Tag: Advocacy

Brain injury & law

In some instances, an acquired brain injury may be the result of an accident. Examples of this can include motor vehicle collisions or workplace accidents. If you acquired your brain injury through an accident, you may consider hiring a lawyer to represent you in any legal proceedings. This can include representation in court cases, negotiating settlements, and more. They can also help you understand the legal process related to accident-based claims with insurance companies.

Topics in this section include:

Brain injury because of a motor vehicle collision?

If you have a brain injury because of an automobile accident, your automobile insurance policy entitles you to “Accident Benefits” that can assist with your treatment and recovery. Depending on the severity of your injury and its impact on your daily life, you may be entitled to additional benefits such as private medical care, rehabilitation and attendant care, that may not be available under the provincial medical insurance plan.

Even if you do not have your own automobile insurance policy, you are entitled to these benefits if you are in an accident involving an automobile.

The insurance system can be confusing and difficult to navigate on your own, so you may choose to hire a personal injury lawyer to help you with your claim. Free initial consultations with lawyers are often available.

Provincial auto insurance regulators
Each province and territory has an automobile insurance regulator. You can find yours from the list below.

Brain injury because of a workplace accident?

Some people are injured at their workplace or on the job. Legal action may be possible if the employer did not follow proper safety procedures, did not take care of the workplace, or in other ways contributed to the cause of the accident. Workplace accident claims can be a challenging process to navigate on your own. Much like with other accidents, you may want to consult a lawyer.  Free consultations with lawyers are often available.

Human Rights

As a Canadian, your human rights are protected by federal, provincial and territorial laws.  Human rights laws are in place to protect against discrimination in protected areas such as gender, citizenship, age, place of origin and disability, as well as protections in services, facilities housing and employment. Learn more about human rights laws in Canada.

Finding a lawyer

There are many personal injury lawyers across every province and territory.  Finding the right lawyer for you and your family is important.  There are a few things to consider when selecting your legal council.

Word of mouth
One great way to find a lawyer is to obtain the first-hand testimony of a past client, particularly if the recommendation comes from someone you know and trust. This past client should be able to tell you about the lawyer’s qualifications, performance, and give you an accurate picture of what it was like to work with them and the law firm in question.
The internet
Many people do search the internet to look for and compare the values of goods or services.  This is true for lawyers or law firms too. You can search and compare the lawyers or law firms to see who best suits your needs or the needs of the injured person.

“Brain injury” and “personal injury” are keywords that are often used in the search. Be aware that many companies, including law firms, will spend money to be at the top of the list on internet search pages. Most of us that search the internet for products or services know that, it is not necessarily the firm at the top of list, which will best suit your needs. Here is a little hint: When you look at a search page, check the listings for the word “ad” next to the website’s URL. An ad means the company has paid to be at the top of the search page.

Remember – The ranking on Google doesn’t rank the quality of services or past case history, so be sure to visit their website, read about the lawyers, past cases and client testimonials. These are important steps when looking for a lawyer on the internet.

Legal directories
There are a variety of legal directories available that rate lawyers as the “top” in their field. These must be viewed with caution, as many of these classifications are done by an annual peer survey. The classification most often means that they are popular and well regarded amongst their peers and others who participated in the survey. Their ranking does not necessarily mean they win the most cases, provide the best customer service or will be right for you. While these rankings may be meaningful to some, you would be well advised to look at the services that the law firm provides, past cases and client testimonials.

Find a lawyer with expertise in your area

You will want to be sure the lawyer or law firm you are contacting has expertise in the areas of law for which you are seeking advice (for example, person injury, motor vehicle collisions, or insurance cases).  Make sure to ask for specific recommendations or tailor your search using terms like ‘person injury lawyer’ and the name of your province/territory.

The legal consultation

Most law firms offer a free initial consultation. Once you have narrowed your choices to a few names, you should set out to meet with them by calling or emailing the office.  Please note that it may not be necessary to go to the office location for a meeting.  Most lawyers will meet with you and your family in the hospital or at your home or some other alternate place that is convenient for you.

It is advisable to meet with as many as three lawyers (or more if necessary) to get a sense of the lawyer’s priorities and to learn about the services that their firm provides.

Prepping for your consultation

To make the most of this initial visit and to ensure the lawyers have enough information to discuss your case, you should bring a few things with you:

  • Liability information: officer details, the other driver’s contact details (if applicable), the accident location, names and phone numbers of witnesses, photos taken at the accident scene or afterwards;
  • Your insurance information: insurer, policy number, claim number and adjuster information (if claim has already been started);
  • Other insurance information: Workplace insurance, short-term disability, long-term disability, health benefits, employment insurance;
  • Employment information: employer, wage info, how you are paid, how often, other sources such as provincial disability funds;
  • Details of family members: names, birth dates and ages;
  • Health card, driver’s license, Social Insurance Number of injured person;
  • Medical information: family doctor and contact information, list of hospitals visited, summary of pre-accident medical issues, list of service providers.

