HMN 2026: How Brain injuries often come before homelessness

More than half of those who are homeless have suffered a brain injury at some point in their lives, whether it be a traumatic brain injury (TBI) such as a blow to the head or concussion, a stroke, a brain tumor or an alcohol-related injury. And that injury most likely occurred before the person became homeless, not as a result of living on the street.

To better understand the connection between brain injury and homelessness, Quebec’s Ministry of Health and Social Services and the Fonds de recherche du Québec issued a call for research proposals in 2023.

Two professors at Université de Montréal’s School of Rehabilitation—Laurence Roy and Carolina Bottari—answered the call. They’ve launched a long-term research program to trace people’s trajectory from brain injury to homelessness and then identify effective intervention strategies.

Exploring personal narratives

Rather than examining broad trends and external factors, Roy, Bottari and rehabilitation sciences doctoral student William Jubinville turned to personal narratives to explore the issue through the lived experiences of those directly affected. Their research is published in the journal Brain Injury.

“To our knowledge, this is the first time anyone has documented the life journeys of people with brain injuries who are experiencing homelessness,” said Jubinville.

While a brain injury does not inevitably lead to homelessness, it does create a profound vulnerability that can alter the course of a person’s life.

“A TBI impacts many aspects of cognition, including memory, attention, problem-solving and money management, as well as emotions and behavior,” Bottari explained. “Since a person lives with TBI for a long time, it becomes a heavy burden for their family and support network.”

The research team conducted in-depth interviews with 26 people living with a brain injury who were homeless, or had previously experienced homelessness. “The perspectives of those affected are at the heart of this project,” said Roy.

Their stories provide an accurate and nuanced picture of the complex paths leading to homelessness. For some, the brain injury was one factor among many; for others, it was the turning point.

“One of our participants had a relatively stable life until her brain injury turned everything upside down,” recalled Jubinville. “But in other cases, the effects were more subtle.”

Missed opportunities to intervene

To understand the current landscape of care, the team also conducted a literature review of studies evaluating strategies to address the combined challenges of brain injury and homelessness. The review is published in the Annals of Physical and Rehabilitation Medicine.

“One of the things that stood out is that there are so many moments in these individuals’ life trajectories when the brain injuries could have been detected—for example, by youth protection services or the correctional system,” said Roy.

Furthermore, when people do receive support, it is not always effective. “Since traditional interventions do not work in this situation, these individuals never receive the help they need,” she said.

This was confirmed by an earlier study published in Disability and Rehabilitation in December, which collected input from Quebec health care and community professionals. It identified significant gaps in care, including a disconnect between existing health care services and the realities of homelessness, and a reliance on community groups that lack TBI expertise.

According to Roy, these findings “reveal the complexity of the clinical and social situations that these individuals face due to institutional structures that operate in silos and deliver treatment limited to isolated ‘episodes of care.'”

Coordinated care is essential

Roy described a “perfect storm” fueled by shorter rehabilitation stays, an aging population—which brings an increase in non-traumatic brain injuries such as strokes—and crumbling support networks. “The needs are growing,” she warned.

According to Bottari, the high prevalence of brain injuries sustained before any experience of homelessness points to the need for longer follow-up by rehabilitation services.

Occupational therapists have “all the expertise needed to work with these people—to teach them how to manage their lives and relearn how to perform everyday tasks,” she argued.

Unfortunately, the effects of brain injuries are often mistakenly attributed to mental-health issues or substance abuse. Consequently, proper diagnosis and support at the right time are key: “This would truly change the course of peoples’ lives,” said Jubinville.

The good news is that the researchers have received funding to continue their detailed investigation into brain injuries and homelessness.

Drawing on insights from both community stakeholders and individuals with lived experience, they plan to design, implement and evaluate cross-sectoral interventions involving the community, health and rehabilitation sectors.

Ultimately, the goal is to prevent homelessness. “The fact that these brain injuries occurred before these individuals became homeless means we missed a critical window to intervene and prevent it,” Roy concluded.

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