The Economic and Social Impacts of Acquired Brain Injuries

An acquired brain injury (ABI) refers to damage to the brain that happens after birth. ABI can happen due to a number of reasons such as infection, disease, accidents, head trauma, alcohol or substance misuse, stroke or a lack of oxygen. 

Acquired brain injuries can be further categorised into traumatic brain injury (TBI) and non-traumatic brain injury (NTBI).

• A traumatic brain injury is the result of force, such as a blow to the head or a car accident.
• A non-traumatic brain injury is caused by a non-traumatic cause such as a near-drowning accident, where the brain is starved of oxygen, or a stroke.

Both TBIs and NTBIs can result in a person acquiring an injury to their brain that they were not born with. These acquired brain injuries can have major consequences for everyone including the person themselves, their family, the wider community and vital services. 

Acquired brain injury is a leading cause of death and disability. Caring for people with brain injuries puts a significant strain on the healthcare service. The costs associated with traumatic brain injury alone are estimated to stand at £15 billion per year (0.8% of UK GDP). 

Additionally, living with the effects of an acquired brain injury can impair a person’s quality of life and hinder their productivity in both the short and long term. In turn, this can lead to both social and economic consequences.

The Hidden Costs: Economic Impact

A brain injury can cause bruising and bleeding on parts of the brain; it is also common for a person to lose consciousness for an amount of time afterwards. Often, people may feel confused and have trouble retaining information or remembering new events. This state is known as post-traumatic amnesia (PTA). 

The long- and short-term effects of an acquired brain injury can vary from person to person. The impact of ABI on a person can range from being mild to severe. One common consequence of ABI is cognitive impairment, such as:

• Memory problems
• Problems processing language
• Issues focusing or paying attention
• Poor decision-making

A brain injury can also cause fatigue, anxiety, changes in mood and behaviour as well as emotional problems. The changes that an ABI can cause in a person can lead to people becoming impulsive, saying or doing things that are inappropriate, speaking without thinking or having ‘no filter’. These cognitive changes may act as a barrier to a person returning to work, even once people feel like they have physically recovered. 

If people are unable to work for a time and are economically inactive this can put them in financial difficulty. They may have to rely on state benefits for a period of time which will usually be significantly less than a person was earning before their brain injury.

Not being fit for work for a while will impact a person as they will usually have less money to live on. This can lead to stress and worry and may mean that a person ends up living in poverty. It can also have an impact on their family and loved ones. 

Economic consequences of ABI further impact wider society due to:

• Burden on the NHS and healthcare systems, including medication, prescriptions, operations, rehabilitation and check-ups
• A person being unable to contribute and pay tax or make NI contributions whilst not working or having reduced capacity for work
• Costs of long-term care (if required)
• A person having to rest and recuperate for some time and being unable to go out and spend money in local businesses as they usually would
• Future cost implications for the NHS and prison services (due to links between brain injuries and poor mental health or increased risk of offending)

Many people recover well from an ABI and may be fit to work and live independently after some time and the appropriate treatment. However, some people are impacted forever and may require long-term care or respite care and may never fully return to the life they had before.

Social Consequences and Challenges

It is thought that 1.3 million people in the UK live with an ABI. Living with an acquired brain injury can pose many different social and personal challenges. The level of impact ABI has depends on how bad the injury is, the quality of care the patient receives and how well the patient responds to treatment. 

Outcomes may also be better for people who have a tight support network around them, adequate housing and financial support. However, it is important to note that ABI can put a genuine strain on relatives and loved ones and they may also require support to navigate the new challenges they now face.

If you have had an ABI, you may notice that it affects your family, friends and romantic relationships. 

This is due to a combination of factors, for example:

• It can cause changes in relationships as people struggle to adjust to your altered state, lack of filter or mood swings
• You may appear to have had a ‘personality change’
• The added financial pressure of being out of work can cause issues
• You may be forgetful or prone to mood changes that can upset people
• Sometimes people may be embarrassed and anxious about how to speak to or behave around someone with an ABI
• Romantic partners may withdraw from intimacy, feeling that their partner is somehow impaired or not able to fully give consent any longer
• Additional caring responsibilities can put pressure on families and relationships

There are also work-related challenges that can arise after a person has a brain injury, such as:

• Significant time spent off sick from work
• Limited mental and physical capabilities (short or long term)
• People may feel under pressure to return before they are actually ready
• Memory, organisation and communication can be impacted while a person recovers

Additional social and personal consequences of an ABI include:

• Social isolation as people may withdraw and not know how to act around you
• Mental health challenges (such as low mood, anxiety or depression)
• A traumatic brain injury in early life more than doubles the risk of a person developing mental health problems in later life
• Research on traumatic brain injuries suggests they may increase the risks of criminal offending in later life

The Role of Support Systems and Rehabilitation

Rehabilitation plays a key role in recovery after an ABI and should include both physical and psychological therapy. 

