Nearly three-quarters of homeless mentally ill adults in Canada show signs of cognitive deficits such as difficulties with learning, memory, and problem solving, say researchers at St. Michael’s Hospital in Toronto. The study was published in the journal Acta Psychiatrica Scandinavica. The study analyzed neurocognitive functioning indicators such as the speed of mental processing, and verbal learning and memory. These skills are needed for following treatment instructions, maintaining stable housing, or finishing everyday tasks.
“This points to an often unrecognized problem for the segment of Canada’s homeless population that suffers from mental illness,” said Dr. Vicky Stergiopoulos, chief of psychiatry at St. Michael’s Hospital and a scientist in its Centre for Research on Inner City Health. The participants in the study were 1,500 homeless adults who had experienced mental illness.
The participants were recruited from the At Home/Chez Soi study, a four year project designed to support people who are homeless and have mental health issues in Toronto, Montreal, Moncton, Vancouver and Winnipeg. Approximately half of the participants fit the criteria for substance abuse, major depressive disorder, and psychosis.
After tests that assessed the participants’ neurocognitive performance:
Seven out of 10 had problems with verbal learning and memory
Four out of 10 had problems with the speed of information processing
Four out of 10 had problems with cognitive processes such as task flexibility, problem solving, reasoning, and planning and execution
“The data doesn’t help us to predict whether someone will have cognitive challenges, but it does show that if they experience homelessness and mental illness, it’s very likely,” said Dr. Stergiopoulos. “It adds to our understanding about why people may have difficulty accessing or keeping housing.”
Dr. Stergiopoulos said that the results of the study are important for those who work with disadvantaged and homeless people because it shows that there needs to be an improvement in how treatment and support options are managed. People who does not adapt and accept treatment may not understand how to access support. Their lack of engagement does not necessarily mean that they are rejecting help – the homeless may not know how to access or use it.
“Front-line staff may need more training in how they work with this population,” said Dr. Stergiopoulos. “It reinforces the necessity to understand the needs and strengths of disadvantaged populations so that we can help address them.”
Up to 200,000 Canadians are homeless every year. Mental illness is much more common among homeless people than in the general population. More than 40 percent are addicted to drugs or alcohol, 12 percent have a severe mental illness, and 11 percent have mood disorders.
Other factors that explained part of the poorer cognitive functioning in homeless people were less education, older age, psychotic illness, speaking a foreign language other than English or French, and being a visible minority. Substance abuse or traumatic brain injury was not associated with lower cognitive abilities.
“While cognitive remediation practices are in place in some specialty settings, we need to design better strategies that include programs for homeless people,” said Dr. Stergiopoulos.
