Traumatic brain injury in the homeless population: Incidence and impact

Traumatic brain injury (TBI),common in the general population,is particularly common within the homeless population. Homeless persons are at risk of brain injury due to exposure to violence, the high incidence of trauma and accidents, and the prevalence of substance abuse within this population. Neuro-psychiatric and behavioral deterioration following TBI may lead to homelessness. Alcoholism decreases the brain's ability to heal and increases the risk of neuro-psychiatric and physical sequelae of brain injury. People with multiple diagnosis including mental illness, substance abuse and TBI often find it difficult to access appropriate services. These individuals may have trouble negotiating complex systems due to cognitive or behavioral problems. Even with help, barriers exist. The multiply diagnosed are often unable to get assistance because of their co-morbid diagnosis. When a multiply diagnosed patient is homeless these barriers are magnified.In my presentation I plan to elucidate the potential sequelae of TBI and discuss how the neuro-psychiatric and behavioral difficulties can handicap patients ability to care for themselves or access assistance. I hope to show potential approaches that can lead to success in this complicated group. Example experiences will be drawn from my urban homeless primary care practice with Boston Healthcare for the Homeless Program. New data regarding the prevalence of TBI in patients seeking care with Boston Healthcare for the Homless Program will be presented.