Traumatic brain injury and potential safeguarding concerns

Publication Date12 Nov 2010
Pages31-42
DOIhttps://doi.org/10.5042/jap.2010.0642
AuthorAndy Mantell
SubjectHealth & social care,Sociology
The Journal of Adult Protection Volume 12 Issue 4 • November 2010 © Pier Professional Ltd 31
10.5042/jap.2010.0642
Introduction
Acquired brain injury (ABI) is a generic term encompassing
a range of conditions that can affect the brain. This includes
traumatic brain injury (TBI), strokes, anoxic brain damage,
tumours, toxins, infections and surgical misadventures. This
paper focuses on TBI, ie. physical trauma to the brain (Simpson
et al, 2002), as an example of the complex impact of ABI on
individuals and those around them. Many of the issues raised
are also relevant to other forms of acquired brain injury but it is
important to remember that there are significant differences, for
example, unlike dementias, TBIs are not progressive.
TBI has been called the ‘hidden disability’ (Department of
Health and Social Services Inspectorate, 1996; Simpson et al,
2002) as 75% of people with a TBI do not have an accompanying
physical disability (Tate et al, 1989) highlighting that they may
need support. Where there are clear physical disabilities, these
can easily become the focus of attention, neglecting the impact of
the damage to the brain. Often the person may have no physical
impairment, but lack insight into their needs. Consequently,
they do not look like they need any help and do not think that
they need any help, so not surprisingly they often do not get
any help. Family members report little distress about physical
disabilities, but frequently complain about personality changes
and their social consequences (Forssmann-Falck & Christian,
1989). Todd and colleagues (2004) point out that in trying to
intervene to change behavioural problems from people with TBI,
generic services often fail to acknowledge the impact of cognitive
impairment. Services assume too high a level of competence to
engage in the process and tend to target the person with a TBI as
the focus of their intervention, when in fact the person may have
limited potential to adapt (Todd et al, 2004).
Traumatic brain injury and
potential safeguarding
concerns
Andy Mantell
Senior Lecturer, University of Chichester, UK
key words
Traumatic brain injury,
safeguarding, social work, carers
abstract
Safeguarding people who have
sustained a traumatic brain injury
(TBI) requires not only knowledge of
safeguarding practice and procedures,
but also the implications of a brain
injury. This paper provides an
introduction to the nature and impact
of TBI upon individuals and their
families. Drawing on anonymised case
material and practice experience, it
explores how the sequelae of TBI, in
particular cognitive, emotional and
behavioural changes can produce
potential safeguarding issues. The
person with TBI’s potential vulnerability
to different forms of abuse is then
considered and the relevance of the
legislative framework explored. The
paper then summarises key points for
safeguarding practice in this complex
field. It concludes by emphasising that
gaining knowledge of how TBI impacts
on individuals and their families is
essential to understand their risk of
abuse. In doing so, it also highlights
that simplistic dichotomies between
victim and perpetrator can ignore the
complexity of the interactions in which
safeguarding occurs.
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Policy and practice paper

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