Traumatic brain injury - exploring the gaps in unmet needs through critical discourse analysis

Following sustaining a Traumatic Brain Injury (TBI), individuals describe reduced access to adequate services. Research cites barriers to access as funding disparities between localities, disjointed communication from acute to post-acute services, an inadequate workforce, and charities filling the gaps between services. Inadequate services significantly impact the lives of those with TBI and can affect the development of functional gains post-injury. Research has yet to explore the influence of policy on meeting the needs of those with TBI. The current study aimed to address the social problem of unmet needs within a TBI community by critically appraising relevant recent parliamentary texts. With an added intention of exploring ways clinical psychologists can engage with the political context of their work. Fairclough's (2001) 5 stage framework for Critical Discourse Analysis (CDA) was utilised to explore the underlying conceptual frameworks within these texts and their impact on how services were operationalised in this community. A critical realist epistemological position was adopted. A comprehensive historical analysis was undertaken to identify wider discourses that influence this social problem. Seven debate titles from June 2018 to November 2020 were identified for a detailed discursive analysis. These debates were organised following the establishment of the All-Party Parliamentary Group on Acquired Brain Injury (APPG-ABI) in 2017. The analysis indicated that discursive obstacles to the social problem could be found in systemic barriers, conflicting roles of obligation and action, implicit and explicit prejudice, the power within the personal experience and gendered narratives. These discourses allowed for the generation of new knowledge regarding the networks and structures that cause inertia in solving this social problem. Networks and structures these identified discourses operated in included unintegrated care pathways, structures within government operations and the reality of working in NHS settings. Implications for clinical psychologists overcoming these barriers and working in social policy settings were considered.