Increasing awareness of female brain injury

While the prevalence of brain injury is still higher in men, who are 1.5 times more likely to experience a brain injury than women, the rate is rising among women. Data from brain injury association Headway shows that the incidence of female brain injury increased by 28 per cent from 2019 to 2020 compared to 2005 to 2006.

St Andrew’s Healthcare provides specialist support for women with acquired brain injuries who also have comorbid psychiatric difficulties.

NR Times speaks to Dr Kevin Beckles, Clinical Psychologist at St Andrew’s Healthcare, to find out more.

Rising incidence of female brain injury

St Andrew’s female brain injury ward, Elgar, has seen a shift in its patient cohort over the past two years, receiving an increasing number of referrals for women who have sustained a brain injury as a result of a failed self-harm attempt.

Dr Beckles explains that the comorbid complexity of these cases has also increased, as self-harming behaviours often occur in the context of pre-existing complex mental health conditions such as emotionally unstable personality disorder, paranoid schizophrenia and others.

“Previously, we saw a more varied range of admissions, including individuals who had experienced neuro-oncological events such as brain tumours, the neurological consequences of metabolic conditions, and cerebrovascular incidents,” said Beckles.

While there is no solid data to make a conclusive determination on what is driving this increase, Beckles suggests that today’s digital age could be a factor – with the impact of social media having a significant effect.

“Unfortunately, the individuals coming through our service tend to be quite young, typically between 18 and 23,” says Beckles.

“Many may have transitioned out of child and adolescent mental health services, moved into adult placements or back into the community, but without sufficient wraparound care.

“In addition to this, social media exposes people to idealised lifestyles, fostering unhealthy comparisons with their own lived experience. There is also the troubling ease of access to information about self-harm, with some websites even providing instructions on how to harm oneself, sometimes glorifying these behaviours.

“Beyond that, I think we are still experiencing the lingering effects of the Covid-19 pandemic. Reduced in-person interaction may have negatively impacted the ability of mental health professionals to adequately contain the difficulties experienced by service-users. While telepsychology has created access for those who might otherwise have none, it does not fully replace in-person support, particularly for individuals at higher risk.

“All of these factors, social isolation, the shift to remote communication, the difficulties services face in managing and mitigating risk, the impact of social media, and the transition out of mental health services – likely contribute to what we are seeing. While each factor has independent contribution, they intersect in ways that appear to be driving this worrying trend. Based on our patient cohort, this is my working hypothesis.”

“We need to focus on prevention, ensuring that healthcare providers work intensively to reduce the likelihood of self-harm attempts occurring in the first place.”

Other trends that may account for an increase in female ABI

Under the umbrella term of acquired brain injury, traumatic brain injuries, cerebrovascular accidents, subarachnoid haemorrhages and other haemorrhages and brain tumours are included.

Beckles highlights that the increasing prevalence of heart disease and other chronic non-communicable diseases suggests that these conditions are contributing factors, as well as the increasing prevalence of lifestyle-related health issues.

For example, there has been an increase in conditions such as hypertension, high cholesterol, and diabetes, all of which contribute to stroke and sudden cardiac arrests, which in turn can lead to hypoxic brain injuries following cardiac arrest.

“Unfortunately, this suggests that the overall prevalence of these types of brain injuries may continue to rise,” says Beckles.

Improving mental health care

Beckles highlights that in recent years there have been significant efforts to improve mental health awareness and reduce stigma, however, he emphasises that there is a need for an increase in awareness of what female brain injury looks like in relation to mental health.

“When people think of acquired brain injury, they often picture a man riding a motorcycle or being involved in a vehicle accident,” says Beckles.

“So, the emphasis needs to be on preventative care, ensuring that mental health campaigns remain active, that they are regularly reviewed for effectiveness, and that they do not inadvertently cause harm or further stigmatise individuals.”

Beckles says that people are experiencing catastrophic changes to their lives as mental health services are underfunded and under-resourced.

“They’re doing the best they can in a difficult situation,” says Beckles. “Better-resourced mental health services are essential, whether that means improved equipment, increased funding, or the ability to employ more and better trained staff. Mental health provision has historically been underfunded compared to physical health services, despite the profound impact mental ill health has on individuals and society as a whole.

“At present, many services are unable to engage in advocacy and outreach because they are constantly firefighting. With better resources, they could go into communities, hold conversations in schools, and work with services that support vulnerable populations. This would not only increase awareness of available support but also help break down the stigma associated with seeking help, empowering people to have those conversations.

“Having subject matter experts involved in the policy-making is also really important. Psychologists, neurologists and psychiatrists, trained in a formulatory approach are able to pull information from disparate sources and present it in such a way that is easily digestible and also meaningful.

“We also need to consider the impact of the media. I know it’s a contentious issue, but regulation must catch up with these industries to safeguard the most vulnerable in our society, young people, those struggling with mental ill health, and individuals who have experienced trauma or neglect.”

Supporting women with brain injury

Beckles notes that one specific issue with female acquired brain injury is the societal expectation of gender roles, as women are traditionally seen as caregivers, homemakers, and central figures within family systems.

“If a mother, grandmother, or older sister who has caregiving responsibilities sustains a brain injury and can no longer fulfil that role, the knock-on effect on the entire family can be significant,” says Beckles.

“While brain injuries in men also have serious consequences, the impacts tend to differ, for instance, they may be more related to financial provision or identity as a provider.

“As a service, we take a systemic approach, considering both the individual’s experience and the wider impact on their family and support network. Where possible, we signpost individuals to local services that can provide additional support.

“Through our social work team, we are also able to refer families to mental health services in their local area.

“Our role is to determine how best to manage heightened risk, taking into account both pre-existing vulnerabilities and post-injury escalation. We must establish safeguards and structured support systems that promote independence, resilience, and progress while ensuring the individual’s safety.”

Beckles explains that, since many of these patients struggle with memory and recall, St Andrew’s healthcare implements cognitive strategies such as visual prompts and proactive intervention with nursing teams and healthcare assistants able to offer “real time” prompts.

“If a patient begins to show signs of distress, staff can intervene with supportive strategies, such as suggesting breathing exercises, listening to calming music, or going for a walk,” says Beckles.

“This ensures that individuals receive the necessary support even when they are unable to regulate themselves independently.

“Given the recent shift in patient demographics, it requires us to navigate the intersection of two highly complex presentations. Our approach must be both effective and meaningful, recognising that progress is often gradual rather than dramatic.

“Not every patient will leave our care completely free from behaviours that challenge. Instead, success may look like a transition from more extreme behaviours, such as physical aggression or severe self-harm, to less harmful expressions, such as verbal aggression.

“This can enable the individual to move into a less restrictive environment, where they can continue their journey towards recovery.”

Dr Beckles and Neelam

During her time at St Andrew’s, Dr Beckles has worked closely with Neelam who recently moved from Elgar to one of the hospital’s step-down rehabilitation houses.

Listen to Neelam’s recovery story.

Elgar: Elgar » St Andrew’s Healthcare, St Andrew’s female brain injury ward, is a specialist service able to support women with a range of complex behavioural, cognitive and physical needs following their brain injury. The programme of care is designed to enhance recovery and facilitate community reintegration.

If you would like to find out more about St Andrew’s neurobehavioural services you can contact Rob Walsh, Service Development Manager
T: 01604 616592 / 07714 600699
E: ​robert.walsh@nhs.net

Or visit the website: Neuropsychiatry services – brain injury » St Andrew’s Healthcare

The Workbridge café – part of St Andrew’s award-wining vocational services providing courses, work environments and skills-based opportunities for patients.