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Sometimes it's not a behavioral health diagnosis

March 1, 2006
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March is Brain Injury Awareness Month

Given that March is Brain Injury Awareness Month, now might be an opportune time to evaluate how your organization screens for and handles people with brain injuries, especially since soldiers returning home from the conflicts in Iraq and Afghanistan are showing higher rates of brain injuries than seen in previous wars.

It's important to “go an extra mile and do an assessment” for brain injuries in people who present with behavioral health problems, notes Geoffrey M. Lauer, national director of affiliate relations for the Brain Injury Association of America, because the treatment modalities for brain injury can be very different than those for behavioral health disorders.

Lauer notes that brain injuries have many causes. Brain injuries can be caused by strokes and disease (such as cancer), and those considered

traumatic brain injuries are caused by an external force, such as car crashes or falls. Lauer admits that there is no easy test for determining whether someone is presenting with a mental health disorder versus a brain injury, although he suggests some good resources are available to help. For example, the Ohio Valley Center for Brain Injury Prevention and Rehabilitation has a tool for community professionals who are not experts in brain injury but want to identify persons in need of more comprehensive assessment (see Lauer suggests materials from the Traumatic Brain Injury National Data Center might be useful (see, as well as information on the Brain Injury Association of America's Web site (, which includes materials on Brain Injury Awareness Month.

Although neurologic imaging options are available, they are not necessarily an accurate measure of a brain injury's symptom severity. Explains Lauer: “There are people who have very mild injuries but have moderate, significant, or severe outcomes. Those mild injuries might not result in any visible changes in medical or neurological imaging. On the other hand, there are people with severe injuries, which are quite visible with neurological imaging, who end up with mild if any symptoms as a result of brain injury.” Thus, “Having a severe injury doesn't absolutely mean there is going to be a severe outcome, and having a mild injury doesn't necessarily mean there is going to be a mild outcome,” he says.

Patients with suspected brain injuries can be referred to specialized treatment providers. And the Brain Injury Association of America has 700 to 1,000 support groups across the country that provide educational, informational, and social support to people with brain injuries.

Behavioral health providers might encounter more people with brain injuries as soldiers returning from conflicts in the Middle East reintegrate into civilian life. Although improved body armor is saving soldiers’ lives, those who survive powerful blasts, common in today's hostile environments, often suffer brain injuries. Lauer notes that the Department of Defense has found that in injured soldiers returning from Iraq, more than half were identified as having sustained a brain injury, compared with an estimated 20% in previous military engagements. Lauer says this means brain injuries have become the “defining injury of the current conflict.”

The Brain Injury Association of America is lobbying for all soldiers returning from combat to receive brain injury screenings, and is also pushing for increased availability and access to ongoing, community-based services for veterans with brain injuries.