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