More than half of the people who are homeless in Toronto are
suffering from a traumatic brain injury, according to a new study
that suggests early diagnosis and treatment may help stem the number
of homeless people in major cities.

In Tuesday's issue of the Canadian Medical Association Journal, Dr.
Stephen Hwang, of the Centre for Research on Inner City Health at
Toronto's St. Michael's Hospital, and his colleagues reported the
results of their survey of 601 men and 303 women at homeless shelter
and meal programs in 2004 and 2005 — the largest study of its kind in
Canada.
The lifetime prevalence of traumatic brain injury that leaves someone
dazed, confused, disoriented or unconscious was 53 per cent, the
researchers reported, compared to the 8.5 per cent lifetime
prevalence rate among the general population in the U.S.

The injury most commonly results from falls, motor vehicle crashes
and assaults.

What's more significant, 70 per cent of the people had the injury
before they ended up on the street, said Hwang.

"That really raises the intriguing possibility that perhaps the brain
injury in and of itself is a risk factor for becoming homeless," said
Hwang.

Brain injuries, especially those involving the frontal lobe behind
the forehead, often go undetected for years. The injuries can lead to
cognitive problems and unpredictable or impulsive behaviour — traits
often found among street people.

"One moment they might be acting normally and in another moment they
might be screaming in an uncontrollable rage," Hwang said. "So you
can imagine that these kinds of behaviours might put someone at risk
for losing their housing, and certainly once a person becomes
homeless, might increase the risk that they stay homeless for a long
time."

Many turn to alcohol and drugs as a form of self-medication, Hwang
said. Being on the street exposes people to more injuries through
falls and fights.