“It was a terrible place…my life was turning upside down” – brain injury and homelessness in focus

How researcher is using personal experience to inspire mission to break the cycle between brain injury and homelessness

It is now undisputed that homelessness and head injury are interlinked; with overwhelming evidence suggesting a significantly higher prevalence of traumatic brain injury (TBI) in the homeless population than elsewhere.

In fact some studies in the UK and North America in recent decades have found levels of past TBI experiences among homeless people to range between as high as 45 and 55 per cent. Research also suggests the vast majority of TBIs happened before homelessness occurred (90 per cent in one study in Leeds in 2012).

Meanwhile, homelessness is on the rise, heightening the need for a greater understanding of TBI on the streets. The charity Shelter reported that there were 309,000 homeless people in England by the end of 2023, a 14 per cent increase on the previous year.

The lingering cost of living crisis is likely to see a further rise when the next figures are published. Steph Grant has seen at close hand how easily a TBI can lead to a downward spiral through social isolation and unemployment to homelessness.

During the aftermath of his own TBI in 1985, including the loss of his first wife and the challenges of caring for their child, Grant became acutely aware of how brain injury can lead to life on the streets, and saw how severely the homeless could be impacted by the condition.

Grant is now a champion for the homeless TBI community, and chairs the Sheffield-based Brain Injury Social Work Group (BISWG) – an association of head injury survivors, families, researchers, clinicians, commissioners and front-line staff.

BISWG is collaborating with various organisations to address unmet needs and improve services for TBI survivors, particularly those experiencing multiple disadvantages. Grant sustained his TBI in a head-on collision in which both drivers were killed instantly, leading to a turbulent experience following the injury.

“Ensuing from that, for quite a long time after, around 10 years or more, life was turning upside down,” he says.

“I didn’t know what was what. My first wife died, and we had a little boy. In order to keep my boy, I had to move up to Scotland to stay with my parents. My folks up in Scotland could help me look after my little boy. But I wasn’t very well at all, and back in those days there was very little known about the effect of TBIs.

“So I ended up experiencing great travesty, I suppose, and getting disenfranchised from benefit services because I couldn’t remember anything, and I really struggled at university.

“Somehow, I eventually moved back down to Doncaster, after I finally graduated from Stirling University, however, nobody wanted to give me a job, and most people didn’t want to know me, because I was different to what I was before – unpredictable, and speaking aggressively.

“There were lots of other symptoms, like my eyes would go out of focus and I would lose my balance and start foaming at the mouth. I’d forget people and I was having difficulty talking.

“Sometimes, the way I reacted to things was appalling. I guess I became aggressive, and I started trying to survive until eventually a place was found for me in a Sheffield rehabilitation service.

“This was way back in 1992, and Sheffield had phenomenal services at the time with a brain injury team. I got access to social workers. There used to be a lot more of them in those days.

“My social worker came to me one day while I was doing drugs and drinking alcohol, and she refused to go until I went away with her.

“She took me to stay in an assessment centre, and I didn’t look back, because that gave me access to rehabilitation with several community health teams.

“Before the brain injury social worker came to my house I was in a terrible place. People used to come to our house – there were prostitutes, there were drug dealers, there were robbers, all sorts of people, and lots of homeless people, drug addicts, and alcoholics. Many of them stayed in our house, and it was pretty dangerous.

“After I’d done my rehab, I started to look back on my life and ask ‘why?’ Why are there so many people like me? I used to think at the time that it was like birds of a feather flocking together, but I’ve since learned through my research that actually, a lot of us had sustained a head injury, and that we had the same experience of being excluded from benefit services, unable to get a job because of cognitive problems, and none of us understood.

“People just thought we were either mad or bad and kept away. So looking back on my life, I thought that I had to do something, because there are not enough services.

“I realised as I moved around the country that not everywhere is provided for in terms of services.

“I didn’t want to just be somebody who has an invisible disability. I wanted to do something, so I started trying to go to university to get a master’s degree.”

Following completion of his master’s, Grant started attending disability awareness groups and began to deliver brain Injury awareness training to housing staff, social workers, probation workers, and other support workers.

His experience led to his role as chair of BISWG, where he has been carrying out research on the prevalence of TBI in the homeless and prison communities. In particular, Grant wanted to find out why so many people with brain injuries were becoming homeless.

“I’m so passionate about this, and I believe that the team’s intuitive knowledge we have from our experience, and especially our collective experience, is a great thing to be able to encourage other professionals under specific disciplines to get away from silo working, and to really work together.”

Grant led research looking at experiences of homelessness and brain injury in collaboration with the Head Injury and Homelessness Research Group that explored the perspective of people with lived experience of TBI.

Participants for the research were recruited from Ben’s Centre for Vulnerable People, Sheffield, and the team used the Brain Injury Screening Index to understand if they had a history of TBI, finding that TBI was prevalent and highlighting difficulties in accessing services or receiving the correct care.

In light of its findings, its report made a number of recommendations to help improve TBI care such as improving screening, implementing TBI services where homeless people can be found, and improving preventative support.

“Now we’re doing further work with BISWG leading into a national resource, so social workers and other professionals can learn more about brain injury,” says Grant.

“We’re driving things forward in a different way to what has previously been done, and we feel that’s why brain injury and unmet need has existed so long, because we’re not involving people from those excluded groups in the work.

“That’s what’s crucial about the knowledge that we have created in Sheffield and all about the country now.

“We’re also teaching, we’re continuing to teach adult social care delivery, and we’ve delivered this to well over 100 workers now.”

BISWG is also contributing to the TBI- REPORTER project which is aiming to transform TBI research and care through its unique data hub, experimental medicine platform and a biomarker resource.

Grant says: “I think that’s a great project and absolutely essential – I find it amazing that they’ve got together and feel privileged to be part of that group, waving the flag for brain injury and unmet needs.”

Grant is now working on a book that will explore how research, health and social services can provide a different approach to looking at brain injury for social workers, neurologists, psychologists, or anyone who is interested in working with or understanding more about brain injury.