people would benefit from increasing their fruit and vegetable

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intake. A life time habit of eating adequate amounts of fruit and vegetables every day can help prevent: coronary heart disease, some forms of cancer, obesity and constipation.

It can also reduce blood pressure and blood cholesterol levels and improve control of diabetes. Health authorities recommend you eat at least 2 serves of fruit and 5 serves of vegetables every day.

Keeping healthy snacks available for you, your care recipient and even visitors is great and cuts down on convenience foods like take away.

You don’t have to prepare or stress over food preparation when days are busy or demanding.

Healthy snacks can be purchased in the health food isle at most grocery stores. Frozen balanced meals are also convenient for busy carers. You may purchase healthy take away meals, frozen meals or freeze home-cooked meals to keep stored for when they’re needed. Remember to drink plenty of water to remain hydrated and make time for exercise when possible.

Exercise doesn’t mean having to join a gym or participate in any formal activity. Physical activity throughout your day can include a walk, bike ride or stretching exercises in your own home.

Regular exercise is recommended for your health and well being. There are publications of the National Physical Activity guidelines available from the Department of Health and Aging by phoning (02) 6269 1080 or emailing health@ nationalmailing.com.au

Maintaining relationships Relationships can change dramatically as your caring role changes and your time becomes limited. Friends and relatives may struggle to

understand these changes and may therefore not understand your lifestyle changes. Communicate clearly that your life is changing and your need for maintaining the relationship is very important.

Asking a friend, relative or organization to give you respite from your caring role is a great way to maintain social activities such as bowls, darts or cards.

Come up with ways of socializing with your friends or relatives that fit around your caring role. This may mean buying take away and eating on your verandah rather than going out for a meal. Having a movie night at home may be another alternative.

Asking for help in simple ways can also bring about new and deeper relationships with friends and family. Sharing a cup of tea whilst cleaning, talking about issues while doing dishes and confiding to a friend while tidying the yard are all creative ways of remaining in relationships.

Try new ways of communicating with your friends such as texting, emailing or joining an on line support group or blog. Ask your friend or relative to allocate a weekly or monthly date and time for catching up over the phone.

Carers Queensland support groups are held state wide and are a great way to meet others who will understand your situation.

Start a ‘friendship chain’ for when things get tough. This may include three or more close friends that can help out when you need them.

This line of command or ‘friendship chain’ lets your closest friends know that you are in need of help just by making one phone call. You call your 1st friend who then calls your 2nd friend.

Your second friend then calls your 3rd friend and so on – letting everyone in the ‘friendship chain’ know what your need is. The ‘friendship chain’ can be used for crisis situations to call for back up.

Carers Queensland represents the diverse needs and interests of carers in Queensland by providing information, education, advocacy, counselling and other support services that may assist them in their caring role. Visit http://carersqld.asn.au or call 1800 242 636.

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SELFMEDICATION, ALCOHOL & OTHER DRUGS SELF-MEDICATION IS THE USE OF A DRUG, LEGAL OR OTHERWISE, WHICH IS SELF-ADMINISTERED FOR NON-CLINICAL PHYSICAL OR PSYCHOLOGICAL AILMENTS

Even a so called “mild� Brain Injury can completely disrupt lives, with all the various physical, cognitive and emotional changes that can occur. It is not surprising that some people will experiment with a range of drugs when dealing with depression, fatigue, mood swings, boredom, anxiety and the loss of work, friends and their old lifestyle.

Example of self-medication Depression is often self-medicated with drugs such as alcohol, tobacco and cannabis. Various anxiety disorders such as post-traumatic stress disorder often lead to the use of drugs which act as central nervous system depressants, such as alcohol and benzodiazepines (e.g. Valium,

Serapax) which temporarily lead to feelings of calm and relaxation. Opiates, such as heroin and morphine, are analgesics which reduce the perception of/reaction to pain and can have a similar calming effect.

Stimulants such as cocaine, amphetamines, caffeine and nicotine lead to short-lived

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improvements in physical and mental functioning, including increased energy and feelings of selfesteem.

While providing some immediate relief, these drugs often make existing problems worse, can lead to drug dependency, and often have sideeffects with long-term use.