To make the best of your time with the lawyer, it may be helpful to have prepared some questions.

Questions to ask during your consultation
  • Do you believe I have valid claims?
  • Have you previously represented clients in similar cases?
  • What were the outcomes?
  • How many years have you been practicing law?
  • What can I expect from you in terms of communication?
  • Will I be dealing with you (the lawyer) directly or will it be your legal team?
  • What can I expect from the legal process?
  • How many other cases are you handling?
  • Have you ever faced disciplinary action or been suspended from practice?
  • What is your fee? Do you work on a contingency fee basis?
  • Can I speak to past clients to get a reference?
  • Is there any way to predict what the compensation might be?
  • How long will my case take from start to finish?
  • What will be expected of me during the case?

Options for (free) legal services

The legal process can be a barrier for someone with a cognitive impairment.  There are timelines, deadlines, and immense amounts of paperwork. It can be frustrating and overwhelming. You may have to hire a lawyer out of pocket, but this can be expensive and not an option for everyone.

There are “pro bono” or free legal services you can explore.

Homelessness

Being homeless is defined as “the situation of an individual or family without stable, safe, permanent, appropriate housing, or the immediate prospect, means and ability of acquiring it. It is the result of systemic or societal barriers, a lack of affordable and appropriate housing, the individual/household’s financial, mental, cognitive, behavioural or physical challenges, and/or racism and discrimination”[1].

Research shows that over 235,000 people experience homelessness across Canada each year[2]. In reality, this number is much higher because many people stay with friends or family or don’t go to emergency/homeless shelters. Communities across the country perform regular Point-in-Time (PiT) counts of people experiencing homelessness to get the most accurate number. Approximately 50% of people experiencing homelessness have had a brain injury with varying symptoms and outcomes[3]. This is a large percentage of the population who often don’t get the support or resources they need for treatment and recovery. Many may not fully realize they have had a brain injury.

The study also explored the idea that the relationship between brain injury and homelessness may be bi-directional: acquired brain injury can lead to homelessness, and homelessness may increase the risk of acquiring a brain injury[4]. These reports have made Canadians more aware of the issue and the importance of homeless resources and prevention. This includes addressing the lack of affordable housing.

Housing

A lack of affordable housing is a barrier for many Canadians and can contribute to homelessness. The challenge that many people face is finding housing that will support the transition process from homelessness.

There are several models of housing and housing supports in Canada that can aid the process.

Transitional housing
This is a supportive, temporary accommodation that is meant to bridge the gap from homelessness to permanent housing by offering structure, supervision, support (for addictions and mental health, for instance), life skills, and in some cases, education and training[5]
Subsidized housing
This type of housing is partially paid for by the local government. Subsidized housing has eligibility requirements that need to be met.
Housing-based case management
These case managers help unsheltered individuals find housing and housing support.

Many areas of Canada are also implementing Housing First initiatives, which prioritizes those with high needs for housing and supports.

Different supports will be available based on where you live. Finding housing can be challenging, and it will be a long process. But by working with local organizations, shelters, and government programs, it’s possible to make strides towards permanent housing.

Support for individuals experiencing unstable housing

It’s overwhelming and scary to not have a place to live, and there are barriers that will make the transition from homelessness more difficult, such as:

  • Discrimination
  • Health challenges
  • Intimate partner violence
  • Lack of affordable or appropriate housing
  • Lack of acquired brain injury training for frontline workers
  • Lack of knowledge about homelessness in brain injury specialists
  • Personal situations
  • Poverty
  • Problematic substance use
  • System failure

While these barriers seem impossible to overcome, it is possible. The process of finding appropriate housing requires a mix of supports and services and a multidisciplinary support team. These services may be specialized with programs for people experiencing homelessness or they may be broad services (health services, libraries, treatment facilities etc.) that are geared to anyone who needs them. Governments, charitable organizations, faith communities and/or the non-profit sector may also provide helpful services[6]. To access these services, the person needs to advocate for themselves or find someone (a family member, friend, health professional, or social worker, for example) who can advocate for their needs on their behalf.

If you are experiencing homelessness, there are resources available to you to help you through these difficult circumstances.

Community mental health services
Many individuals with a brain injury experience mental health challenges as a result of the injury. When a person is homeless, they don’t often have the coping tools necessary for managing their emotional, physical or behavioural symptoms, let alone their mental health.

