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A new CMAJ commentary argues that Canada's homelessness crisis is fundamentally a cognitive impairment crisis. Causes like fetal alcohol spectrum disorder, traumatic brain injury, mental illness, and opioid-related brain damage compound one another among people experiencing homelessness. The author calls for better screening, guardianship pathways, and intensive supportive housing — not just shelter — to address the crisis compassionately and effectively.
A new commentary published in CMAJ argues that Canada's homelessness crisis should be reframed as a cognitive impairment crisis — a shift that could unlock more effective, compassionate policy responses. Addiction medicine specialist Dr. Sumantra Monty Ghosh highlights how conditions like fetal alcohol spectrum disorder (FASD), traumatic brain injury (TBI), adverse childhood experiences, mental illness, and substance use — including anoxic brain injury from opioid overdoses — compound one another among people experiencing homelessness (PEH).
A stark double standard exists in how the healthcare system responds: housed patients with dementia or TBI receive supervised discharge to long-term care, while PEH with equally severe impairments are routinely sent back to the streets. Stigma in clinical settings is so severe that many PEH report they would rather die than seek hospital care.
By the Numbers:
Why it matters: Reframing homelessness through a cognitive impairment lens could drive investment in screening tools, guardianship systems, and intensive supportive housing — moving beyond "Housing First" alone toward integrated medical, behavioral, and cognitive care that matches the complexity of this population's needs.
