Brain injuries, not addiction alone, may be root of Edmonton homelessness crisis: researcher

Homelessness in Canada is, in large part, a hidden brain-injury crisis, according to research by an Edmonton addiction specialist who is calling for routine cognitive screening and new housing models built around intensive, medically-supported care.

Dr. Monty Ghosh, an associate professor at the University of Calgary and University of Alberta, argues in September's Canadian Medical Association Journal that treating homelessness as primarily an addiction or mental illness issue oversimplifies the problem. Half the people experiencing chronic homelessness have suffered a traumatic brain injury, he says, and many more show significant cognitive impairment from causes ranging from fetal alcohol spectrum disorder to childhood trauma to repeated overdoses.

Ghosh is calling for governments to build "intensive housing"—long-term, medically supported residential care similar to nursing homes for homeless individuals whose cognitive impairment leaves them unable to manage independent life. Beyond that, he argues, there needs to be continued expansion of supportive housing, improvement of the Canada Housing Benefit plan, and creation of interprovincial standards for managing housing and homelessness.

The researcher has spent time with unhoused individuals near an addiction treatment centre in Edmonton, observing the complex interplay of brain injury, substance use, and survival strategies on the street. Some people rely on methamphetamines to stay awake at night to protect their belongings or prevent sexual assault, he notes. Others with meth-induced psychosis—a known side effect of the drug—display the aimless, repetitive movements and outbursts that mark both addiction and untreated brain injury.

Society applies a troubling double standard, Ghosh argues: housed Canadians with dementia or brain injuries are kept safe in supported care, while homeless populations with comparably severe impairments are routinely left to fend for themselves on the street, fueling a cycle of illness and public safety incidents. The cognitive damage compounds vulnerability and subjects people to scorn rather than attracting the care they need.