Dr Jess Barton, Lead of the Westminster Homeless Neuropsychology Pathway, has released a podcast episode on brain injury and homelessness on her channel ‘Wired for Hope’. In this blog she shares key takeaways from the podcast, outlining the links between brain injury and homelessness and the challenges this creates and offering tips for homelessness staff who support people with a brain injury.
Brain Injury and Homelessness
Research shows that more than 50% of people experiencing homelessness have an acquired brain injury, related to assault, alcohol related brain damage, road traffic accidents, falls, and strokes. This means that they will have some sort of organic change to the brain – change that can affect emotions, behaviour, and social relationships. We also know that most people sustained their first brain injury before becoming homeless and there is a higher incidence of brain injury in men from lower socio-economic backgrounds.
Furthermore, evidence shows that people become more vulnerable to sustaining a subsequent brain injury once they become homeless – for example, they are 17x more likely than the general population to be a victim of physical assault. We also know that people with a brain injury are four times as likely to suffer from anxiety and depression for several reasons: the world becomes harder to understand and navigate when you have a disability, emotional reactivity can be affected by changes to the brain, and work and social relationships can become strained.
Barriers to Accessing Help
Many people experiencing homelessness and brain injury find it difficult to access mainstream mental health and neuropsychological rehabilitation services in the UK. The reasons for this are:
i) Most services exclude patients based on drug and alcohol dependence
ii) Strict did not attend (DNA) policy in the NHS means that many clients who struggle with building trust are not given the flexibility to slowly create relationships with professionals
iii) Most neuropsych services only work with people who sustained their brain injury within the last 18 months. However, many of our clients will have sustained their injury several years ago but never received treatment.
Spotting a Neuro Need
The impact of brain injury varies quite considerably between people based on the severity and location of the injury, their health prior to the brain injury, and their coping mechanisms. Some things you might see after a brain injury include: difficulties regulating emotions and managing impulsive behaviour; difficulties with remembering new information, such as appointment details or what you spoke about in your key working session; slower speed of information processing; fatigue and irritability; difficulties with getting organised and following through on intentions.
Top Tips for homelessness support workers
i) Prepare well for your sessions: pick one or two topics, rather than trying to cover lots of issues; set an agenda at the top of your keyworking session to structure your thinking;
ii) End your sessions well: you (or your client) can summarise the main points of your discussion; consider writing them down so your client can stick these notes up on their wall
iii) Consider slowing your speech down and presenting information one at a time – avoiding stacking your questions
iv) Walk through complicated information slowly and together (e.g. PIP, UC); help someone to follow the steps one-at-a-time
v) Consider the sensory needs of your client: does the person you are working with prefer highly stimulating environments (e.g walking sessions, sessions in a coffee shop?) or quieter environments (e.g. quiet room, turning the TV/Radio off?)
vi) Use calendars (electronic or paper) to keep track of appointments; help your client enter these details into their calendar to get them into the habit of using this system
vii) Gently check out your client’s understanding: sometimes people will nod and say they understand but they have interpreted your meaning differently;
viii) Consider using pictures and easy read information for clients who struggle with reading, writing, and remembering verbal information
Training and Bitesize Information
If you or your staff team wishes to learn more about brain injury, check out the free podcast ‘Wired for Hope’ on Spotify, Youtube, and Apple.
You can also complete CPD accredited online-training on brain injury and homelessness via the Aneemo website: CPD‑accredited Digital Learning for Health & Social Care | aneemo