In order to help someone who is cognitively impaired understand the what, why and how of treatment, the clinicians must be able to fully understand the individual. The assessment is one of the most important parts of the recovery process, says Duane Reynolds, Associate Director of Vinland National Center (Loretto, Minn.), which specializes in serving brain-injured individuals. To do this, Illness Management and Recovery (IMR) is deployed at Vinland and brain health, chemical health, mental health and physical health are assessed and addressed in treatment.
IMR is a form of treatment promoted by the Substance Abuse and Mental Health Services Administration (SAMHSA). According to the Minnesota Department of Human Services website, IMR is “a step-by-step, evidence based approach that assists people to set meaningful goals for themselves, make informed decisions about their treatment, acquire information and skills to develop greater mastery over the symptoms of their psychiatric illness, and make progress toward their own personal recovery.”
A large majority of Vinland’s patients (73%) have a brain injury and just over half (56%) have a mental illness, according to 2012 data from the organization.
The Center for Substance Abuse Treatment (CSAT) assisted Vinland in modifying the IMR questions to fit the brain injury clientele—offering less reading and asking questions that are more to the point rather than open-ended. When a patient enters treatment, he or she is given a number of statements to which the individual can choose an answer on a spectrum ranging from strongly disagree to strongly agree. Some examples of the statements are:
- “I set my own goals for recovery”
- “I have a plan to deal with potential challenges”
- “I recognize my personal relapse warning signs”
- “I know which strategies will help me cope with stress”
These statements are addressed once more as the patient is exiting treatment, and overall Reynolds says the patients usually improve about 19%.
He says this is an indicator that there is an increase in patients’ ability to set their own goals and that IMR is successful in the organization’s treatment program.
Areas of discussion
All of the patients at Vinland suffer from a substance use disorder. The most common primary substances are alcohol (62%), marijuana (14%), methamphetamine (10%), crack cocaine (6%), and opiates (3%), as reported to the state last year.
Patients attend a weekly 2-hour mental health group that is co-facilitated by a substance abuse professional and a mental health professional. Here, they are educated about mental illness – what it is, what the symptoms are, relapse prevention and details about their prescribed or recommended medications.
“It’s important to talk to them about medications that they are taking, the need to take them on a regular basis and what will happen if they miss taking them,” Reynolds explains.
With a brain injury client, too much noise can be distracting and/or disorienting. For this reason, Vinland often engages patients in one-on-one therapy. Reynolds says the individual time allows the patient to “understand and plan better.”
Another major area of discussion is lifespan changes. Some patients who are in their 50s either currently are or soon will be experiencing a number of changes that are normal but that they may find upsetting. “We try to teach them to use flexible problem solving and to seek various challenges in their life to try to keep them mentally alive,” Reynolds explains.
As in any treatment setting, it’s important to remind patients to maintain supportive social networks—whether it be with Alcoholics Anonymous (AA) or other groups.
Coping with everyday situations
A major area of work with this population is mindfulness-based stress reduction (MBSR), which was developed by Dr. Jon Kabat-Zinn of the University of Massachusetts Medical Center. This technique is about teaching patients how to relax and how to stop and think before they act. When a patient is becoming upset or agitated, he or she may choose to freeze in place, take deep breaths, suck on hard candy, drink something cold, hold onto a piece of jewelry, or get up to move around. These activities all will help the patient to relax and take his mind off of the agitating idea.
Reynolds says certain smells can allow a person to focus as well – laundry detergent, candles, bubble bath, aromatherapy or even food smells can work. Vinland also tries to teach its patients to listen to soothing music. Harp music plays as the patients lie in their beds at night and try to calm down and fall asleep.
“Oftentimes,” Reynolds says, “it’s physiological things like breathing, relaxation and stretching that can give them the ability to reduce tension in their system.”