The level and intensity of rehabilitation required will depend on your individual needs. A team of healthcare professionals will be able to assess your needs during your initial hospital stay after your injury. They may also ask for feedback from relatives or those who know you well. 

Rehabilitation for people with an ABI may look like:

• Inpatient care in a hospital setting
• Outpatient care in a hospital setting
• Home-based care
• Rehabilitation at a specialist facility

Rehabilitation and care for people who have had a brain injury may include physical therapy, medication, occupational therapy, social support and speech and language therapy. The duration of rehabilitation and follow-up care is dependent on various factors, such as your general health prior to the event that caused the injury, how serious the injury was and how well you respond to therapy.

Your doctor or neuropsychologist will be able to give you help and advice on the signs and symptoms to expect, when to call a doctor, safety-related advice and the importance of self-care. It is important to try to follow this but also work out exactly what works for you. 

Self-care also plays a key role in recovery.

• Take medication as prescribed
• Prioritise sleep and practise effective sleep hygiene
• Use positive coping strategies
• Try to eat a healthy balanced diet and stay hydrated
• Reach out for help as soon as you need it
• Try to avoid drugs, alcohol, stress or anything that makes your symptoms worse

If a loved one or friend incurs a brain injury, try to be understanding and supportive during their journey to recovery. If they are forgetful or acting out of character, try to not blame them or, worse still, ignore them. Instead, provide understanding and a caring ear for their problems and consider helping with practical tasks that they are struggling with. Outcomes are always better for people who have a solid support system around them.

Economic Benefits of Adequate Care

Early intervention, the right treatment and adequate care improve outcomes for people who have an ABI. By getting the correct healthcare and having a good support network around you, you stand a better chance of recovering more fully and more quickly. 

In turn, this can lessen the social and economic impacts caused by your injury due to:

• Being ready to return to work sooner
• Becoming independent again more quickly
• Having a greater chance of recovering your old personality and attributes
• Putting less of a strain on your friendships and relationships
• A reduced burden on the healthcare system as you require care for less time

Reducing the economic impacts of ABI is beneficial to everyone. Research suggests that effective healthcare and rehabilitation lead to a decreased chance of long-term impacts. Effective rehabilitation should also include family members of the person with ABI who may struggle significantly due to the changes in their loved one. Families affected by the effects of an ABI often report feeling stressed, depressed and anxious. 

If you have had a brain injury, it is important to work with your healthcare and rehabilitation teams. Avoiding seeking care, not taking medication or skipping appointments has a negative effect and costs the NHS more in the long term. Engaging with professionals and getting the right healthcare is key to regaining your independence after an ABI. 

Immediately after a brain injury it is vital to have a period of rest and recuperation; don’t push yourself too hard or be in a rush to return to your normal routine such as work or childcare.

The Call for Awareness and Advocacy

Increasing awareness around the potential economic and social impacts of acquired brain injuries can help people to become more understanding and proactive. The symptoms of an ABI may reduce over time and outcomes are improved with the right treatment, support and care. 

Advocating for inclusivity and improvements in our approach to treating an ABI might look like:

• Employers making reasonable adjustments so that their employee can return to work
• Policy changes that ensure those who are temporarily unable to work due to an ABI have adequate financial support (including free prescriptions)
• Being understanding and not overreacting if someone with an ABI says something crass or inappropriate
• Normalising discussing our health and mental health in general
• Training and upskilling healthcare staff to better understand ABI
• Making improvements across all areas of healthcare from diagnostics and treatments through to rehabilitation

It is important not to stigmatise or marginalise anyone who has suffered from an acquired brain injury or any other disability. 

Although in many cases an ABI is caused by a factor such as disease which is unavoidable, some brain injuries are preventable. By increasing awareness about the devastating impact that brain injuries can have on people’s lives, we may encourage people to take precautions to protect themselves, for example:

• Using protective equipment to protect the head during sport
• Wearing a helmet when cycling or riding a scooter
• Making lifestyle changes (such as losing weight, exercising and eating a healthy diet) to reduce the chances of strokes or other health issues
• Increasing awareness about the dangers of head trauma (this might encompass educating young offenders, preventing child abuse etc.)

The economic and social impacts of acquired brain injuries are far reaching. ABI affects people of all ages and backgrounds. The consequences of a brain injury can have an effect across a range of vital public services, including the NHS, the education system, the Department for Work and Pensions, and the justice system. It is also a key issue to consider in some sports. As such, MP Chris Bryant, backed by various charities, has campaigned for an Acquired Brain Injury Strategy to improve communication across departments and promote better outcomes for everyone affected by ABI in the UK.