A new UVic study has identified gaps in health-care services for a particularly vulnerable group: people experiencing homelessness who live with brain injuries, mental health issues and substance-use disorders.
The study, involving 163 community stakeholders, including individuals with lived experience, found that the current health-care system is not designed to address these overlapping issues holistically.
“There is plenty of research detailing the burden of these conditions ... in homeless populations, but far less on how to best support them,” study lead author Cole J. Kennedy, UVic clinical neuropsychology PhD student, told Saanich News.
Yet, the prevalence of brain injury and mental health/substance use (MHSU) disorders is high amongst people experiencing homelessness.
Meta-analytical evidence shows that about three out of four of those experiencing homelessness have an MHSU disorder. Over half have a history of traumatic brain injury (TBI), which, when compared to the general population, is 2.5 to 4 times higher.
Kennedy said one of the more "concerning things" the researchers learned from participants was "how commonly brain injury survivors are being discharged to the streets."
Gathered as part of the BC Consensus on Brain Injury, an initiative that looks at the three common issues rattling the homeless community, the study identified six key priorities for improving care.
A housing-first approach was central to the priorities, emphasizing that housing instability exacerbates health problems. Housing should be tailored for those with brain injuries, including multiple support levels and consideration of sensory and mobility issues, the study said.
To complement this initiative, a top research priority was identified: to collect meaningful data on intersections and impacts, which includes proving the cost-effectiveness of housing-first approaches.
The study noted that brain injury is a lifelong condition that needs continuous, multidisciplinary support, especially since brain injury is something that perpetuates the cycle of homelessness, Kennedy said.
"The relationship between brain injury and homelessness is not just intersectional, it’s cyclical," Kennedy said. "Brain injury is the root cause of many pathways to homelessness. People experiencing homelessness or those who are precariously housed are also at higher such of experiencing violence and non-fatal overdose – strong risk factors for brain injury occurrence. This means that people can get stuck in a perpetual cycle of brain injury – the outcomes of which get worse as the cycle perpetuates."
Between 51 and 92 per cent experience their first TBI before becoming homeless, the study noted.
The study also recommended increasing funding, staffing and training for service providers, expanding services into homeless communities and reducing reliance on complicated referral systems.
Five research priorities were outlined, including evaluating existing programs, developing better diagnostic tools, and reducing the risk of brain injuries and homelessness.
The study, titled UVic Brain injury, mental health and substance use in homeless populations: community generated recommendations for healthcare service delivery and research study, was released May 17. It was published just in time for Brain Injury Awareness Month, which is in June in Canada.
“This research was possible because people living with brain injuries and experiencing homelessness were engaged and supported to be part of a dialogue that we hope will lead to better diagnosis, treatment and opportunities for housing and health care,” Kennedy said.
The need for greater collaboration and bolstered support in addressing the intersections of issues affecting those experiencing homelessness has been highlighted not only by this study, but through other community group efforts, including a less-than-year-old program at Camosun College that focuses on the intersection of mental health, addictions and criminal justice.