Community mental health services cover a variety of areas, including:

  • Psychiatric and medical help
  • Housing assistance
  • Crisis services
  • Peer support
  • Self-help programs
  • Employment services
  • Case management services

Needs are specific to the individual – some services will help a person’s mental health more than others.[7]

Local brain injury associations or medical professionals will be able to direct you to local mental health resources. The Canadian Mental Health Association also has several branches across Canada listed on this map.

Community services
Community services are offered by non-profit organizations with the goal of providing support to a specific group of people. These services and programs can include counselling, peer support, socialization/recreation groups, education classes as well as food banks, out of the cold programs and drop-in centres. Some of these programs may be specific to acquired brain injury, while others are open to all.  Availability of support is dependent on where a person lives – rural communities have fewer supports than larger urban areas.

One community service that is incredibly helpful is local brain injury associations. Not only do they have knowledge of brain injury, but they can familiarize a person with other available supports in the area.

Emergency shelters
Emergency shelters serve as a place for homeless individuals to stay overnight. These stays are short-term and dependent on available beds and shelter rules.

Discharge planning
Discharge planning occurs when a person leaves a hospital, in-patient rehabilitation, mental health facilities, prison, or any other official facilities/programs. The purpose of discharge planning is to confirm that when the person leaves the institution/facility, they are ready to be independent, or released into the responsibility of a caregiver or with community support in place.

If a person doesn’t have the proper coping mechanisms or supports in place after they are discharged, there is a greater risk they will be homeless. Unfortunately, there are no standard discharge processes across Canada, so individuals might not get the assistance they need [8].

The important thing to remember is that discharge planning should start as early as possible, and include plans for living arrangements, working (if possible), continuing treatment (if necessary), and identifying supports in the community for both the individual being released and the caregivers. If you’re going to be leaving the hospital soon, ask your medical team or caregiver about starting a discharge plan.

Harm reduction
According to the Canadian Observatory on Homelessness, harm reduction is a strategy you use to reduce the risks and harmful effects of substance use

Problematic substance use is a complex issue that many people experiencing homelessness face. Harm reduction aims to not just address the issue of substance use, but other issues that may have contributed to substance use in the first place. It’s primary focus is to lead people to safer choices with the eventual hope that they will seek treatment. Harm reduction methods include:

Rehabilitation
Rehabilitation can be difficult to get if you don’t have a health card or physician, as public programs need a referral from a doctor. But it is possible to begin the process of finding appropriate rehabilitation through homeless outreach organizations and housing programs. Cities and provinces/territories have their own programs in place, so this impacts what’s available to you. Rehabilitation goals will be different for each person. In some cases, you may be able to find vocational rehabilitation that can help train you for work.

Reach out to your local brain injury association as they may be able to provide you with information about rehabilitation that is available in your area.

Intimate partner violence and homelessness

Intimate partner violence (IPV) is a leading cause of traumatic brain injury (TBI), with the majority of the people affected being women. Many shelters and programs are equipped to deal with men or with alternate causes of homelessness such as substance use problems. This means that women and children who flee their homes because of IPV often can’t get the supports they need at standard shelters. There are women and family shelters across Canada that can offer temporary housing.

Resources and studies

See sources

Substance use

It is estimated that approximately one in five Canadians aged 15 years and older experience substance use in their lifetime [1]. Substances include:

  • Alcohol
  • Opioids and other prescription drugs
  • Tobacco
  • Cannabis
  • Methamphetamines
  • Cocaine
  • Heroin
  • Ecstasy

Problematic substance use is when any substances are used in a manner, frequency, situation, or amount that is harmful to a person or those around them [2]. Examples of situations of problematic substance use that can lead to a brain injury include:

  • Excessive consumption causing impaired faculties (i.e. loss of balance or reduced vision)
  • Impaired driving
  • Opioid overdose
  • Lowered inhibition and an increase in risk-taking behaviour

Barriers to recovery for substance use and brain injury

Individuals coping with addiction/problematic substance use and brain injury face a lot of challenges that make recovery more difficult.

Lack of services for complex needs
Brain injury survivors that are struggling with addiction/withdrawal do not have access to many rehabilitation services that can treat both addiction and brain injury.  Either the program requires participants to be sober, or the addiction programs are not equipped to handle the complex needs of people with brain injury. This makes it difficult for people to get the help they need.
Continuing addiction after brain injury
People with a brain injury may have a continuing addiction that they struggle with during their recovery. In some cases, an addiction may develop post-injury. The use of substances (including alcohol) can have negative effects on a person’s recovery and even make symptoms worse.
Stigma
There is a stigma around substance use/addiction that can impact the quality of life for the survivor and their support circle [3]. A stigma is framing a situation in a negative light, and is often adopted by society as a whole.

