High cognitive impairment rates among homeless people demand radical policy change

Cognitive impairment is a prevalent but often unaddressed factor in chronic homelessness, and it must be addressed to help reduce homelessness, argues the author of a commentary published in CMAJ.

"Chronic homelessness in Canada is a human tragedy and a public policy failure," writes Dr. Sumantra Monty Ghosh, an addiction medicine specialist and associate professor at the University of Alberta, Edmonton, Alberta. "An important reason for the latter is insufficient recognition that many people who are homeless have cognitive dysfunction severe enough to limit their ability to live independently."

People experiencing homelessness are often exposed to several causes of cognitive impairment, including fetal alcohol syndrome disorder, negative childhood experiences, traumatic brain injury, injuries from substance use disorders, and mental health conditions that can affect memory, executive function, and comprehension.

Rather than using a blanket approach, Dr. Ghosh argues that care for people with cognitive impairment experiencing homelessness should include a similar level of support as that offered to people with dementia: 24-hour supervision and safety monitoring, brain rehabilitation, and structure that goes beyond conventional interventions like Housing First. Routine screening is important to help identify people with cognitive impairment and to provide appropriate care and support for this group with complex needs.

Reframing chronic homelessness as a cognitive impairment crisis is essential. If this foundational driver remains unaddressed, most conventional responses to Canada's homelessness crisis will continue to fail. By focusing on the estimated half of people experiencing chronic homelessness and who have substantial brain injuries, outcomes for both vulnerable unhoused people and wider communities could be meaningfully improved in Canada."

Dr. Sumantra Monty Ghosh, addiction medicine specialist and associate professor, University of Alberta, Edmonton, Alberta

"High rates of cognitive impairment in people experiencing homelessness demand radical policy change" is published September 21, 2026.