daphne bramham: startling research on brain injury reveals the tragic plight of canada's homeless
opinion: people with brain injuries are two-and-a-half times more likely to be incarcerated. so what is canada doing about it? not enough.
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finally, a report that pulls together evidence that helps explain some of the tragedies and rising chaos on urban streets across canada. more than half of the unhoused have traumatic brain injuries. that’s some of the startling research that’s been compiled by the canadian traumatic brain injury research consortium for brain injury canada.
of those unhoused, 70 per cent had moderate to severe injuries. that’s 14 times the rate in the general population. close to a quarter of the homeless people with brain injuries also have substance-use disorder.
and while most people sustained brain injuries before losing their homes, they are also more likely to sustain additional brain injuries from falls and assaults.
traumatic brain injuries can be a single severe concussion, multiple concussions or concussions occurring in rapid succession.
even mild cases of traumatic brain injuries can cause debilitating headaches, dizziness and confusion. moderate to severe injuries can cause cognitive, mood and behavioural changes and decreased mobility. the most severely injured require assistance with daily life’s basics, such as eating, bathing and going to the toilet.
it makes it difficult to work, which is why unemployment rates among the injured have risen to 75 per cent post-injury from 13 per cent.
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people with traumatic brain injuries are 2½ times more likely to attempt suicide and more likely to have psychosis. they’re also 2½ times more likely to be incarcerated.
widely regarded as a single, devastating event, the consortium along with brain injury canada want health canada to classify moderate to severe traumatic brain injuries as a chronic condition that results in long-term cognitive and neurological decline that requires more than only the initial hospitalization.
“many of these effects may be invisible, which leads to a host of daily challenges for the individual — the least of which are stigma, isolation, and a reduced quality of life,” they say in a report released last week.
reclassifying it would trigger provinces to provide more supports and long-term treatment for the more than 165,000 canadians injured each year in falls, sports-related “hits,” vehicle accidents and assaults.
tent city at crab park in vancouver.
nick procaylo
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as with almost every health-related issue in canada, the indigenous are disproportionately injured. the high incidence is attributed to poverty, inadequate housing, limited access to health care and intergenerational trauma.
evidence also indicates that 60 per cent of women who survive intimate partner violence have traumatic brain injuries.
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but the data on children is particularly chilling. along with seniors, they are most at risk of injury. falls account for half the injuries. but for kids aged five to 19 who are hospitalized, 45 per cent of the brain injuries are sports related.
the short-term effects are that these school-aged children are significantly more likely to report psychological distress and attempt suicide. long term? they’re potentially the next generation of homeless, drug addicted and incarcerated.
it’s why this report needs to be read in concert with the canadian paediatric association’s position paper from earlier this year — an update from a decade earlier — that reiterated urgent calls for prevention, better education, diagnosis and treatment but added a recommendation to end bodychecking in all recreational hockey leagues and for all players under 15.
both the pediatricians’ report and one by the american academy of neurology note that sports-related concussions continue to rise along with repetitive head injuries, which are more difficult to diagnose because they often have fewer symptoms or none at all.
in the u.s., there are an estimated 3.8 million sports-related concussions each year. half go unreported.
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in canada, more people annually suffer a traumatic brain injury than are diagnosed with breast cancer, multiple sclerosis, spinal cord injury, and hiv/aids combined. and that doesn’t account for the others who fall under the broader category of acquired brain injury. those injuries result from asphyxiation from an opioid overdose, strokes, tumours and other neurodegenerative diseases.
although canadian data on opioid-related anoxic brain injuries is scant, health canada says its best information is that five per cent of people hospitalized after an opioid overdose have anoxic brain injuries.
the numbers are large enough that b.c. recently added $6.7 million to its health budget to deal with these injuries — $1.2 million to expand a pilot project in vancouver and $4.5 million over three years for the brain injury alliance.
so what’s the cost of all these injuries? the consortium concludes that it’s impossible to know because canada has no systematic data collection that goes beyond the costs of initial hospital stays, neurosurgery, prolonged coma periods and extensive therapy.
the human cost is easier to describe, if not always quantify. without help, the lives of people with moderate to severe traumatic brain injuries can be miserable. even if they have family members willing and able to provide the help they need, it places a terrible burden on them.
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untreated and unsupported, too many end up in survival mode on the streets, making this one of those root-cause, societal problems that continues to go unaddressed.
yet as important as it is to help this generation that’s suffering, there’s another societal issue that needs urgent attention — instituting the recommended preventive measures to protect the next generation from harm.
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