The stigma surrounding substance use is made worse when you factor in the stigmas that still exist around brain injury and disabilities. It can take a long time to dismantle these stigmas, and they can be harmful to people.

Advocating for more support for substance overdose survivors

Survivors of opioid overdose, addiction and brain injury need more supports and services that can help them cope with these concurrent challenges. Advocating for more research into the relationship between overdoses and brain injury as well as services is one way to bring further attention to this important issue.

Visit the advocacy section of our website to find out how to be an effective advocate as well as templates for letters.

Addiction & problematic substance use

Substances like alcohol can have detrimental effects on a person before and after a brain injury. This is especially true if a person is coping with addiction.

Addiction is used to describe an attachment to a substance or behaviour that is out of control [4]. The Centre for Addiction and Mental Health (CAMH) indicates that you can determine if you or someone you know has an addiction if there 4 C’s are present:

  • Craving
  • loss of Control of amount or frequency of use
  • Compulsion to use
  • use despite Consequences

In extreme cases, addiction and problematic substance use can completely destroy a person’s life, leading to homelessness, severe health consequences (such as brain injury) and a loss of support from family and friends.

Opioids and brain injury

Problematic substance use is a big problem in Canada, costing thousands of lives and billions of dollars. Here are the most recent statistics from the Canadian Centre on Substance Use and Addiction.

  • Substance use costs Canadians almost $46 billion a year (2017)
  • Over 5,000 people died from opioids in 2017

Illegal street opioids laced with dangerous components such as fentanyl increase the risk of overdose and can cause catastrophic brain injury or death through oxygen deprivation.

While there are a lot of statistics on the number of deaths related to the opioid crisis in Canada, more information is needed on the number of people who acquire a brain injury due to an opioid overdose.

Resources

See sources

Human rights & employment standards in Canada

As a Canadian, your human rights are protected by federal, provincial and territorial laws.

Human rights describe how we instinctively expect to be treated as persons.  Human rights define what we are all entitled to – a life of equality, dignity, respect, and a life free from discrimination. You do not have to earn your human rights. You are born with them. They are the same for every person.  Nobody can give them to you. But they can be taken away.” Canadian Human Rights Commission

Human rights laws are in place to protect against discrimination in protected areas such as gender, citizenship, age, place of origin and disability, as well as protections in services, facilities housing and employment.

According to the Human Rights Commission of Canada, the following are some examples of discriminatory acts that could be accepted as a discrimination complaint.

  • If you go to a federally regulated organization and you are denied goods, services, facilities or accommodation.
  • If you are provided with goods, services, facilities or accommodation in a way that treats you differently and adversely.
  • If you are refused employment or you are fired from your job or are being treated unfairly in the workplace in a discriminatory fashion.
  • If the company or organization is following policies or practices that deprive people of employment opportunities.
  • If you are a woman and are being paid differently when you are doing work of the same value.
  • If you have been the victim of retaliation because you have filed a complaint with the Commission or because you have helped someone else file a complaint.
  • If you have been the victim of harassment.

It must be noted that not every situation where you think you have been treated unfairly is considered a human rights violation. The Canadian Human Rights Commission has a detailed Frequently Asked Question page, which can be helpful in determining what would fall under a human rights violation and the process for lodging a complaint.

Provincial and territorial human rights

Provincial and territorial human rights laws share many similarities with the Canadian Human Rights Act and apply many of the same principles. They protect people from discrimination in areas such as restaurants, stores, schools, housing and most workplaces. If you are not working in or accessing services from the federal government, First Nations governments or private companies that are regulated by the federal government, these laws will apply.

Use this template for tracking advocacy calls.

The following list of provincial and territorial human rights contacts can give you more information for your region:

Communicating with the government

Communicating with your elected government representatives is a great way to let them know about the issues and policies that are important to you as one of their constituents. It’s helpful to know who to speak with and how to speak with elected representatives at different levels.

Provinces and territories are broken up into ridings. Each riding has an elected representative at both the provincial/territorial level and the federal level.

Provincial and territorial government

The elected representative of your riding at the provincial/territorial level is someone who can assist with issues that are directly connected to your province/territory. Acronyms in the political world can be confusing and make it difficult to figure out to whom you should be speaking. To add to the challenge, these acronyms are not the same in every province.  Here is a quick breakdown of the acronyms use for elected members in each province:

Federal government

Elected representatives to the House of Commons are called Members of Parliament (MPs). They represent your riding at the federal level and can be a good person to write to when advocating for yourself.

