On any given night, 60,000 people in Canada will go to sleep homeless. Research estimates that more than half of them have had a brain injury at one point in their lives, most of them being injured before becoming homeless. An estimated 22.5 per cent live with moderate or severe brain injuries, a rate nearly 10 times higher than the general population.
Several avenues can lead a person to experience homelessness, including abuse, criminality and other adverse life events, all of which can be interrelated with brain injury. For example, experiencing a brain injury can lead to the onset of a mental health or substance use disorder, impulsivity and aggression, which can, in turn, lead to unemployment, family breakdown or other known causes of homelessness.
“Acquired brain injury” refers to brain damage after birth, either from external physical force (called traumatic brain injury) or internal problems like stroke or infection (non-traumatic). The more severe the brain injury, the greater the impairment, with cognitive abilities often being the most affected.
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Cognitive impairment and homelessness
At the CORTEX Lab at the University of Victoria, one of our research interests is the impact of brain injury.
Brain injury often leads to a wide range of cognitive challenges, including mental fog, fatigue, difficulty concentrating and memory problems that disrupt learning and daily functioning. Executive functioning, including decision-making and problem-solving processes, can be particularly affected.
When these impairments go undiagnosed and unsupported, the consequences ripple across every aspect of life: work and school performance decline, relationships suffer and healthy coping mechanisms erode.
(Planet Volumes/Unsplash)
Sustaining employment, education and family responsibilities becomes overwhelming. Remembering medications, appointments, and effectively completing tasks such as filling out a form can feel nearly impossible. Financial strain, interpersonal loss and chronic stress compound these difficulties.
Without adequate recovery supports, these factors converge, increasing vulnerability to homelessness and perpetuating a cycle where further brain injuries become more likely.
Systemic gaps in supports
Our research identified several systemic barriers that make it difficult for people living with brain injuries to break the cycle of housing instability and homelessness.
Stigma is pervasive and can undermine the quality of care people receive. People may be discouraged from seeking help when they need it because their trust in systems and service providers is broken.
Health-care and housing systems operate in silos. Long wait-lists, complex application processes and limited communication between organizations make the available services difficult to navigate, especially for people with brain injuries who may require additional support to complete paperwork, attend appointments and advocate for their needs.
Many people with brain injuries rely on income assistance. There is growing concern about the discrepancy between these supplements and the rising cost of living. In today’s rental market, “affordable” housing is financially inaccessible for those relying on income assistance. When housing is obtained, individuals are left with minimal resources to meet their basic needs after rent is paid. This, coupled with under-investment in existing supportive and transitional housing, further limits the availability of appropriate shelter options.
THE CANADIAN PRESS/Darryl Dyck
What can we do? Top five solutions
Our community partners’ insights yielded the following recommendations for improving the health and well-being of people experiencing homelessness and brain injury, listed below in order of priority:
1. Provide accessible and affordable housing
People with a brain injury need affordable, accessible housing with special support, including alternative transportation, age-appropriate settings and flexible living options. A housing-first approach with adequate financial help provides the stability needed for successful community living.
2. Enhance resources for service providers
Specialized training for health-care and public service workers who commonly interact with people experiencing homelessness, such as community outreach workers and police, can help to improve the quality of care. The expansion of brain injury health-care services into homeless communities is also key, with particular emphasis on screening and diagnostic services as the first step to connecting people to specialized care.
3. Design needs-based services
Health-care services must consider basic needs that are often overlooked. For example, providers should offer storage, even without ID, so that unhoused patients can safely store their belongings while attending appointments, which can be plentiful following a brain injury.
4. Improve collaboration and adopt a long-term integrated approach
Improving communication between health authorities and housing service providers may facilitate a smoother transition from hospital (post-brain injury) to housing, in turn preventing people from being discharged to the streets. The idea of “care with distinction” is critical, as a team of multidisciplinary health-care professionals are needed to understand needs specific to brain injury, psychiatric or physical conditions, and how these challenges interact in people experiencing homelessness. Continuity of care is also crucial, as brain injury can require lifelong support.
5. Reduce stigma through public health education
Public health education campaigns arose as a promising means for promoting awareness and reducing stigma. By fostering greater awareness for the interconnections between brain injury and homelessness, greater compassion might be promoted.
Supporting a national strategy: Bill C-206
The high burden of brain injury among people experiencing homelessness is undeniable. Bill C-206, an Act to establish a national strategy on brain injuries, represents a critical step toward addressing brain injury in Canada and, as an outcome, addressing homelessness.
The legislation aims to improve prevention, treatment and recovery support for the millions of Canadians affected by brain injury. The bill emphasizes collaboration, public education, and comprehensive care for individuals and families navigating life after a brain injury. A national strategy will have a visible impact not only on affected individuals but on our communities at large.
