You see a young man* walking towards you on the sidewalk. At first he appears just fine, but as you approach you notice that his steps aren’t quite as direct and sure as your own. You notice him fumbling in his pocket for a note. As you get close enough, he requests your help in words that aren’t quite clear, “can you read this for me – I’m not sure where I need to go.”
Do you stop and help? Do you shake your head and move on? Do you make assumptions about substance abuse or mental illness?
This scenario is one that is fairly typical for an issue that is anything but – acquired brain injury. Every brain injury is unique depending on factors that include the severity, location or cause of the injury and the age, health, and support systems of the survivor. Although no two injuries are alike, many survivors of brain injury experience a similar after-effect: difficulty completing physical or mental tasks, loss of job, family breakdown, development of substance abuse or mental illness, and eventually homelessness.
According to “The Mind of Homelessness,”  a white paper completed by staff at The Cridge Brain Injury Services, the brain injury epidemic in Canada (approximately 4% of the population sustains a head injury with permanent effect annually) includes the following hard costs:
- Acute Care/Rehabilitation/Emergency hospital bed $1500/day (Island Health)
- Federal Prison $323/day (Statistics Canada)
- The Cridge Brain Injury Program Residence* $203/day (Cridge Budget)
- The Cridge Independent Housing with Support* $60/day (Cridge Budget)
*Similar residential and support programs report similar per day costs.
Not included in those numbers are the social costs related to brain injury and its all-too-common result, homelessness: petty crime or vandalism, police staffing hours and associated court costs, addictions and mental illness and their treatment, and the harder-to-quantify demands on society of family breakdown and lost income for wage earners.
According to a 2008 study in Toronto, 53% of homeless men had a traumatic brain injury, and as many as 70% of those individuals had experienced their first traumatic brain injury before they became homeless. Homeless survivors of brain injury often deal with substance abuse or mental health issues in addition to cognitive or behavioural problems. Homeless survivors of brain injury face an increased risk of being victimized and complicate their health concerns by lack of appropriate self care.
There is hope. Early intervention and appropriate, individualized support make all the difference in ending the spiral from injury to homelessness. Counselling for survivors and their families, appropriate options along a spectrum of care and support, employment, education, and life-skill training, and connections with other survivors all helps change the downward path to homelessness into a journey towards recovery.
*Although brain injuries can happen to anyone, the most typical survivor of brain injury is a male between the ages of 18 and 45.
 G. Sing, J. Breese-Biagioni, M. Fournier. THE MIND OF HOMELESSNESS: A Position Paper on Brain Injury and Homelessness. The Cridge Centre for the Family – Brain Injury Program. April 2013 Available online at http://cridge.org/wp-content/uploads/2010/12/News_THE_MIND_OF_HOMELESSNESS1.pdf
 Hwang, S. W., Colantonio, A., Chiu, S., Tolomiczenko, G., Kiss, A., Cowan, L., et al. (2008). The effect of traumatic brain injury on the health of homeless people. CMAJ: Canadian Medical Association Journal = Journal De l’Association Medicale Canadienne, 179(8), 779-784.