Depending on the topic of the issue you are writing about, you may want to direct your letter to a specific Cabinet Minister (i.e. Minister of Health).  The Prime Minister sends mandate letters to each Minister to identify issues of priority, so you may want to explore if the issue has been designated a priority in the Minsters mandate letters.

The most common way to communicate with government officials is by a mailed letter or by email. While hardcopy, mailed letters have an increased chance of being read, elected officials receive letters and emails from across the country. It is possible that not all letter/emails will be read or receive a response.

How to address the letter

Here are a few suggested strategies to increase the chance your communication will be read:

  • Be clear and concise.  Keep letters to a page or two, as longer letters will most likely not be read in their entirety.
  • Start with a brief intro about yourself
  • Briefly explain the issue you want to raise awareness about and what your concerns are
  • Identify what you would like to see happen or if any solution is available and what action you would like the reader to take
  • Indicate whether you would like a reply
  • Use spell check
  • Be polite. A calm, friendly tone in a letter is more likely to get a response than a negative one
  • Maintain a professional dialogue. This will not only give you more credibility but will increase the chance they will respond and possibly engage you in action. This does not mean you can’t comment on a policy or program they support but do it in in a constructive way

Appropriate, affordable housing for individuals with brain injury

In addition to the physical changes experienced after brain injury, many of the following common cognitive, emotional, and behavioural symptoms/impairments can increase the chance of homelessness:

  • Anger management issues
  • Challenges with processing information
  • Engagement in high-risk behaviours
  • Inability to initiate
  • Inappropriate emotional response
  • Lack of impulse control
  • Memory impairments
  • Perseveration
  • Poor judgment

Additional contributing factors include discrimination, intimate partner violence, poverty, and systemic barriers.

Discrimination
Discrimination is often a precursor to homelessness and can continue after the fact. Discrimination is when a person is treated differently based on race, religion, ability, mental illness, age, gender, or socioeconomic status. Individuals facing discrimination often experience restricted options, difficulty accessing housing and services that contribute to their position on the streets [1].

Approximately 28 – 34% of people experiencing homelessness in Canada are Indigenous peoples. This is a percentage of the Indigenous population, which makes up 4.3% of the overall Canadian population [2].

Intimate partner violence
Intimate partner violence (IPV) and family violence can lead to homelessness. It is estimated that 237 people per 100,000 people are affected [3] (Statistics Canada, 2016). In some cases, it becomes necessary to leave home quickly with no supports. According to the Canadian Observatory on Homelessness:

This is particularly an issue for youth and women, especially those with children. Women who experience violence and/or live in poverty are often forced to choose between abusive relationships and homelessness. Young people that are victims of sexual, physical, or psychological abuse often end up experiencing homelessness. As well, seniors that are experiencing abuse and neglect are increasingly at risk of homelessness.” [4,5].

Poverty
Many individuals who live below the poverty line are living paycheque to paycheque. They are at risk of being homeless, particularly if their ability to work is compromised through job loss or illness.
System failure
Sometimes Canadian systems don’t work as intended. This includes inadequate discharge planning for people leaving hospitals, corrections, and mental health and addictions facilities and a lack of support for immigrants and refugees [6]

Homelessness is not something that happens quickly and in isolation. There are usually many cascading effects that lead to homelessness and it is very rarely a choice. 

Statistics on homelessness and brain injury

  • Almost half of all homeless men who took part in a study by St. Michael’s Hospital had suffered at least one traumatic brain injury (TBI) in their life and 87% of those injuries occurred before the men lost their homes [7].
  • Studies find that 60% of homeless individuals with TBI report sustaining multiple injuries [8].
  • The majority of first TBIs occur prior to homelessness, suggesting that brain injury is a risk factor for homelessness. However, homelessness has also been found to be a risk factor for subsequent TBIs [9].
  • TBIs have been linked to increased mental health problems, physical health problems, and drug problems among the homeless [10].
  • Homeless individuals with TBIs appear to have worse cognitive impairment than homeless individuals without TBIs [11].
  • In a study of women with TBI in Canada, poverty was found to be a significant barrier to accessing health care [12].

Advocating for affordable, appropriate housing

No one should have to choose to pay rent over food, but it happens everyday. Financial assistance in provinces is too low – especially in cities – for people to find affordable housing without sacrificing basic needs. Once a person becomes homeless, it becomes even more difficult to find housing. There is also a stigma around homelessness driven by ignorance and judgement, and that stigma can negatively affect a person’s ability to escape homelessness. This is especially true for individuals with a brain injury who may not be able to work, don’t have the cognitive abilities to manage money, or are experiencing additional challenges.

Housing programs geared towards supporting individuals with acquired brain injury (ABI) are underfunded and specialized ABI housing programs in Canada have extensive wait lists, leaving people exposed to ongoing social, emotional, and financial risks.