Brain Injury an added complication

Regular exercise

A Brain Injury increases the chances that self-medication will have serious long-term consequences. Issues with alertness, memory, problem-solving and controlling behaviour and emotions are very common after a Brain Injury – prolonged use of alcohol and other drugs will usually only make existing problems worse.

Volunteer work or short study courses Create a structure and routines.

Advice for family members The impact of a drug dependency can have a huge impact on the lives of partners, families and the wider community. You can talk with rehabilitation specialists and health educators, or attend support groups like Al-Anon and NatAnon. A good place to start is the Brain Injury Association in your State.

People who already self-medicated before a Brain Injury are even more likely to do so as they cope with their disrupted lifestyle, and often will be more impulsive and less aware of the consequences of their actions.

In the long term, it is vital to set boundaries – that is the limits on what is acceptable behaviour.

Boundaries are needed to develop the trust, stability and respect needed for any healthy relationship, but a drug dependency can shatter these boundaries. Families can feel helpless when they try to limit a loved one’s drug use, only to be met with violence, threats or emotional manipulation.

A variety of prescription drugs may be used during the recovery phase, and self-medicated drugs may interact badly with these (e.g. alcohol can lower the threshold for epilepsy).

Alcohol - the legal drug Alcohol is one of the most popular drugs for selfmedication due to its social acceptance. Many specialists recommend that people abstain from alcohol for at least one year after their injury, and often ideally on a permanent basis. If a person eventually decides to start drinking again, it should be in very small amounts and with the agreement of family members who can monitor its effect on behaviour and overall health.

Giving way to threats or manipulation usually makes things worse. Setting boundaries can help in a number of ways: Encourage taking responsibility for one’s

actions

Drug dependency

Develop awareness that behaviour affects

In some cases, a person may have already been dependent on a particular drug prior to acquiring a Brain Injury – this dependency will almost inevitably worsen after the injury. For others, a dependency may result from trying to cope with depression and frustration, or personality changes may mean the controls are lifted on what was once a safe usage. If the person is still involved with rehabilitation specialists inform them of any drug use and get them involved.

others

A GUIDE TO COPING “A Guide to Coping: support from families faced by problematic drug use” is the result of collaboration between Family Drug Support (FDS) and Synapse (or known then as the Brain Injury Association of Queensland).

This practical guide is full of useful information: Introduction to various drugs Understanding drug use and the drug cycle Supporting someone through detox Setting boundaries Relapse prevention and management Harm reduction.

This publication is available free to members of FDS.

Boundaries are part of healthy relationships Potential to minimize harm from drug use.

Can disrupt negative roles such as the

victim, persecutor and rescuer.

A key principle to remember is you can never change anyone else no matter how much you want to. What you do have total control over is you, your behaviour and how you respond to situations. The great thing about this is that if you do change yourself it can often lead to changes in the other person too.

Remember self-medication is often a response to the depression, frustration and sense of loss that occurs so often after a Brain Injury. An important part of long-term rehabilitation is to support the person in creating a new meaningful lifestyle. Some tips here include: Activities and hobbies to reduce boredom Relearn social skills to maintain friendships

FAMILY DRUG SUPPORT (FDS) Special thanks to Tony Trimingham and Antonia Ravesi from Family Drug Support (FDS) for their contributions to this article. FDS is a caring, non-religious, non-judgemental organization primarily run by trained volunteers who have had direct or indirect experience with drug problems in their own family. FDS recognizes the need for a new approach to drug use so that families feel better able to cope with this complex and difficult problem, while still providing a supportive and positive influence to the drug user. Visit their website at www. fds.org.au. FDS services include: A seven days a week, 24-hour Australia-wide family support phone line 1300 368 186 Open and regular family support meetings Bi-monthly member newsletter and updates A nine-week or two weekends Stepping Stones to Success course.

SELF HARM SELF-HARM REFERS TO PEOPLE DELIBERATELY HURTING THEIR BODIES.

It is usually done in secret and on places of the body that may not be seen by others.

The most common type of self-harm is cutting, but there are many other types of self-harm including burning or punching the body, or picking skin or sores.

In general people self-harm as a way of coping.

People often talk about harming themselves as a way to relieve, control or express distressing feelings, thoughts or memories. Some people harm themselves because they feel alone, while others self-harm to punish themselves due to feelings of guilt or shame. However, the relief they experience after self-harming is only short term and at some point the difficult feelings usually return. With the return of these feelings often comes an urge to self-harm again. This cycle of self-harm can often be difficult to break.

