Domestic and Family Violence

Any assault to the head, neck or airways can cause an Acquired Brain Injury (ABI), with the likelihood increasing when assaults are repeated and frequent. Concussions, minor head injuries and strangulation within a domestic and family violence (DFV) setting can happen without the victim having any understanding of the potential long-term consequences.

In 2016–17, almost 2 in 3 (63%, or 2,200) hospitalisations of women due to assault by a spouse or domestic partner were for treatment of injuries to the head and/or neck, including 248 (7%) of hospitalisations due to brain injuries.[i]

Head injuries and intimate partner violence, however, remain underreported – and these difficulties in understanding prevalence are compounded by a lack of specific screening tools, as well as issues classifying and diagnosing mild traumatic brain injury.[ii]

For Aboriginal and Torres Strait Islander communities, where family violence occurs at higher rates, the problem is even greater. In 2014–15, 1 in 7 (14%) Indigenous women experienced physical violence in the previous year. Of these, about 1 in 4 (28%) reported that their most recent incident was perpetrated by a cohabiting partner (ABS 2016).

One study of women in three domestic violence shelters found that:

• 92% had been hit in the head by their partners, most more than once.
• 83% had been both hit in the head and severely shaken.
• 8% of them had been hit in the head over 20 times in the past year.
• The more times individuals had been hit in the head or shaken, the more severe, and the more frequent, were their symptoms.[iii]

People affected may not receive appropriate treatment due to being unaware of the link between these assaults and delayed symptoms. An Brain injury caused by strangulation, for example, will not show up immediately, but can develop in the weeks and months after the event. Similarly, concussion/mild-brain injuries, do not show-up on brain scans, but are identified only by symptoms, cognitive testing and history of physical trauma. One study indicated that functional impairment was present for up to 33% of cases at 3 months and 22% at 1 year.[iv]

Crucially, brain injury can impact people’s capacity to recover from their experiences and safeguard their future wellbeing. Brain injuries caused by DFV can lead to a range of symptoms, including:

• changes to personality and mood;
• cognitive delays or dysfunction;
• physical disability;
• changes in behaviour and coping strategies;
• problems with communication and speaking;
• chronic pain;
• memory loss;
• fatigue;
• headaches;
• changes to the senses – sight, hearing, touch, taste and smell.[v]

In order to respond adequately to the needs of victims of DFV with brain injury, there needs to be broad upskilling across the health and DFV service sectors – including clinicians, social workers and domestic violence shelters – to make sure brain injury is understood and can be screened for, so that appropriate supports can be provided.

Given the likelihood of brain injury impacting on a person’s ability to leave a relationship, gain financial independence, and engage with services and supports, it’s a critical piece of the puzzle.

Domestic violence service providers should screen everyone who seeks services for brain injury, and, when an brain injury is suspected, refer for specialised screening, evaluation, and services.