As brain injury is a lifelong condition, affordable housing support and strategies need to be improved to address barriers and supports across their life span. We also need to understand the path to homelessness for those living with brain injury, as it is a critical piece in the prevention strategy.

Housing First model

Housing First is “a recovery-oriented approach to ending homelessness that centers on quickly moving people experiencing homelessness into independent and permanent housing and then providing additional supports and services as needed… The basic underlying principle of Housing First is that people are better able to move forward with their lives if they are first housed. This is as true for people experiencing homelessness and those with mental health and addictions issues as it is for anyone. Housing is provided first and then supports are provided including physical and mental health, education, employment, substance abuse, and community connections.” [13]

This model focuses on providing permanent housing to individuals despite their circumstance and needs.

  • Some people need affordable independent housing options that do not have extensive wait lists.
  • Some people need supported living where they may have a room or an apartment but have access to supports as needed.  This is essential for those with memory impairments and organizational challenges.
  • Some have complex medical needs and require full-time care, but are in a long-term care facility with seniors with Dementia and Alzheimer’s. While their medical needs are provided for, this does not meet their need for socialization and engagement with peers in any meaningful way.

For those living with brain injury, supports need to be put in place to ensure housing is secured and sustainable over the long-term. Supports should include:

  • Access to mental health and other health care supports
  • Addiction services specific to those with brain injury
  • Affordable childcare
  • Community engagement
  • Help with filling out forms – health cards, income taxes, available subsidies, etc.
  • Help with organization – paying bills, opening mail, budgeting, planning, etc.
  • Mediation and dispute resolution supports
  • Supports for victims of intimate partner violence
Housing first in action: At Home/Chez Soi project
The At Home/Chez Soi project was a $110 million government-funded project by the Mental Health Commission of Canada to explore housing-first approaches to assisting the homeless population in Canada. The project was four years long – 2 years of active participation with 2 years of follow-up – and covered the cities of Winnipeg, Toronto, Vancouver, Montreal, and Moncton. There were over 2,000 homeless participants with mental health challenges. Along with the focus on mental health, the different cities had their own smaller focuses [14]:

  • Vancouver, British Columbia – people also experiencing problematic substance use
  • Winnipeg, Manitoba – urban Indigenous population
  • Toronto, Ontario – ethno-racialized populations, including new immigrants who do not speak English
  • Montréal, Quebec – included a vocational study
  • Moncton, New Brunswick – services in smaller communities

This project provided housing to people experiencing homelessness along with various mental health service models to determine success rates and more. 66% of the participants had reported a brain injury, or an instance of trauma/unconsciousness that could have led to a brain injury. At Home/Chez Soi showed that Canada could make positive strides to ending homelessness by using a housing-first model. The following findings were shared in the final report.

Over the two years of the study, participants in Housing First spent an average of 73% of their time in stable housing compared with 32% in treatment as usual (TAU). In scientific terms, these differences are considered to be highly significant; that is, there are large differences between the groups. Specifically, since the study used a randomized design and all other characteristics that could result in stable housing were equivalent between groups except the intervention, the finding can be reasonably and confidently attributed to the provided housing [15].

  • Housing itself was motivating to participants, since it inspired people to behave in a way that would maintain their homes and allow them to reclaim their lives.
  • Housed participants from the HF group reported more choice over where they lived, including the choice to live in a place where they felt safe, and in some cases away from previous problematic social circles.
  • Housed participants in the HF group often expressed a feeling of stability and permanence [16].
  • Participants had lower uses of emergency shelters and emergency hospital services.
  • HF participants had improved eating and health habits because they had a place to store food (self-reported).
  • All participants reported less contact with the justice system.
  • Every $10 invested in Housing First leads to between $3.42 – $9.60 average reduction in costs of other services.
  • Quality of participants’ daily lives changed from being survival-oriented to being “more secure,” “peaceful,” and “less stuck,” which enabled them to move forward in their lives

Any solution for homelessness will require a collaborative approach of all levels of government, community organizations, private companies and, most importantly, the input of those living with brain injury.

The difference between social housing vs. affordable housing
Many people use the terms’ social housing and affordable housing as if they are the same – but they have different meanings. Social housing is housing that is subsidized by the government and made available to low-income households.

Affordable housing is defined by the Canadian Mortgage and Housing Corporation as, “including housing provided by the private, public, and non-profit sectors. It also includes all forms of housing: rental, ownership, and co-operative ownership, as well as temporary and permanent housing.”

Housing reports and resources

How to advocate for appropriate, affordable housing

Advocacy for appropriate, affordable housing happens at several levels. There needs to be more education of the public on the housing plight in Canada; outreach to the National Housing Strategy council advocating for appropriate housing for brain injury survivors; and large-scale advocacy from organizations to government departments.

