Homeless & Insecurely Housed

As one can imagine, it is difficult to survey the homeless population, as they rarely remain in one place for long. The rate of people experiencing homelessness who screen positive for TBI has been reported to be anywhere between 8% and 53%. One systematic review and meta-analysis found that the lifetime prevalence of moderate or severe TBI was 22.5%.

Of homeless TBI survivors, 70-90% experienced their first brain injury prior to becoming homeless. Cognitive and behavioral deficits lead to an increased risk for economic and housing instability. Brain Injury is associated with unemployment, with only about 40% of traumatic and non-traumatic acquired brain injury survivors able to return to work within the first 2 years.

People experiencing homelessness are more vulnerable to common causes of TBI. High rates of substance misuse can lead to overdose or accidents, such as falling. They may be the victims of violence, and they may be arrested and incarcerated. About 11% of the adult homeless population are veterans, and homelessness disproportionately affects African American and Hispanic veterans.

Insecure housing also contributes to Intimate Partner Violence and Child Abuse. When a person in an abusive household has no means to secure a safe home away from their abuser, they may see no other choice but to stay and endure continued abuse. Housing insecurity can also contribute to a person falling victim to trafficking.

Justice-Involved & Incarcerated Individuals

Researchers estimate that jail and prison inmates may be up to ten times more likely to be living with a brain injury than the general population. Nearly a third of TBI survivors report some involvement with the criminal justice system within five years of their injury. This may be partly due to the symptoms of TBI causing impulsivity, disinhibition, and aggression. Brain Injury survivors are also more likely to engage in substance misuse, which could lead them to be the 1 out of every 5 incarcerated people who are locked up on nonviolent drug charges. Women only make up about 8% of the incarcerated population, but one study found that 65% of female prisoners show signs of brain injury, and that two thirds of those said the injury was a result of interpersonal violence.

Brain injury or not, inmates are at risk for injury while incarcerated. Accidental injury is reported more often (22% state, 23% federal) than injuries arising from a fight (16% state, 8% federal). After release, previously incarcerated people may fall into other vulnerable populations. They are nearly ten times more likely to become homeless than people who have never been incarcerated. Women are more likely than men to end up homeless, with women of color being the most at risk to experience homelessness after incarceration. If a person struggles with substance misuse prior to incarceration, it is likely they will return to use after release, especially without the necessary support to reintegrate successfully into society. A return to drug use can lead to more problems, including being sent back to jail or prison.

Military Service Members & Veterans

From 2000 through 2011, 4.2% of those who served in all components of the Army, Air Force, Navy, and Marine Corps were diagnosed with a TBI. About 76.7% of these were classified as mild TBIs, while less than 3% were severe or penetrating. However, “mild” does not always mean that a person’s symptoms will be mild.

Service members encounter many dangerous situations that can result in brain injury. An obvious cause is gunshot wounds, but others include motor vehicle crashes, assault, falls, and blast exposure. This can happen at war overseas, but also at home during training. Service members and veterans may also acquire PTSD, a condition which can actually change the brain and cause symptoms similar to TBI.

Brain injury may contribute to the fact that roughly 10% of the homeless population are veterans. It may also be a factor for the 1 in every 15 veterans who struggle with a Substance Use Disorder each year. Brain Injury may also contribute to the approximately 25% of veterans who receive a mental health diagnosis. Unfortunately, less than 50% of those receive the treatment they need, and about 22 veterans per day die by suicide. Falling into these additional categories of vulnerability can lead to subsequent brain injuries for our veterans.

Serious Mental Illness

People who suffer from serious mental illness may have some of the same difficulties we often see in survivors of frontal-lobe brain injury, including impaired judgement, impulsivity, trouble problem solving, depression, distractibility, behavioral changes, and balance issues. These kinds of deficits can lead to risky behavior or accidents. They may also lead to a person falling into another vulnerable population, such as becoming homeless or justice involved, struggling with substance misuse, or getting stuck in an abusive relationship.

Mental illness and brain injury can co-occur, but whether both are recognized and treated properly is not always straightforward. Undiagnosed brain injury can be misdiagnosed as mental illness, leading to improper treatment and poor outcomes. However, brain injury can sometimes lead to mental health issues, or exacerbate pre-existing mental health issues.

Approximately 1 in 5 people may experience mental health symptoms up to 6 months after a mild TBI. In one study, 48% of respondents reported developing a major mental health disorder after their TBI, and 23% had at least one personality disorder.

Substance Misuse

Problematic use of drugs or alcohol can either cause brain injury or result from it. Substance use can affect a person’s balance, coordination, and reaction time which can lead to falls, vehicle accidents, and other dangers. At least 20% of adolescents and adults hospitalized for TBI, and 30% of those requiring rehabilitation, are intoxicated at the time of injury. One study found 43% of patients with TBI reported problem drinking prior to injury, while 29% reported illicit drug use. Another study found that 21.9% of drivers injured in non-fatal traffic accidents screened positive for substances, usually alcohol.

Many illicit drugs are linked to increased risk of stroke, including cocaine, amphetamines, Ecstasy, and opioids. An additional danger for those who use opioid drugs, such as heroin or oxycodone, is that overdosing on these drugs reduces or stops oxygen flow to the brain. If the brain is deprived of oxygen for even a few minutes, it can result in hypoxic or anoxic brain injury and have lasting consequences.

People who misuse substances are also likely to cross over into other vulnerable populations, or even contribute to them. One out of every five incarcerated people are there for a nonviolent drug offense. Substance misuse is a factor in 40% – 60% of reported domestic violence incidents. In 2017, 36% of children entering foster care had parental drug abuse listed as a reason for their removal. Substance misuse can also contribute to homelessness. One study found that 34.7% of all sheltered adults who were homeless had chronic substance use issues.

Please visit our Brain Injury and Substance Misuse page for more info.