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All In Their Head: Brain Injuries And Homelessness

From Street Roots contributing writer, Kate Cox:

It all ended with the smack of a crowbar. Nick was 32 and alone on the night he was attacked, and there were no witnesses. With no memory of the assault, he has few clues to the story except for the scar on his forehead where the crowbar cracked his skull. 

“First it hurt the front of my brain, because that’s where they hit me. Then, the force caused my brain to hit the back of my skull, back here. Then, there was also some swelling, so that caused more damage – way down here in my brain stem.” 

Nick woke up in an Anchorage hospital, but nothing was ever the same. His gregarious nature was now drowned out by voices and hallucinations, and reality was lost in the din. 

“I couldn’t deal with society anymore. I didn’t know what was real or who to trust. I ended up cutting all ties to the world.” 

Alcohol and drugs became his only way of coping. “If I stayed high I could deal with it.” For the first time in his life, Nick found himself unable to work and spent the next several years selling heroin, panhandling, and living on the streets. 

Unfortunately, Nick’s story isn’t unique. 

News about traumatic brain injury, or TBI, has increasingly come to light in recent months, from a spate of sports-related injuries particularly among football players, to the blast injuries of veterans returning from Afghanistan and Iraq. Although, homelessness can be the ultimate tragic consequence of a brain injury, the medical world is only beginning to connect the dots between TBI and homelessness. 

According to the National Healthcare for the Homeless Council, at least half of all homeless individuals have experienced at least one head injury in their lifetime. 

“Brain injury in the homeless community is a very common thing that we’re just starting to learn about,” says Dr. Barb Wismer, a practicing physician who serves on the board of the Council. Few formal studies have been done, but those few are sobering. 

In one recent study of 904 homeless men and women in Toronto, Ontario, 53 percent reported some type of traumatic brain injury. Studies in Milwaukie, Wisconsin and Boston, Massachusetts offer similar statistics of 48 and 67 percent. 

The Toronto study found that for those who had experienced a head injury, 70 percent had suffered the injury prior to becoming homeless. And although there is no clear cause and effect, the results suggest that TBI could be at least one contributor to some individuals’ homelessness. 

That shouldn’t be so surprising, as the long-term effects of a brain injury can be debilitating. Symptoms vary widely. Some are as dramatic as Nick’s hallucinations. Others are much more subtle. Sometimes described as an “invisible disability,” brain injury often causes problems with memory, concentration and thinking, as well as the ability to regulate emotion and behavior. 

As a result, brain injury survivors often have a hard time doing the work they did before their injuries. Family and social relationships suffer, straining the most immediate safety net before homelessness. 

The same symptoms can also create barriers for those individuals once they are on the streets. Navigating shelter systems, attending to basic health and hygiene, and accessing services can be overwhelming and difficult. Controlling anger can be a daily struggle. 

And once on the streets, the risk of brain injury continues. Steve Hill suffered head injuries throughout his adolescence and adulthood, from sports injuries to snow boarding to fight clubs. He describes each one as taking him down another notch. Even small injuries caused intense reactions including vomiting and confusion. “You’re more edgy when you’re homeless,” Hill said. “And you’re closer to violence when you’re on the streets.”

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