Cognitive impairment identified as key driver of chronic homelessness

Dr. Sumantra Monty Ghosh, an addiction medicine specialist at the University of Alberta, argues in a commentary published in the Canadian Medical Association Journal (CMAJ) that cognitive impairment is a critical, unaddressed driver of chronic homelessness.

Many individuals experiencing long-term homelessness face difficulties with memory, attention, planning, and comprehension. These impairments can stem from traumatic brain injuries, substance use, mental health conditions, fetal alcohol spectrum disorder, or adverse childhood experiences. Such cognitive challenges can create a cycle where individuals struggle to manage bills, attend appointments, follow housing rules, or maintain stable households, even after housing is secured.

Dr. Ghosh suggests that conventional interventions, such as the ‘Housing First’ model, may be insufficient for those with severe dysfunction. He proposes a more structured approach similar to the care provided to individuals living with dementia, including brain rehabilitation, safety monitoring, and increased levels of supervision. Additionally, he recommends routine cognitive screening to allow health and housing workers to provide more tailored, hands-on assistance.