When we discuss the homelessness crisis, the conversation too often begins and ends with addiction or mental illness. But as Dr. Monty Ghosh recently highlighted in the Canadian Medical Association Journal, this is a dangerous oversimplification. In reality, we are facing a hidden cognition crisis.
Dr. Monty Ghosh’s recent commentary in the Canadian Medical Association Journal identifies the homelessness crisis as a hidden cognition crisis driven largely by traumatic brain injuries. Approximately 50% of people experiencing homelessness have had a brain injury, with an estimated 22.5% living with moderate or severe brain injuries,.a rate nearly 10 times higher than the general population. Ghosh highlights a devastating societal double standard: housed individuals with brain injuries or dementia receive safe, supported care, while unhoused populations with comparably severe cognitive impairments are left to fend for themselves on the streets. When unhoused populations experience comparable impairments from TBIs, fetal alcohol spectrum disorder, or childhood trauma, they are routinely abandoned to fend for themselves, fueling a tragic cycle of illness and vulnerability.
To address this, he advocates for routine cognitive screening and the creation of “intensive housing”, long-term, medically supported residential care functioning much like nursing homes for those unable to manage independent life. He’s essentially describing the Neurohomes community project.
I explore the roots of these systemic failures in my book Autism In America. In the chapter “Western Parenting Impacts on Human Development and Behavior: America’s Hidden Health Crisis,” the text examines how dominant cultural norms pathologize divergence and rely on hierarchies to maintain order. The systemic betrayals woven into the American fabric rely on these false binaries and power dynamics to function. This macro-level coercion is mirrored perfectly in how America approaches housing and poverty. The United States lacks a true social safety net because homelessness itself is weaponized as a form of coercive control. The threat of absolute destitution is used to enforce compliance within an economy that relies on fear and punishment to function, reflecting a broader culture that enforces supremacy and pathologizes behavior. Coercive control in turn literally causes developmental delays and cognitive damage.
Using the threat of the streets to manage a population creates a constant state of nervous system distress. This paradigm is neither sustainable nor grounded in fundamental human rights. Housing is a human right, and abandoning neurologically vulnerable individuals to the streets is a failure of our social contract.
This is why the model we are developing at Neurohomes is considered “curb cut technology.” The curb cut effect refers to how sidewalk ramps, originally designed and fought for by disability rights advocates to accommodate wheelchair users, ended up benefiting everyone, from parents pushing strollers to travelers pulling luggage. By designing intensive, long-term, medically supported housing for individuals whose cognitive impairments leave them unable to navigate independent life, we are building the safety net that America is missing.
Creating the safety net that doesn’t yet exist isn’t just about housing; it’s about fundamentally transforming our communities to replace coercive control with relational integrity and collective healing.
Approximately 50% of people experiencing chronic homelessness have suffered a traumatic brain injury (TBI), and the vast majority sustained these injuries before losing their housing. With an estimated 22.5% living with moderate or severe brain injuries (a rate nearly 10 times higher than the general population), the reality is stark. Individuals are surviving on the streets with severe cognitive impairments, sometimes relying on substances like methamphetamine just to stay awake at night to protect their belongings or prevent assault.
The threat of absolute destitution is used to enforce compliance within an economy that relies on fear and punishment to function.
But this paradigm is neither sustainable nor grounded in fundamental human rights. Using the threat of the streets to manage a population creates a constant state of nervous system distress and systemic trauma. Housing is a human right, and abandoning neurologically vulnerable individuals to the streets is a failure of our social contract.
This is why the work we do at NeuroHomes Foundation is so critical, and why we view our supportive housing models as “curb cut technology.”
When we design systems of care that support the most marginalized individuals in our communities, we don’t just solve a singular issue. We replace coercive control with compassion, we replace punitive systems with true support, and we create a society that actually works for all of us. Creating the safety net that doesn’t yet exist isn’t just about housing, it’s about fundamentally transforming our communities to benefit everyone.
Carmichael, J. (2026, August 31). [Commentary by Dr. Monty Ghosh from the September Canadian Medical Association Journal]. Edmonton Journal.
Snow, I. S. Autism in America: One Woman’s Search for Healing (Chapter: “Western Parenting Impacts on Human Development and Behavior: America’s Hidden Health Crisis”).