Your brain controls everything you think, feel, say and do. Reading this blog and perhaps enjoying a coffee? Your brain is seeing, recognising and remembering what the letters mean. It is coordinating your movement of the coffee cup, it perceives the temperature of the drink and automatically seals your airway when you swallow so that you don’t choke. And then there’s your breathing, heart rate and mood.
Now, imagine it’s damaged. Perhaps a blow to the head by way of an accident, oxygen cut off due to cardiac arrest or blood supply interrupted by stroke. You may no longer perceive the world the way others do. You may have paralysis or lack coordination. Your communication abilities might be different now. Emotions and behaviour may change too making you vulnerable to abuse.
Now imagine you are sleeping on the streets. How would you manage?
My name is Leigh Andrews and I have been working with Westminster City Council, St Mungo’s, Great Chapel St GP Surgery and Headway East London to identify people who have been sleeping rough who may have experienced brain injury. We call it the Homelessness and Brain Injury Project (HABIP) and it is funded by the Greater London Authority.
The average age of death of someone who is homeless is 47 for men and 43 for women. Research shows that a person sleeping on the streets is likely to have experienced ‘systematic disadvantage’ from childhood. This is exacerbated by brain injury; an individual who is homeless with brain injury is twice as likely to die within the same period as a person who is homeless without brain injury.
The HABIP sees the human face to these facts and figures. Rough sleeping is harmful and dangerous. The most common reasons for A&E attendance for this group are assaults, accidents and alcohol – all of which can result in brain injury. We see people who experienced serious head trauma over a decade ago while living independent lives and then over years lost employment, accommodation, health and relationships to find themselves rough sleeping alone with nothing.
We encourage healthcare staff to access the free Homelessness and Brain Injury Good Practice Guide produced by Homeless Link to better understand what steps to take to help people who are homeless where brain injury may be a factor. We are identifying changes to practice within homelessness services that will help ensure brain injury is considered from assessment to support planning e.g. using a validated screening tool for brain injury developed by the DT Group.
There are two other major areas that need coordinated action:
- The ability to make informed decisions, called ‘mental capacity’, may be affected by brain injury because memory, communication, and understanding are controlled and managed by the brain. This is not always fully understood by organisations coming into contact with people who are homeless. Two useful resources that can be used by healthcare staff and others when considering capacity where brain injury may be a factor are:
The identification, treatment and management of brain injury by the NHS is critical, but accessing services is not easy for people who are rough sleeping.
The HABIP is making links with NHS neuro-rehabilitation and substance use services along with a wide range of homelessness organisation to raise awareness of these issues and see how we can work together to best help those affected by brain injury who are also homeless.
To find out more:
- Check www.headway.org.uk
- Contact www.streetlink.org.uk to get help for someone rough sleeping
- Work for the NHS or local authority? Find homelessness services here https://www.homeless.org.uk/search-homelessness-services to discuss how you can help each other.
- The London Homeless Health Programme’s Resource Pack https://www.healthylondon.org/resource/homelessness-health-resource-pack/
- Start planning for Brain Injury Awareness Week 14 – 18 May 2018.
- Find out how to look after your brain here: https://www.thedtgroup.org/media/2505/100415_sybsl_a5_10pp_flyer_final.pdf
About the author
Leigh Andrews, founder of Change Communication, has worked with vulnerable adults experiencing homelessness for 20 years. She developed an interest in the links between brain injury and homelessness in 2012 and is a key delivery partner of the Homelessness and Brain Injury Project funded by the Greater London Authority. Leigh is studying Speech and Language Therapy at City University where her clinical placements have included acute neuroscience and education settings. Leigh has personal experience of the impact of brain injury on those close to the survivor and promotes a holistic approach to working with all affected.