Roughly half of people who are homeless or in unstable housing have experienced a traumatic brain injury in their lifetime, a new study has found, with potentially severe consequences for their mental and physical health.
The study, by a group of B.C. researchers, analyzed previous research on the subject from six high-income countries including Canada, and was published Monday in the journal Lancet Public Health.
Not only did the researchers find that around half of homeless people had a traumatic brain injury (TBI) in their lifetime, they also found that one quarter had experienced a moderate or severe injury — defined as being unconscious for at least 30 minutes or a visible injury on an MRI scan with lingering disability.
By comparison, only around 22 per cent of the general population has ever experienced TBI, and only three per cent have experienced a moderate or severe brain injury.
“What we found with this study is a strikingly high burden of TBI in this population,” said lead study author Jacob Stubbs, a PhD candidate in the UBC psychiatry department who works with the BC Mental Health and Substance Use Services Institute.
“TBI is broadly associated with poor health and functioning in this vulnerable population.”
Traumatic brain injury is linked to a host of problems, the researchers found, including poorer reported mental health, substance abuse, suicidal ideation, and even involvement with the criminal justice system.
When a person experiences brain injury, their brain essentially bounces around in their skull, said Nathan Churchill, a scientist at St. Michael’s Hospital, causing damage to the brain tissue with a “cascade” of effects.
Issues with blood flow and swelling can lead to further damage, Churchill explained. With less severe injuries, damage can still occur at a microscopic level.
The effects can be short-lived, or quite long-term in the case of repeated head injury, he said.
Studies of former boxers and football players show they can have problems regulating their mood, depression, irritability, and problems with thinking and planning due to damage to the frontal cortex, he said.
Dr. Gary Bloch, who has worked with homeless and marginalized populations for 17 years as a family doctor with Toronto’s St. Michael’s Hospital and Inner City Health Associates, said the numbers are “shocking” but not that surprising.
His patients are often experiencing many mental and physical health challenges at once, he said, so teasing them out can be tricky. When he sits down with a patient to try to get a detailed medical history, “There’s often a piece that seems to be missing.”
When he digs deeper, he often finds a history of head injuries.
“Having a history of traumatic brain injury becomes interwoven with just about every other health issue that a person is dealing with,” he said.
“So I think knowing that someone has experienced traumatic brain injury raises my index of suspicion for other health issues, physical health issues and mental health issues.”
Traumatic brain injuries happen both before and after a person becomes homeless, according to the study. They can contribute to the likelihood that someone becomes homeless, Stubbs said, and make it harder to get out.
“TBI is obviously an important factor in the health and functioning of this population, but it actually might be a component that represents a barrier to exiting homelessness or unstable housing, given that homelessness and unstable housing itself is a risk factor for sustaining more TBIs.”
Michelle McDonald, executive director of Brain Injury Canada, agrees that these injuries could contribute to a higher risk of becoming homeless.
“Many, many people with TBI or brain injury in general live below the poverty line,” she said.
“There’s many factors that lead to homelessness, but brain injury can be the root cause of some of those factors, such as unemployment, substance abuse, family breakdown.”
These injuries can often be treated, Churchill said, though the exact treatments will vary considerably depending on the nature of the brain injury.
But the care needs to be available. Even just having a place to rest and recover, and getting some immediate medical attention after the injury is “critical,” he said.
This is obviously a problem for many people who are experiencing homelessness. It’s “near impossible” for his patients to get proper treatment and rehabilitation for TBI, Bloch said.
“It is a source of constant frustration to me on the front lines, that I do not have access to the resources to either identify or address the needs of people who have experienced these types of injuries.”
He argues for a holistic approach to address both the health and social issues that people encounter while homeless, including a heightened risk of traumatic brain injury.
“The number one preventive intervention is helping people get housed.”