Support for mental wellbeing after spinal cord injury

Statistics show that 43% of people aged 16–85 years in the general population have experienced a mental health disorder at some point in their lives, with 22% experiencing one in the past 12 months. While experiencing mental health difficulties is relatively common, people with a spinal cord injury (SCI) are at increased risk of developing mental health concerns. Evidence indicates that suicide is approximately three times more common among individuals with a spinal cord injury. Psychological distress can also reduce a person’s ability to engage in rehabilitation, which can negatively affect overall health and wellbeing. For these reasons, it is important that all people who have experienced an SCI are offered a mental health assessment and opportunities to participate in psychosocial rehabilitation.

Understanding support needs

There are important things to consider when beginning to work with a person following spinal cord injury, including:

• Timely assessment: A psychosocial assessment should be conducted by a trained professional (e.g., a registered psychologist) within a few days of hospital admission (unless earlier assessment is needed), if the patient consents. The patient should then be reviewed throughout their admission and prior to discharge to support their transition to the community.
• Health literacy: The World Health Organization defines health literacy broadly as a person’s ability to “gain access to, understand and use information in ways which promote and maintain good health” for themselves, their families and their communities. It is important to consider health literacy when working with individuals and their families, as it supports them to make informed choices about their health and decision-making, promoting wellbeing and quality of life. Supporting health literacy can also help the teams working with the person to encourage understanding of their condition and adherence to treatment.
• Biopsychosocial approach: Assessment and rehabilitation should be approached through a biopsychosocial lens, considering each person’s:
  • Biological factors such as family history of physical or mental health difficulties, prior medical history, history of head injuries or other injuries that may impact cognition, current pain, fatigue, spasticity, sleep quality, medication effects and changes to current physical functioning.
  • Psychological factors such as mental health history (e.g., anxiety, depression, psychosis, trauma-related difficulties or history of self-harm), neurodevelopmental conditions, current mental health concerns, personality and coping style, presence of suicidal ideation or self-harm risk, body image and identity changes, and broader adjustment to injury.
  • Social factors such as culture, religion or spirituality, relationships and sexuality, living arrangements, quality and availability of social supports, any current legal concerns or forensic history, educational background, vocation, finances and systemic impacts.
• Objective measures: Trained clinicians may consider using objective measures and psychometric tools to screen for anxiety or low mood. Examples include:
  • Generalized Anxiety Disorder-7 (GAD-7)
  • Patient Health Questionnaire-9 (PHQ-9)
  • Hospital Anxiety and Depression Scale (HADS)
  • Depression Anxiety and Stress Scale (DASS-21 or DASS-42)

Supports to promote psychosocial wellbeing within hospital

There are a number of pathways that can help support psychosocial wellbeing and adjustment for people admitted to hospital with a spinal cord injury. Support may be provided by the multidisciplinary team or may involve accessing external services. Examples of supports include:

• Psychologists: Psychologists are key members of the team who can support patients and the multidisciplinary team throughout the rehabilitation process. Individual therapy can assist with adjustment and coping by providing evidence-based therapies (e.g., Cognitive Behaviour Therapy, Acceptance and Commitment Therapy). Psychologists may also conduct cognitive assessments and develop positive behaviour support plans.
• Psychiatrists: Psychiatrists can address complex mental health needs that may accompany spinal cord injury and can offer pharmacological treatment options to support mental health.
• Local support services: Multidisciplinary team members can help connect patients to local services that provide professional support for comorbidities that may affect mental health and coping (e.g., drug and alcohol support services, pain management teams).
• Allied Health Team: Health professionals such as social workers, occupational therapists, physiotherapists and leisure therapists may support participation in social, recreational and leisure activities to enhance quality of life and engagement in valued activities during hospital admission.
• Medical and Nursing Teams: Medical and nursing team members can help assess and address factors such as sleep, diet and physical concerns that may impact mental health and coping.
• Support Groups: Local peer networks and support groups can offer shared experiences, social connection and opportunities for community engagement.
• Aboriginal and Torres Strait Islander Hospital Liaison Officers: These officers can visit patients and their families in hospital, explain hospital procedures and the environment, and connect individuals to other culturally appropriate health or community services.
• Pastoral Care: Pastoral care services provide spiritual and religious support for patients and families while in hospital.
• Interpreter and Translation Services: These services are available in person, by telephone or via Telehealth to support people in accessing the full range of Queensland Health services when communication in English is difficult, including for people who use sign languages.