Acquired Brain Injury may result in significant impairments across many domains including cognitive, communicative, behavioural and psychological/psychiatric. These difficulties may impact on the person’s ability to consent to and cooperate with necessary care and treatment. If the following difficulties are evident, they may result in the need to consider the use of compulsory measures in order to provide care and treatment:
- Significant cognitive and/or communicative impairments may result in increased vulnerability.
- The brain injured person may present with high levels of confusion in the early stages following brain injury (post traumatic amnesia), which may adversely affect their ability to comply with necessary care and treatment.
- In the context of significant cognitive and/or communicative impairments the person’s decision making ability may be significantly impaired as a result of difficulties understanding and retaining relevant information leading to an inability to make informed decisions.
- Executive functioning difficulties, in particular lack of insight and poor judgement, may potentially lead to the person putting himself/herself at risk. For example there may be evidence of the person placing himself/herself in situations which they are unable to cope with due to significant cognitive difficulties.
- In the context of severe cognitive impairment and/or psychiatric disorder there may be evidence of significant lack of motivation and initiation. This may result in profound self-neglect and difficulty complying with necessary care and treatment.
- There may be evidence of significant self-harm behaviour (e.g. suicide attempt, repeated self-injurious behaviour).
- The person may demonstrate behavioural difficulties, which may present a significant risk to others (e.g. aggressive behaviour, sexually disinhibited behaviour) and in turn result in the person being more vulnerable.
- The person may present with symptoms of a psychiatric disorder.
- Significantly impaired ability to understand pertinent information and/or express their views subsequent to e.g. global aphasia, dyspraxia or other conditions causing significant communication impairment.
- The person may not be willing to accept care and treatment on a voluntary basis due to their lack of understanding of the extent of their significant cognitive difficulties and a lack of awareness of the potential impact of these on their life (impaired insight).
Measures which may be helpful in supporting the person who has an Acquired Brain Injury to participate as fully as possible:
- Involving a relative, partner, friend, carer and/or health professional (e.g. Speech and Language Therapist, Neuropsychologist) in consultations where appropriate.
- The provision of written and/or audio information, if deemed helpful.
- Implementing strategies to maximise the person’s communication skills.
- Implementing strategies to maximise the person’s cognitive skills.
- The provision of emotional support to those with psychological/psychiatric difficulties.
- Explaining the issues and proposed intervention in a place and at a time when the person is likely to be best able to understand and retain the information. If the person has difficulty retaining information, then it may also be helpful to provide them with a written record of discussions, detailing what decisions have been made and why.
- The provision of support to the person from an Independent Advocacy Service.