Researchers have dedicated a great deal of attention to understanding how and why people become homeless. A study led by our own researchers sheds light on the complex nature of the relationship between homelessness and brain injury—with traumatic brain injury a possible contributing factor to poorer mental health and substance use.
Dr. Panenka’s team combined data from 38 studies done between 1995 and 2018 from six countries, including Canada. According to their findings, published in The Lancet Public Health, over half of all people who are homeless have suffered a traumatic brain injury at some point in their lifetime.
Compared to the general population, people who are homeless or have unstable housing are up to four times more likely to have a history of some type of traumatic brain injury, and 10 times more likely to have a moderate or severe injury—described as being unconscious for at least 30 minutes or having visible brain damage on an imaging scan.1
Traumatic brain injury is the damage caused by a blow to the head, often from a fall, a motor vehicle accident or an assault. In some cases, the traumatic brain injury can cause long-term damage to the brain, and lead to neurological and psychiatric disorders and poorer health outcomes overall.
“Individuals who are homeless or marginally housed are a vulnerable population and often have complex health challenges,” says Stubbs, the lead author of the study and Vanier Scholar. “Traumatic brain injury can often lead to additional challenges with memory, concentration, mood, and decision-making, which may compound existing health or functioning challenges.”
Researchers reported links between traumatic brain injury and poor physical and mental health, thoughts of suicide and involvement in the criminal justice system.
The BC Mental Health and Substance Use Services Research Institute is dedicated to advancing the understanding of people with complex mental health and substance use disorders in B.C.
"I find it especially striking that we found such a high prevalence of moderate or severe traumatic brain injury," says Stubbs. "Our work emphasizes that healthcare workers be aware of the burden of traumatic brain injury in this population, and how it relates to health and functioning."
"It’s time that we acknowledge that hidden wounds are common, the individual is not to blame, and they deserve the same treatment afforded to the rest of us so that positive outcomes can be maximized."
Dr. Panenka’s team hope the findings raise awareness about the issues that people suffering from brain injuries face, and encourage care providers and others working with homeless populations to consider these issues in their treatment plans.
“It’s easy to point a finger of blame and attack those who are homeless or marginally housed for their personal behaviours. The stigma further marginalizes them, compounding problems with fair and equitable health care,” said Dr. Panenka, the study’s senior author. “Instead, it’s time that we acknowledge that hidden wounds are common, the individual is not to blame, and they deserve the same treatment afforded to the rest of us so that positive outcomes can be maximized."
The authors noted that comprehensive health assessments, such as checking for a history of traumatic brain injury, will improve the care and services provided to those in need.
Many of BC Mental Health and Substance Use Services’ clients and patients live with cognitive impairment, which can make it difficult for them to concentrate, learn new things, or make decisions, in addition to co-occurring addiction and mental illness.
In light of this, the model of care at Red Fish Healing Centre for Mental Health and Addiction, set to open in October 2021, includes a care pathway especially for people who live with cognitive impairment.
While the study is not able to determine if traumatic brain injury increases the risk of homelessness or vice versa, findings suggest that providing stable housing may lower the risk of injury, though more research is needed.
“The relationship between homelessness and traumatic brain injury could function both ways—traumatic brain injury could increase the risk of homelessness, and homelessness could increase the risk of traumatic brain injury. We need a better understanding of this relationship to address the issue, and to improve outcomes in the homeless and marginally housed population,” said Jehannine Austin, the executive director of the BC Mental Health and Substance Use Services Research Institute.
Stubbs will continue his research as a visiting scholar at Harvard University, having recently won the Friedman Award for Scholars in Health. The award provides opportunities for graduate students or medical residents to learn from global experts in their chosen field.
1 American Speech-Language-Hearing Association (n.d.). Traumatic Brain Injury in Adults (Practice Portal).