Most people who self-harm are not trying to kill themselves but there is a chance that they may hurt themselves more than they intended to; this

increases their risk of accidental suicide. People who repeatedly self-harm may also become suicidal and feel trapped.

It is possible to learn to manage really intense feelings in ways that do not cause harm, and many of these alternatives can also offer you long-term relief. Some people can begin this process on their own but many need the support of their friends and family. If the self-harming is particularly intense or long term then the support of a health professional will be essential.

Having supportive people around you is always important. Surround yourself with people that you trust, who will listen to you without judgment and that you enjoy being with. It’s good to work on some things that you can do for yourself, but you don’t to have to face this challenge alone. It’s important to let others know how you feel when things don’t go to plan. Don’t build up worries, anger or disappointments – talk about them.

BRIDGE

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If you are worried about someone who is selfharming it is important to talk with them about it.

It can be a hard conversation at first so approach it with care, respect and without judgment. Let them know that you are there for them and encourage them to seek help.

It can be overwhelming and at times distressing to know someone you care about is self-harming.

To look after others you need to also look after yourself – try to get enough sleep, keep fit and healthy, and seek your own support from friends or professionals. Visit www.beyondblue.org.au or call 1300 22 4636.

Reproduced with permission from www. beyondblue.org.au

PTSD TREATMENTS & NEW RESEARCH Treating and recovering from PTSD is often a gradual process of coming to terms with the traumatic event, then learning to cope with the associated thoughts and feelings. Two forms of therapy that are particularly helpful are Behavioural and Cognitive-Behavioural Therapies. These involve providing education and information about PTSD, learning ways to control anxiety and anger, and being exposed to feared situations, feelings and any memories related to the event.

Medications may be used to treat symptoms of PTSD such as anxiety and depression, with selective serotonin Reuptake inhibitors (SSRIs) proving effective.

Relaxation exercises can help as PTSD is an anxeity disorder. These include breathing exercises, meditation, yoga, swimming, listening to music and going for long walks.

Recent research has looked at virtual reality simulations of combat to help soldiers with post-traumatic stress disorder. A study at the US Naval Medical Center in San Diego involved soldiers with PTSD either discussing their traumatic experience while looking at images of similar scenes, or were immersed in virtual reality simulations designed to be similar to their traumatic memory. The study showed that after three months there was still a consistent improvement in symptoms, whereas the effects wore off for those treated with traditional exposure therapy.

This suggests that virtual reality may help by reactivating emotional engagement for soldiers who can emotionally “unplug� with traditional treatment.

Another US study revealed successful treatment of PTSD in 80% of emergency workers and soldiers treated with MDMA, the main ingredient in the illicit drug ecstasy. The drug was administered twice during a three month period of counselling. One participant described how the MDMA allowed him to feel more relaxed about the treatment for the first time ever. The treatment is controversial due to the use of MDMA as an illicit drug, and attempts to begin a similar study in Australia have not found any universities willing to back the research.

Family and friends can assist in a number of ways: Be available to listen Provide non-judgemental support Learn about PTSD and Traumatic Brain Injury Be aware of negative coping mechanisms such as social withdrawal and alcohol and drug use.

There’s a lot to do to get ready to manage your own care...

With the introduction of the National Disability Insurance Scheme (NDIS) comes a new era of control and choice for those Australians living with a disability and requiring care.

To assist those seeking to make the most of their disability funding, be it NDIS or a private scheme, we took the initiative to develop our Synapse Options services.

With this new found control also comes the responsibility to ensure that the outcome of your care is to your benefit, and can be sustained financially. A situation that will require administration and reporting.

Part of Synapse Options is our Planning service that will guide you step by step through everything you need to consider when putting together a plan for managing your care whilst ensuring that you get the most of life.

Our work in assisting those with a Brain Disorder to reconnect their lives has provided us with the insight, expertise and resources to make managing the care of those with a disability easier, whilst maintaining an unwavering focus on quality outcomes.

With our assistance you maintain control and choice over both your funding and care without any added stress ...

And really, isn’t that the whole point?

Let’s get you connected... synapse.org.au