Mild traumatic brain injury: a silent epidemic in our practices.

In recent years, mild traumatic brain injury (mTBI), also known as concussion, has emerged as a major public health concern. Of the 1.5 million Americans whose TBIs are documented by medical staff each year, estimates suggest that 85 percent are considered “mild” (Bazarian et al., 2005). Although these kinds of injuries were once considered a virtual “rite of passage”—particularly in sports—we now know that they have potentially lifelong cognitive, physical, emotional, and social consequences. Despite this slowly increasing awareness, countless mTBIs go undiagnosed every year as a result of a confluence of underawareness, underreporting, underdiagnosis, and misdiagnosis. The endemic prevalence of undiagnosed mTBI presents a significant and worrisome public health challenge, especially given the clear links between head injury and mental illness, substance abuse, and criminality (Helgeson, 2010). For social workers, this silent epidemic has practice implications that we cannot afford to ignore. There is mounting evidence that individuals in our practices may also be struggling with a history of TBI. One study found that approximately 70 percent of individuals with co-occurring substance abuse and mental health issues had a history—although not necessarily a diagnosis—of TBI (Corrigan & Deutschle, 2008). In another study, an astounding 87 percent of a county jail population reported a history of head injury (Slaughter, Fann, & Ehde, 2003). Combined with findings that suicide rates are higher among TBI survivors (Silver, Kramer, Greenwald, & Weissman, 2001), and potentially highest among the mild injury group (Teasdale & Engberg, 2001), this evidence suggests the need for new standards in competent practice.