The Connection between TBI and Homelessness

JUNE IS BRAIN INJURY AWARENESS MONTH IN CANADA

DisconTent City established itself at Port Drive, Nanaimo in May. After lending its initial support, City Council has since passed a motion in favour of issuing a trespass notice requiring all campers to vacate the site. Local advocates say by removing the camp, or attempting to, the City’s actions will push Nanaimo’s most marginalized constituents “back into the woods” and continue to ignore the issue.

Homelessness and poverty are significant social problems across Canada and the US today, and there is evidence suggesting that Traumatic Brain Injury (TBI) is one of the complex issues leading the individual to homelessness. TBI is a leading cause of permanent disability in North America most commonly caused by falls, motor vehicle trauma, unintentional impacts, assaults, and sports-related injuries. TBI can define as “a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Severity can range from mild, characterized by a brief change in mental status, to severe, characterized by an extended period of unconsciousness or amnesia after the injury.” TBI is more common than we think among young persons.

A recent study, led by Dr. Jane Topolovec-Vranic, a clinical researcher at St. Michael's Hospital Neuroscience Research Program in Toronto found that almost half of all homeless men who took part in the study had suffered at least one traumatic brain injury in their life, and 87 per cent of those injuries occurred before the men lost their homes. According to Dr. Topolovec-Vranic, the fact that so many people suffered a TBI before losing their home suggests such injuries could be a risk factor for becoming homeless. Dr. Topolovec-Vranic looked at data on 111 homeless men aged 27 to 81 years old who were recruited from a downtown Toronto men’s shelter. She found that 45 percent of these men had experienced a traumatic brain injury, and of these, 70 percent were injured during childhood or teenage years and 87 percent experienced an injury before becoming homeless. Recognition that a TBI sustained in childhood or early teenage years could predispose someone to homelessness may challenge some assumptions that homelessness is a conscious choice made by these individuals or just the result of their addictions or mental illness.

Separately, another study by Dr. Stephen Hwang of the hospital’s Centre for Research on Inner City Health found the number of people who are homeless or vulnerably housed and who have also suffered a TBI may be as high as 61 percent—seven times higher than the general population.

The cognitive, physical and emotional consequences of TBI can persist for many years, resulting in considerable social losses across the lifespan. Finding and sustaining employment after TBI is challenging, often contributing to a downward spiral into homelessness. Cognitive impairments increase the risk of remaining homeless. Unhappily, homeless people with a history of TBI are almost three times more likely to experience physical assault, suggesting people with a history of TBI are more likely to be victims of violent crime.

In addition to the societal and financial cost of homelessness, individuals who are homeless often suffer from connected health complications such as seizures, mental health issues, substance use, and are at increased risk of premature death. Homeless individuals are also known to be frequent users of healthcare facilities, especially emergency departments thus the potential to reduce the rate of homelessness and the incidence of injury and illness among people who are homeless has significant financial, societal, and individual implications.

Last week Signy Madden, executive director of the United Way Central and Northern Vancouver Island, said it’s important to recognize Nanaimo is in a crisis and that a recent count shows the number of people experiencing homelessness in the city has nearly doubled in two years from 174 to 335, adding “we know that we under-count by large percentages.”

Of those counted almost 200 respondents identified affordable housing as a solution, “If we don’t have any options to place people out of shelters and into affordable housing, it’s not good, and that’s what we’re seeing,” Madden said.

I would add the provision of permanent supportive housing may be necessary to end homelessness among individuals with significant impairments due to Traumatic brain injury.