Understanding the connection between brain injury and homelessness

Author: Thea Arch

The high prevalence of traumatic brain injury (TBI) within the homeless community has been established in a number of studies. This includes Brainkind’s (formerly The Disabilities Trust’s) own work, finding brain injury could affect almost half (48%) of homeless people and may contribute to the risk of people becoming homeless in the first place. But less research has been into the why behind this concerning relationship; and what can be done to address it.

There are a few reasons why people with brain injuries living on the streets could be at risk of further injury when living on the streets, the work done by Brainkind explores a few suggestions. The persisting cognitive and emotional effects of the brain injury can put those sleeping rough at a greater risk of injury; impaired judgement, impulsivity, mood swings and other common effects of more severe head injury can lead to behaviour and lifestyle choices that incur damage to the head. Those sleeping on the streets are also 17 times more likely to experience violence than the general public, leading to further risk of injury.

All this may account for any damage sustained whilst sleeping rough. However, in earlier research conducted in our Leeds service, most (90%) indicated that they had sustained their first TBI before becoming homeless, raising a lot more questions about how the symptoms of TBI can contribute to homelessness, rather than something that occurs afterwards. Understanding this in more detail could have important implications for preventative policy measures, helping to identify the right support at the right time.

What this support might look like is another question. A strong and adequately funded social sector is a good place to start, with a much greater emphasis on specialised brain injury services. Such a sector should involve robust care in the community programmes and accessible services, such as drop-in clinics, that are helpful in treating injuries before they become worse.

We also need to see appropriate discharge plans from rehab services and hospitals that involve active reaching out and persistent follow-ups; those with a brain injury find it particularly difficult to remember and attend appointments, so much more needs to be done to ensure consistent engagement. Alongside clinical services, such preventative policies would require comprehensive training and education across all sectors and to the public; arming people and professionals with the right information to spot the signs and get help.

It is still unclear the degree to which brain injury is a cause or a consequence of homelessness, although we know that in many circumstances it can be both. What is clear is that more research is needed to understand this complex relationship.