Brain injury, mental health and substance use in homeless populations: community-generated recommendations for healthcare service delivery and research.

BACKGROUND

The prevalence of acquired brain injury (ABI) and mental health/substance use (MHSU) disorders is high amongst people experiencing homelessness, yet guidance for addressing these complex comorbidities is lacking. Therefore, the objective of this study was to engage community-based stakeholders in a health priority-setting process to generate, identify and prioritize recommendations for clinical practice and research to improve healthcare services for individuals with concurrent ABI-MHSU who are experiencing homelessness.

METHODS

Data were collected during a one-day workshop as part of the BC Consensus on Brain Injury. Participants were 163 stakeholders in the ABI-MHSU and homeless communities (M = 46.40, SD = ± 13.80, 72% female), including service providers, people with lived experience, healthcare professionals and other community-based stakeholders. Stakeholders participated in concurrent focus groups based on the nominal group technique. Initial recommendations were generated then collated, themed and rank-ordered by priority and a consensus voting method was used to identify the top five priorities for research and clinical practice.

RESULTS

Stakeholders discussions and subsequent prioritization evaluations identified the following recommendations for clinical practice: (1) Provide accessible and affordable supportive housing; (2) enhance resources (financial, human) for healthcare service providers; (3) design needs-based services that promote quality of life; (4a) improve communication and collaboration between service providers; (4b) adopt a long-term and integrated approach; and (5) reduce stigma and discrimination through public health education. Recommendations for research, also ordered by priority, included: (1) Evaluate and optimize existing interventions for immediate implementation; (2) develop specialized interventions and diagnostic techniques; (3) collect meaningful data to better understand impacts and intersections; (4) increase mechanisms for knowledge transfer; and (5) explore methods for risk identification and prevention.

CONCLUSIONS

This is the first study to identify and prioritize recommendations for research and clinical practice related to healthcare services for people experiencing homelessness with concurrent ABI-MHSU conditions. The stakeholder-generated recommendations from this study provide a valuable resource for researchers, clinicians and policymakers to enhance care for this underserved population.