Spinal cord injuries and the impact on mental health

Spinal cord injury can have a devastating effect on a person’s physical state and rehabilitation is often concentrated around the physical condition. However, the impact upon a patient’s mental health can also be significant and should not be overlooked.

Emotional and psychosocial issues may develop or worsen after a spinal cord injury. There is often an adjustment period after such an injury and sadness, anxiety or clinical depression may develop. A study by researchers at the University of Michigan found “adults living with spinal cord injuries have a near-80% increased risk of developing psychological conditions, such as depression and anxiety, compared to people without the traumatic injury”. In the UK, the Spinal Injuries Association (SIA), along with the University of Reading and the University of Buckingham, produced a report – It’s not just physical. The report found that a person with a spinal cord injury is three times more likely to have suicidal thoughts than a person without injury. It also concluded that “psychological damage caused by a spinal cord injury is, at best, considered as an afterthought, and at worst, completely ignored by the medical profession.”

The importance of psychological treatment and support as well as anti-depressant medication can be crucial in managing this adjustment but availability of NHS psychological support for those with spinal cord injuries can vary. The SIA has therefore developed a telephone counselling service stating it is “essential that everyone affected by spinal cord injuries has access to lifelong, expert counselling support when required”.

In 2020 Ruth Hunt, who lives with a spinal cord injury, described in an article how there had been “a continual failure to register [her] physical disability by the mental health team” and “an inadequate response from the physical disabilities team”. She has recently authored a new article considering the “physical needs of a spinal cord patient and their mental health issues”.

Her article refers to the Standards for Specialist Rehabilitation of Spinal Cord Injury report. The report outlines a set of standards “developed to ensure a consistent pathway and clinical care for spinal cord injury patients from diagnosis to lifelong care.”

It recommends all patients must have a psychological health screen within four weeks of their injury. A positive screen would mean a referral to the patient’s local community services or spinal cord injury centres (SCIC), if the patient is admitted to the SCIC. On admission to a rehabilitation centre, it recommends further screening takes place within 10 days of admission. This psychological health screen would use psychometrically validated and recognised tools to screen for suicidality, anxiety, depression, substance use and cognitive impairment. A psychological health psychometric screening and psychological assessment is then to be repeated prior to discharge if the patient has been transferred to a rehabilitation centre. 

Hunt discussed the recommendations with Dr Jane Duff, Consultant Clinical Psychologist and National Spinal Injuries Centre (NSIC) Head of Clinical Psychology at Stoke Mandeville Hospital. Dr Duff said “There is a wealth of research evidence showing that psychological adjustment continues for some years after discharge from inpatient rehabilitation and the time limited and protocol approach of Improving Access to Psychological therapies (IAPT) is not flexible enough to respond to this need.

“All patients admitted and discharged from the NSIC between 2017-2018 were interviewed and 40 per cent of these said they would have needed, and did not receive, psychological support after discharge.”

The report notes it is essential that “the patient is physically and psychologically ready for discharge, with appropriate support from local services” with “psychiatry referral for patients with mental health problems”.

It is clear the report’s recommendations seek to address the gap in mental health support for spinal cord injury sufferers. Objectives include providing spinal cord injury patients with optimal and lifelong care to minimise long term complications.

Sport and physical activity can also be important in helping maintain mental health. Charities such as WheelPower, the National Charity for wheelchair sport and The Backup Trust, a charity dedicated to supporting people affected by spinal cord injury to get the most out of life, can be useful. Medical staff should be educated in the facilities available to those with spinal cord injury to ensure they are able to lead an as active and fulfilling life as possible.

The report reflects what we see in practice. Public funding for rehabilitation over and above physical therapy is often limited but the psychological impact of such a devastating injury can have a significant impact on the level of physical recovery. Offering early funding under the Rehabilitation Code and the input of a specialist case manager can often identify any gaps in rehabilitation including psychological therapy and have a positive impact in the overall prognosis and degree to which the patient is able to adapt to their injuries.