Treatment of mental health issues neglected during stroke recovery

The health system is failing to recognize the importance of treating mental health issues in stroke recovery.

Stroke attacks the brain, the human control center determining how we move, think, feel and communicate and yet rehabilitation services are continuing to mainly focus on the physical aspects of recovery.

The National Stroke Audit Rehabilitation Service Report 2020, released by Stroke Foundation today, showed 44 percent of patients experienced mood problems but only 63 percent of patients received an assessment for depression and anxiety. Further exacerbating the issue, one-third of services reported having no access to clinical psychologists or neuropsychologists.

Stroke Foundation Clinical Council Member Professor Susan Hillier said diagnosis and consequent support for both patient and families continued to be overlooked in the rehabilitation journey.

Mood changes, such as anxiety and depression, frequently occur following a stroke. Emotional, personality and behavioral changes are also common. This can limit the success of physical rehabilitation and cause problems with community participation, relationships with family and carers. We have known for more than a decade that mood impairment or mental health issues can limit patient recovery, but nothing is changing within our health system to reflect this."

Professor Susan Hillier, Clinical Council Member, Stroke Foundation

“Our rehabilitation health system is currently designed to focus on the physical recovery from stroke, and while I recognize learning to walk and talk after stroke is vitally important there is more to enabling survivors of stroke to live well,” she said.

Stroke Foundation Consumer Council Chair Jennifer Muller said the Audit told a familiar story.

Too often we hear from survivors of stroke about their frustration and distress about not being able to return to their lives before stroke. Physically their recovery from stroke may have progressed well but mentally they are struggling with their emotions and thoughts."

Jennifer Muller, Consumer Council Chair, Stroke Foundation  

Prof Hillier said supporting survivors of stroke and their families beyond the physical was more important than ever as we also tackle the coronavirus (COVID-19) pandemic.

“Survivors of stroke are among our communities most vulnerable to coronavirus, many of those living with stroke were also impacted by the diversion of resources within our health system to manage the pandemic,’’ she said.

“Those who had a stroke in this period experienced early discharge and found themselves self-isolating at home with minimal access to therapy as stroke units were dismantled and rehabilitation services suspended.”

Prof Hillier said clinicians, researchers and survivors of stroke embraced the expansion of telehealth into stroke rehabilitation.

“There is an opportunity to take these innovations and utilize them to strengthen the health system for the future, this includes improving access to specialists – including clinical or neuropsychologists – and tailored services,’’ she said.

Stroke Foundation Chief Executive Officer Sharon McGowan said this year alone more than 27,000 new strokes would be experienced by Australians and there were almost 450,000 survivors of stroke living in the community.

Advancements in stroke treatment mean stroke is no longer a death sentence for many. We must now focus increased attention on empowering Australians to maximize their recovery. We need to improve patient information and education and extend this to family and carers. This encompasses lifestyle advice for secondary prevention, general information about stroke and recovery – including continence management, returning to work, driving and other aspects important to community participation.”

Sharon McGowan, Chief Executive Officer, Stroke Foundation

A recent Deloitte Access Economic report, commissioned by Stroke Foundation showed the direct economic cost of stroke exceeds $6.2 billion annually, with a shocking further $26 billion in lost wellbeing due to short and long-term disability, and premature death.

Ms McGowan said acting now to improve secondary prevention and increase access to clinical or neuropsychologists can reduce the impact of stroke on the community and the health system.

“Stroke can be treated and recovery can be maximized,” she said.

Key findings of the Audit included:

• Four services achieved all 10 elements of the National Rehabilitation Services Framework.  
• One in five services met less than half the Framework elements especially services in remote areas that have reduced resources.
• 64 percent of patients referred for further rehabilitation and have ongoing disabilities.
• 78 percent of patients have a care plan developed with the team and patient for discharge into the community.
• 44 percent of patients experienced mood problems but only 63 percent of patients received an assessment for depression and anxiety.
• One-third of services reported having no access to clinical or neuropsychologists.
• 63 percent of patients received information on stroke, hospital management, secondary prevention and recovery.
• One in five patients received any information about intimacy after stroke.
• 79 percent of patients were discharged on blood pressure lowering medication.
• 35 percent had no education about behavior change and modifiable risk factors to prevent another stroke.