Street roots
3
June 10, 2011
What we
don't
know will
hurt us
P H O T O I L L U S T R A T I O N B V R E U T E R S /H O N E W
B Y S T A C Y BRO W NHILL
C O N T R IB U T IN G w r it e r
"TT"ames Smith is a 53-year-old Portland
I veteran who used to have a job he loved.
I After a,car accident left him with
traumatic brain and neck injuries in 2005,
Smith lost his job, ran out of money and
wound up on the streets. When Smith tried
to apply for Social Security Disability
Insurance (SSDI), he was denied three
times because he was flagged as violent. He
was loud, angry and high-strung — symptoms
of traumatic brain injury, or TBI. For years,
Smith sunk deeper into despair. This week,
with the help of Portland law firm Swanson,
Thomas & Coon and Central City. Concern’s
BEST program, Smith Won his second
hearing, The benefits he was awarded will
give Smith a house, health care and a new
life.
If you read the article in our last issue
“All in their heads,” (Street Roots, May 27)
you’ll remember a similar stofy of Nick
Patton, a homeless Portlander who was
misdiagnosed with schizophrenia when he
was really having seizures from a TBI that
had happened years earlier.
People suffering from TBI, the so-called
invisible disease, can seem angry, forgetful,
antisocial and disinterested. They may slur
their speech, talk too loudly and walk
crookedly. In other words, it’s easy to
mistake people with TBI for being
intoxicated,-high, mentally ill, suffering from
fetal alcohol syndrome or even averse to
getting help. It’s especially easy to make
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This is the second report in our ongoing
coverage of traumatic brain injuries among
people experiencing homelessness.
those mistakes when the person is
homeless and already burdened with
stigmas.
In October 2008, Portland’s Housing
Bureau partnered with New York City-based
Common Ground Institute to survey 646
homeless people on the streets of Portland.
The resulting “Vulnerability Index” found
that about half were medically vulnerable.
One of Hie medical conditions PHB was
curious about was fraumatic brain injury;
however, because TBI cafrbe so difficult to
correctly diagnose, the field was left “To Be
Determined.”
That same year, the city of Hamilton,
Ontario awarded funding for a program that
offered counseling and intensive case
management to 176 chronically homeless
men. Forty-nine of those men agreed to
participate in a more in-depth pilot program
that included advanced neuropsychological
testing; A staggering 98 percent of men in
tKfe pilot program met the criteria for TBI.
Today, we’re as clueless about TBI on the
streets of Portland as we were three years
ago. But TBI is causing a stir ¡among
scientists, social workers, city officials, the
military and the NFL. What they’re
discovering is Surprising.
It can happen to anyone
Traumatic brain injury is indiscriminate,
andit istheleadm geauseofdeathand
disability in North America for people under
45, according to the Brain Trauma
Foundation. There are an estimated 1.7
million deaths, hospitalizations, and ER
visits related to TBI every year, according to
the Center for Disease Control/? 1
Treatment is expensive and complex.
X-rays, CT scans and MRIs help confirm
TBI, «and individualized physical therapy,
speech language therapy, occupational
therapy, psychological therapy and social
support are usually needed to stabilize a
TBI victim. (Oregonian columnist Elizabeth
Hovde was recently hospitalized for 36 days
after a TBI and dedicated a column ^to the
“dozen or so” hospital workers and
therapists who helped her recover.)«
But “the equipment and support are not
always available for homeless people even if
a clinic suspects someone has TBI,” says Dr.
Barb Wismer, boardmember of the National
Hedlthcare for the Homeless Council.
“It’s trial and error,” says Dr. Phil
Shapiro, a psychiatrist at the 12th Avenue
Recovery Center who has many homeless
patients. “We try different things depending
on symptoms.” Shapiro is not convinced TBI
can be separated from PTSD or fetal alcohol
syndrome, and he adds, “Neuropsych testing
is difficult to get these days, and a much
deeper assessment can take hours. Many of
the clients I have couldn’t sit for th a t”
What other cities know
-Cities that have done studies on how
many homeless suffer from TBI report
numbers that are scattered but all
statistically significant 98 percent
(Hamilton, Ontario 2008-2010), 53 percent
(Toronto, Ontario 2008), 67 percent
(Boston, Mass. 2006-2007), 48 percent
(Milwaukie, Wis. 2004), 24 percent (Fort
Lauderdale, Fla.2003) and at least 50
percent (National Healthcare for the
Homeless Council). Of those, 70 percent
occurred prior to becoming homeless in
(Toronto), more than half occurred prior to
age 20 (Boston), and the average age for the
first TBI was 17 (Hamilton),
Compared to an estimated 2 percent of
the general population that gets TBIs,
“we’re seeing an enormous medical crisis,”
says Dr. Theresa Petrenchik, who helped
lead both the Hamilton and Fort Lauderdale
studies. Petrenchik’s research leads her to
conclude that homeless people with TBI use
more services, are homeless more often for
longer periods of time, are more frequently
incarcerated and have greater co-morbid
risks than homeless people without TBI.
TBI among the homeless often overlaps,
masqueraded and partners with a laundry
list of other ugly problems. Sexual abuse,
neglect, domestic violence, substance use,
family breakdown — often occurring in
childhood — are just a few. When Petrenchik
See BRAIN INJURY, page 4