More than half of the people who are homeless in Toronto are suffering from a traumatic brain injury, according to a new study that suggests early diagnosis and treatment may help stem the number of homeless people in major cities.

In Tuesday's issue of the Canadian Medical Association Journal, Dr. Stephen Hwang, of the Centre for Research on Inner City Health at Toronto's St. Michael's Hospital, and his colleagues reported the results of their survey of 601 men and 303 women at homeless shelter and meal programs in 2004 and 2005 — the largest study of its kind in Canada.

'I see halos around light. I can't make out people's faces, It's hell. It's living hell.'— David Westendorn

The lifetime prevalence of traumatic brain injury that leaves someone dazed, confused, disoriented or unconscious was 53 per cent, the researchers reported, compared to the 8.5 per cent lifetime prevalence rate among the general population in the U.S.

The injury most commonly results from falls, motor vehicle crashes and assaults.

What's more significant, 70 per cent of the people had the injury before they ended up on the street, said Hwang.

"That really raises the intriguing possibility that perhaps the brain injury in and of itself is a risk factor for becoming homeless," said Hwang.

Brain injuries, especially those involving the frontal lobe behind the forehead, often go undetected for years. The injuries can lead to cognitive problems and unpredictable or impulsive behaviour — traits often found among street people.

"One moment they might be acting normally and in another moment they might be screaming in an uncontrollable rage," Hwang said. "So you can imagine that these kinds of behaviours might put someone at risk for losing their housing, and certainly once a person becomes homeless, might increase the risk that they stay homeless for a long time."

Many turn to alcohol and drugs as a form of self-medication, Hwang said. Being on the street exposes people to more injuries through falls and fights.

Treat injury to prevent homelessness

"We need to screen people, particularly in high risk populations," said study co-author Angela Colantonio, a specialist in head injuries who teaches rehabilitation medicine at the University of Toronto.

If schools, hospitals and prisons screened people for brain injuries then those who are injured could be identified, treated and given supportive living arrangements to prevent them from ending up on the street, Colantonio said, adding those who are injured need long-term care after the injury.

At Seaton House, a homeless shelter in Toronto, David Westendorn, 25, said he knows his prognosis is not good after suffering a brain injury in a serious car collision two years ago.

"My vision is horrible," said Westendorn, who said that he worked hard as a mechanic repairing trucks before the injury. "I see halos around light. I can't make out people's faces. It's hell. It's living hell."

Westendorn said he now wakes up to seizures, feeling sick until he has his first drink. "And all that does is buy me about an hour before it happens again. I need a miracle."

Treating brain injuries is neither quick nor easy, and there is no pill or technology available. Along with long-term rehabilitation, the researchers suggested referral to community services and treatment of alcohol and substance abuse.