Gaps in Current Complex Care Housing Model

Thesis: Our current complex care housing model does not account for all disabilities present (focus= brain injury) and needs adjustments that can educate staff on outcomes of brain injury (to better understand behavior derived from ABIs that was previously thought to come from personal choice/ substance use

Brain Injury is a complex, ubiquitous condition that affects individuals from every walk of life. From those with secure, well-supported backgrounds, to those facing homelessness, brain injury has a significant impact and can leave an individual in need of support to get use to their “new normal”. Brain Injury is often referred to as an “Invisible Injury” i.e., an inhibiting condition that the objective observer may not recognize, and therefore can put these individuals at risk of being perceived negatively and having any of their adverse behaviors or outcomes discounted as possible signs of substance use or just plain misbehavior. It’s also been observed that individuals living with the effects of brain injury are disproportionately more likely to be homeless, incarcerated, and struggling with substance use disorder (Topolovec et al., 2012; Turskatra et al., 2003; Banks, 2007; Sacks et al., 2009; Dams-O’Connor et al., 2014).

Misunderstanding an individual’s brain injury can lead to a person being punished or face consequences that are unethical, especially in supportive housing settings. If an individual residing in supportive care presents difficult behaviors, they can be at risk of eviction or loss of service. With proper education, training and protocols in place which help not only the individual, but the staff understand outcomes of brain injury, we believe that we can reduce the chances of individuals with brain injury living in improper settings or residing on the street.

Another difficulty in brain Injury is the high correlation of comorbidities, such as mental health issues and substance use. The opioid epidemic is significantly prevalent in British Columbia, and the interconnectivity and cyclic relationship between brain injury and opioids effects on the brain can increase susceptibility for Opioid misuse. When individuals have additional comorbidities, such as chronic pain or noxious psychosocial factors (i.e. trauma), it causes a “perfect storm” for substance use (Adams et al., 2020; Cifu et al., 2013). BC Emergency Health Services statistics on overdoses shows that paramedics responded to more than 33,500 overdose calls in 2022, which may not even grasp the extensive nature of overdoses due to the wide availability of Narcan kits available for public use.

Research has found that individualized housing arrangements align with individuals having a greater sense of self-determination and autonomy and seems to have a positive influence on social relationships, challenging behaviors, mood, and participation in day-to-day tasks (Oliver et al, 2022). It has also been identified that the association between having a disability and mental wellbeing is impacted by housing affordability and whether individuals own or rent their residence (Kavanagh et al., 2016). Residing in unaffordable housing and acquiring a disability in adulthood has been shown to reduce mental health.

The housing options for those with disabilities spans from group home settings, direct family care, and living in the community with supports (i.e. individualized housing) (Connellan, 2015). Individualized housing provides the personal freedom of choosing where and with whom they live, the support they receive, and their daily activities. This provides a return of autonomy, which is an important factor to those living with disabilities and contributes to overall quality of life (Miller & Chan, 2008).

Currently, the housing model favoured in British Columbia is the Complex Care model. The world health organization (2001) defines complex needs as functional impairments which have substantial impact on independence in physical ability and the ability to take care of self and home. Those living with complex needs often lack access to suitable housing or meaningful daily activity (Rankin & Regan, 2004).

Complex care housing in B.C provides health and substance use supports in a home environment, with focus on stable housing, person-centered services, and indigenous designed options (Ministry of Mental Health and Addictions, UNK). It aims to meet the needs of individuals who face housing instability, and it recognizes that many individuals who are sleeping rough have a plethora of conditions, such as mental health disorder or substance use, which puts a barrier between them and secure shelter. It promises services as harm reduction, counselling, access to indigenous supports and other individualized tailored needs. However, as perfect as this model may appear on paper, the actual reality is not as effective for specific demographics.

In a perfect world, everyone with complex needs would be assigned a qualified interdisciplinary team which would support the individual with their goals, who are trained in every aspect of their disability and can handle crisis with a plethora of easily accessible resources. That unfortunately is not the case; the combination of staffing burnout, lack of training, lack of funding, high living costs, and limited community resources impacts the ability to provide this perfect situation. We have observed how the gaps in the current health care system are being filled by non-profit community partners, who are often underfunded and therefore suffer from a lack of stability in services. We also must consider the current housing crisis, which makes access to these supportive housing almost impossible. Also, the lack of recognition of brain injury as a chronic condition reduces funding and services available to help stabilize an individual in proper supportive housing. It’s also been criticized that the complex care strategies are ambiguous and funnels the marginalized population under a single label (“Complex Needs”) and therefore receiving the same care (Luongo, 2021).

No one is to blame- the system in place cannot support this type of care…yet. Its important to observe the deficits in the system as to address them. Further research, funding and community support will help strengthen the complex care housing model as so to make it a stable option for individuals living with brain injury.


Written by: Natalia Bereznicki



Stacey Oliver, Emily Z. Gosden-Kaye, Dianne Winkler & Jacinta M. Douglas (2022) The outcomes of individualized housing for people with disability and complex needs: a scoping review, Disability and Rehabilitation, 44:7, 1141-1155, DOI: 10.1080/09638288.2020.1785023

Kavanagh AM, Aitken Z, Baker E, et al. Housing tenure and affordability and mental health following disability acquisition in adulthood. Soc Sci Med. 2016;151:225–232.

World Health Organization. International classification of functioning, disability and health (ICF). Geneva: World Health Organization; 2001.

Rankin J, Regan S. Meeting complex needs in social care. Hous Care Support. 2004;7(3):4–8.

Connellan J. Commentary on Housing for People with Intellectual Disabilities and the National Disability Insurance Scheme Reforms (Wiesel, 2015). Res Pract Intellect Dev Disabil. 2015;2(1):56–59.

Keogh F. Disability and mental health in Ireland: searching out good practice Ireland. Mullingar, Ireland: Genio; 2009.

Miller SM, Chan F. Predictors of life satisfaction in individuals with intellectual disabilities. J Intellect Disabil Res. 2008;52(12):1039–1047.

Adams, R. S., Corrigan, J. D., & Dams-O’Connor, K. (2020). Opioid Use among Individuals with Traumatic Brain Injury: A Perfect Storm?. Journal of neurotrauma, 37(1), 211–216.

Topolovec-Vranic J., Ennis N., Colantonio A., Cusimano M.D., Hwang S.W., Kontos P., Ouchterlony D., and Stergiopoulos V. (2012). Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health 12, 1059.

Turkstra L., Jones D., and Toler H.L. (2003). Brain injury and violent crime. Brain Inj. 17, 39.

Banks M.E. (2007). Overlooked but critical: traumatic brain injury as a consequence of interpersonal violence. Trauma Violence Abuse 8, 290–298

Sacks A.L., Fenske C.L., Gordon W.A., Hibbard M.R., Perez K., Brandau S., Cantor J.B., Ashman T.A., and Spielman L. (2009). Co-morbidity of substance abuse and traumatic brain injury. J. Dual Diagn. 5, 404–417

Dams-O’Connor K., Cantor J.B., Brown M., Dijkers M.P., Spielman L.A., and Gordon W.A. (2014). Screening for traumatic brain injury: findings and public health implications. J. Head Trauma Rehabil. 29, 479–489

Cifu D.X., Taylor B.C., Carne W.F., Bidelspach D., Sayer N.A., Scholten J., and Campbell E.H. (2013). Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND veterans. J. Rehabil. Res. Dev. 50, 1169–1176

Luogno N. (2021) Power, control & erosion of rights: the politics of BC’s complex care “housing”. Pivot


Related Posts: