More than half of people experiencing homelessness have sustained a brain injury at some point, whether traumatic, stroke-related, tumour-related or linked to alcohol, and in most cases the injury came before life on the street rather than after. A programme of research by Laurence Roy and Carolina Bottari of Université de Montréal's School of Rehabilitation, with doctoral student William Jubinville, is the first to document the life journeys behind that statistic.
The team conducted in-depth interviews with 26 people with brain injuries who were or had been homeless, publishing the life-course study in Brain Injury, alongside a rapid review in the Annals of Physical and Rehabilitation Medicine and a study of care barriers in Disability and Rehabilitation. For some participants the injury was one factor among many; for others it was the decisive turning point. Opportunities to detect injuries were missed repeatedly, including in youth protection and the correctional system.
The researchers describe fragmented care delivered in isolated episodes, community organisations lacking brain injury expertise, and symptoms misattributed to mental illness or substance use. They call for longer rehabilitation follow-up, greater use of occupational therapists, and coordinated cross-sector services, and have secured funding to design and evaluate such interventions with people who have lived experience. Because the injuries typically precede homelessness, they argue, there is a window for earlier intervention that services are currently failing to use.