Accommodating disability in mental health treatment after acquired brain injury

Mental health access is a human right that has not been safeguarded for people with disabilities after acquired brain injury (ABI). ABIs can result in complex profiles of cognitive, motor, speech/language, and sensory/perceptual disability. In part due to the unexpected nature of acquired disability, people with ABI often face difficult recoveries involving high rates of mental health comorbidity and limited participation in meaningful life activities. Despite this need for psychosocial support to adjust to newfound disability, having a disability itself often restricts access to mental health treatment, as existing interventions are not designed to accommodate differences in ability. While there is preliminary evidence to suggest that adapting treatments using accommodations may increase their accessibility, little is known about which accommodations are available and how they can be applied to treatments. To address these gaps in knowledge, this dissertation includes three interconnected projects. The first project was a philosophical analysis of how dominant discourses used to conceptualize disability may either hinder or aid efforts to address mental health treatment inaccessibility for this population. The conclusions of this analysis – that is, a recommendation to conceptualize disability as biosocial in nature – formed the theoretical foundation for this dissertation’s subsequent empirical projects. The second project was a scoping review to examine how and why people with ABI-related disabilities have been excluded from existing research on psychosocial supports, as well as to identify a preliminary list of research-based accommodations that could be used to adapt mental health treatments. Finally, the third project was a modified Delphi study which involved surveying mental health and disability accommodation experts to determine how participating in cognitive behavioural therapy (CBT) may strain abilities that can be impacted after ABI, and to identify practice-based accommodations that were missing from the literature. These accommodations were then applied to CBT to generate hypotheses about how CBT’s functional demands may be addressed through treatment adaptation. Recommendations are given for how researchers and practitioners alike can use the resulting interdisciplinary framework of accommodations to design, evaluate, and implement mental health treatments that are accessible to people with needs across the full spectrum of ABI-related disability.