Ways to advocate for appropriate, affordable housing include:

  • Writing to your local government representatives
  • Sharing research and information about housing with your network
  • Signing petitions for organizations
  • Contact your local brain injury associations to see if they are involved in any initiatives

Resources

See sources

Discrimination & brain injury

There is unfortunately both individual and systemic discrimination in Canada. While there is ongoing work to reform these systems, many individuals living with brain injury have experience with some form of discrimination.

Racism

Racism is the belief that racial differences produce a superiority over others. Racism can be both individual, because of a person’s beliefs and upbringing, as well as systemic/institutional which played a large part in social and political systems when they were established. Systemic racism feeds and shapes individual racism over time.

Black, Indigenous, and People of Colour (BIPOC) communities often have less access to services and resources for support after brain injury recovery due to systemic issues such as geographical location of services, poverty, accessible housing, and more. This impacts recovery, making it harder for people to return to work and live independently. This further contributes to systemic racism.

Disability

Individuals with a brain injury may be discriminated against based on disability. Institutions, systems and infrastructures were often designed without considering universal accessibility. This means that people with cognitive, behavioural, and/or physical disabilities may not have access to the same services and resources as the general public. This can make activities of daily living (ADLs) more difficult and can also discourage a person with a brain injury from going out in the community.

Stigma

A stigma is defined as a mark of disgrace or shame. When people use the word stigma today, they mean that large sections of society perceive something (like brain injury) as negative. Stigmas can be incredibly hurtful and untrue: they can also be difficult to combat because they are so entrenched in society. But it’s important to do what you can to eliminate stigma. There is no shame in brain injury, and no one should make you feel that way.

Ways to combat discrimination & stigma

Not only is it fundamentally wrong to discriminate against people, but studies have been done that show discrimination can be detrimental to mental health[1]. Discrimination at every level of society needs to be dismantled. There are steps you can take to help eliminate discrimination person-to-person and on a systemic level.

Share resources to educate family members and friends

Within family and friend groups, there are often different ideologies and lived experiences. In some cases, there are viewpoints/opinions that are discriminatory. It’s important to speak up and engage in dialogue with family and friends so they understand why what they say or do can be seen as discriminatory, how it affects you, and how to make improvements. These are difficult conversations to have but are necessary to make sure we are all moving towards the goal of equality.

Read anti-discrimination legislation

We all have rights under the Canadian constitution, and there is anti-discrimination legislation in place to protect those rights. It’s important to be aware of your rights so you can make sure they aren’t being violated.

Become an advocate for yourself and others

Discrimination of any sort against individuals with brain injury is wrong, and organizations such as Brain Injury Canada make advocacy for accessible supports and services a key part of their mission. You can advocate for yourself or others on issues of discrimination and for better supports and services.

Watch this presentation from 2022’s Brain Injury Canada Conference on implicit bias

More information & resources

See sources

Traumatic brain injury & the corrections system

Evidence shows that sustaining a traumatic brain injury (TBI) increases the risk of criminal justice system involvement, including incarceration. In addition to the physical changes experienced after brain injury many of the following common cognitive, emotional and behavioural symptoms/impairments can increase the chance of interaction with police and the justice system:

  • Anger management issues
  • Challenges with processing information
  • Engagement in high risk behaviours
  • Inability to initiate which can be perceived as defiance
  • Inappropriate emotional response
  • Lack of impulse control
  • Memory impairments
  • Perseveration
  • Poor judgment

Statistics on brain injury and incarceration

The incidences of incarceration were higher among study participants with prior traumatic brain injury compared with those without one. Men and women who had sustained a TBI were about 2.5 times more likely to be incarcerated than men and women who had not sustained a TBI.[1]

  • TBI is more prevalent among males as than females in incarcerated populations[2]
  • The majority of the incarcerated participants reported having a TBI prior to their first criminal offence[3]
  • The average age of first TBI was 19.6 years for men and 21.9 for women inmates
    • 55% of women reported TBI prior to first crime
    • 41% of men reported TBI prior to first crime[4]

How does brain injury fit in the current criminal code?

Traumatic brain injury does not fit appropriately in the criminal code. It currently falls under the definition of “mental disorder” which is defined as “a disease of the mind.” Individuals living with the effects of acquired brain injury may experience mental health issues, such as anxiety, depression and suicidal thoughts, but the brain injury itself is not a mental disorder.

