This guidance for staff in homelessness explains how to support people who have, or are suspected to have, experienced brain injury. It includes definition and causes of brain injury, and why people experiencing homelessness might be at risk. There is also information on support and access to specialist services.
Brain injury and homelessness
In 2012, a good friend of mine had a cycling accident. I had been working with adults who were homeless for 15 years by this time. I entered the sector at a time of growth and was fortunate to access a wide range of training and different roles. In 2012, I was managing three services in a day centre and considered myself skilled and experienced in the field. All the same, sometimes I would find we were foxed by the behaviour of some clients. There was something we couldn’t put our finger on; substance use might be present, mental health issues a concern, but it didn’t seem to explain what might be at the root of the issue.
My friend’s cycling accident resulted in a brain injury, which changed his life completely and forever. The effects could be seen in his memory, thinking and communication. In work, I began to see similar patterns of behaviour with some clients using our services. I got onto Google.
The Canadian Medical Association Journal, published research in 2008 that 70% of people experiencing homelessness had suffered their first traumatic brain injury before they became homeless. The Disabilities Trust Foundation found in Leeds in 2010 that 48% of people who were homeless had experienced a head injury. In 2013, researchers at St. Michael’s Hospital in Toronto published data showing that men who were homeless and heavy drinkers were 400 times more likely to receive head injuries than the general population.
I was stunned. In all my time of working in homelessness, brain injury had never been raised as a risk, a need, or a training issue. I was so concerned by this gap that I arranged free training with the help of Disabilities Trust Foundation, and Headway from Kent. Both were over-subscribed and staff attended from homelessness organisations, the NHS, and local authorities. They, like me, had been concerned that some clients were not receiving the help they needed because services were unclear what the underlying issues were. They described clients with memory problems, an inability to provide realistic timelines, rigid behaviour patterns, problems with communication and physical impairments. All of which affected their ability to obtain and sustain not only accommodation, but also relationships, health services, and finances. They either stayed on the street for a long time, or were stuck in the ‘revolving door’ of hostels and rough sleeping.
As I learnt more, I became alert to risk factors for brain injury. For example, if a client reported domestic violence did the perpetrator attempt strangulation (which cuts oxygen supply to the brain leading to damage)? Is there a history of assault, falls, or heavy drinking?
All may lead to brain damage and further incidents. I became more confident in raising the possibility of brain injury with clients. Sometimes it was like a weight had been lifted when a client realised that there was the possibility of a clear physical factor for their difficulties. Other times the idea was so unexpected that clients dismissed it. All the same if I employed some basic techniques common in working with people with brain injury (clear communication, breaking tasks into small steps, providing reminders of important appointments), I could still help the individual address their homelessness in some way.
This stuff worked. Some clients affected by brain injury, were accommodated and supported quicker. Staff felt empowered by the additional knowledge, and sometimes it helped us exclude brain injury as an underlying factor so we could focus on other approaches. Having an awareness of brain injury also helped me to appreciate the pressures on our NHS and local authority partners. In addition to how important it is to understand the different perspectives and demands to cope with challenges.
Homeless Link’s Brain Injury and Homelessness guidance has been written to support staff and clients, by increasing awareness of key issues and providing practical steps that can make a positive difference. I hope you find it useful and if the subject is of interest to you there is plenty of further reading contained in the guidance. I’d love to hear your feedback, feel free to contact me via Twitter @LeighSLT2B.
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Founder of Change Communication
Leigh Andrews has worked in the homelessness field for over 20 years and has a particular interest in how communication affects health. Leigh is studying Speech and Language Therapy at City, University of London, sits on the Acquired Brain Injury Forum for London, and is the founder of Change Communication.
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