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For healthcare professionals who work in a medical setting, say in a hospital, and a person has been admitted with a brain injury. There's usually a multi-disciplinary assessment, so the speech and language therapist would be alerted if the person is showing speech problems. The occupational therapists may be become involved, maybe even the neuro-psychologist to actually screen the person for how badly affected their cognitive functions are and the physiotherapist if the person has actually got... So, some motor areas of the brain have been damaged and that's to help the person restore function as much as possible. This is all part of a rehabilitation effort. If a person that just got discharged home because they're medically fit from the point of view of life support, then we may do them a disservice if we don't actually take into account all of their needs following the brain injury, in terms of rehabilitation, to make sure that that actually happens and that the person gets as much of their function back as possible, so they can live independently.

Then later on, the person, when they are living back in the community, may encounter social workers who are coming to make social care assessments because this person has been called to their attention - that this person may need some help from a social work point of view. If the social worker encounters a person who has got the hidden disability type (say they have difficulty with frontal lobe damage), it may not be that apparent to the social work assessor that this person has the type of problems that they actually have, because quite often people who have had brain injuries become aware that they have actually got problems will try to compensate for that by saying, "No, I'm okay, I'm fine. I can do this." Or they may even lack awareness that they are actually as badly affected as they actually are. So the concept of low awareness of their own difficulties comes into view at that point.

The social worker may not get the full picture unless they use a particular type of measure; a particular type of tool that's been developed called the BINI, the Brain Injury Needs Indicator, which is mentioned in the Care Act 2014 guidance. The BINI document helps the social care assessor find out what the true nature of the person's difficulty is if they've got low insight and awareness. So, it causes them to actually also have to interview a person that knows the person with the brain injury quite well, independently of the person with a brain injury, and also to interview a medical professional who has been involved with the person's care following the brain injury, so that you actually get a few different points of view and look to see if there are any discrepancies between what the person with the brain injury is saying. and the people that have been supporting them are saying.

And then this acts as a document that they could say, "Well, this is evidence this person is at risk because their brain injuries left them with a lack of awareness of their own condition, so they may be at high risk and need some specialized further help". The brain injury also has an impact, if you like, on the families and people who are supporting the person who has had the brain injury, and that's particularly so if the person with the brain injury has had frontal lobe and memory problems. The frontal lobe problems can lead to interpersonal difficulties, with the person being less aware of the kind of things that they are doing and saying and tend to be more impulsive. That can put quite a strain on the family or caregivers, and cause them sometimes to feel that are actually dealing with a person that's very different from the person they knew before the brain injury. And some people have actually said [some carers and some family members] have expressed the feeling that this person looks the same, but they seem like their personality has changed. That's particularly so with the frontal lobe type of brain injury.

Therefore the carers, the family, would benefit greatly from the kind of specialist support groups that we actually have here at Headway, Essex, where they can come along and share those concerns and those feelings about how this person has changed, and maybe share ideas about how best to help if there's been behavioural changes and behavioural difficulties, and they need ways of coping and looking after themselves. And it's very hard for the family members not to take it personally, when their loved one has seemingly changed in their attitude towards them because of the brain injury, and they naturally feel sort of hurt and that nobody can really understand what they're going through.