The improper classification of brain injury as mental health disorder causes a cascading effect. Judges are unable to order the proper assessment[5], so are therefore not able to get an accurate picture of the impairments which may have contributed to the criminal behaviour. Without an accurate assessment, judges are unable to give sentencing that would focus on rehabilitative needs and upon release, the individual is likely to re-offend.

Indigenization of the Canadian correctional system

Indigenous peoples are the most over-represented ethnicity in Canada’s criminal justice system. A recent report from Canada’s prison ombudsman has warned, “the proportion of Indigenous people in federal custody has hit a record high of more than 30% due to disturbing and entrenched imbalances”. The situation is particularly dire for Indigenous women, who account for over 40% of the female prison population.[6]

Traumatic brain injury accounts for a substantial proportion of injuries in indigenous North American populations.[7] Unfortunately, while indigenous populations are much more likely to experience serious brain trauma, they are much less likely to receive appropriate rehabilitation, or have access to other post-discharge programs and services.

A proper definition of TBI in the criminal justice code will grant greater power to judges to fulfil the Gladue Principle in sentencing as it relates to their acquired brain injury. Gladue refers to a right that Aboriginal People have under section 718.2 (e) of the Criminal Code. Gladue asks judges to recognize the unique circumstances of Aboriginal offenders and focus on a traditional Aboriginal justice approach, which is more restorative in nature and may not include jail time. This restorative approach will help reduce the drastic over-representation of Indigenous people in Canadian jails.

Key recommendations

  1. Amend the Criminal code to include a proper and accurate definition of acquired brain injury.
  2. Ensure there is a place in the criminal code for assessments specific to ABI. This would allow judges to have the ability to order a report that would assist the court in determinations of disposition or judicial interim release.
  3. Brain injury and proper assessment, including the Gladue principle where applicable, added as a consideration in sentencing to ensure there is a focus on rehabilitative and restorative approach, rather than just punitive.

How to advocate for criminal justice system reform for brain injury

  • Write government representatives and members of the criminal justice system about the need for an updated definition in the criminal justice code.
  • Share information and statistics about TBI and the criminal justice system with your network
  • Support Canadian groups that are advocating for criminal justice reform

See sources

Intimate partner violence & advocacy

While awareness about the diagnosis and treatment of concussion/mild Traumatic Brain Injury (mTBI) has increased in the last decade, most of the focus has been around sports-related injury. Research projects are finding differences in how sex and gender influence recovery outcomes after concussion. One area of research that is growing is women with concussion and mTBI due to intimate partner violence.

  • 35-80% of women affected by IPV experience symptoms of traumatic brain injury[1]
  • 92% of IPV incidents involve hits to the head and face, and strangulation[2]
  • Survivors and care providers can also mistake brain injury symptoms for the emotional distress brought about by the abuse itself[3]

It is estimated that for every NHL player who suffers a concussion during the season, approximately 7,000 Canadian women suffer the same injury at the hands of their intimate partner each year…this equates to about 250,000 new cases every year. 

– Dr. Paul van Donkelaar, co-founder of the Supporting Survivors of Abuse and Brain Injury Through Research (SOAR) project and professor at the University of British Columbia,

The high prevalence of mTBI in victims of intimate partner violence and the challenge this poses in recovery can no longer be overlooked.

Need for more research & collaboration

Existing research is scarce, limiting the ability of health care providers to develop effective supports. The recent funding from the Government of Canada for the SOAR project out of University of British Columbia’s Okanagan is a huge step in the right direction, but we need to ensure there are tools being implemented to support victims today. Without proper supports, victims of IPV can easily fall through the cracks. Often the symptoms of TBI are overlooked. Individuals face challenges managing everyday tasks and then also have to deal with a range of physical, emotional, behavioral, or cognitive issues indicative of post-concussive symptoms. It’s difficult for victims of IPV to enter the recovery stage if they are subjected to repeated injuries.

Along with more research into the relationships between IPV and brain injury, we need more collaboration between researchers and frontline workers who interact directly with victims of IPV. They need more education in recognizing symptoms of brain injury and how to make referrals to specialists. IPV is an immensely complex situation; the more support and education there is for frontline workers and the general community, the more women will be helped.

Key recommendations

  • Raise awareness about IPV-related TBI
  • Educate front-line workers on IPV-related TBI
  • Early identification of IPV-related TBI with standardized, evidence-based screening tools

Implementation of tools and strategies for those living with IPV-related TBI

Ways to advocate for IPV and brain injury supports

Advocating for more education, research and support for victims of IPV and brain injury can happen in a variety of ways.

  • Share information about IPV and brain injury with your networks, indicating the need for supports and education
  • Support organizations and groups advocating for increases in IPV and  brain injury supports
  • Research the issue thoroughly
  • Write to government officials and representatives

Resources on IPV and brain injury

See sources