Brain Injury and Domestic Abuse

Brain Injury and Domestic Abuse

Millions of people are affected by domestic abuse, which is a serious public health issue. We also know domestic violence and abuse are among the top causes of acquired brain injury in women worldwide. However, our studies to date, with survivors and practitioners and global research from other leading academics, institutions, and organisations, indicate that brain injuries and their effects are not widely recognised nor regularly assessed in this population – including those accessing domestic abuse services.

There is also a clear gap in national data and, therefore, national knowledge, as most published works have not focused on UK populations or prevalence.

With 1 in 3 women globally reporting physical or sexual IPV, and up to 92% of blows being to the head, face, or neck, it is imperative that practitioners, decision/policy makers, and affected women be aware of this co-occurrence of IPV and BI and have access to necessary supports.

Colantonio, A. and Valera, E.M., 2022

What is Domestic Abuse?

The UK government’s definition of domestic abuse is ‘any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are “personally connected” or have been, and this includes intimate partners or family members, regardless of gender or sexuality. Children who see, hear, or experience the effects of the abuse and are related to either of the parties are also considered victims of domestic abuse.

Recent UK data suggests that as many as 1 in 4 women and 1 in 7 men are affected by domestic abuse each year.

Our work in this area to date

From 2016-2018, in the first pilot study of its kind in the UK, we provided a dedicated service to support identifying and rehabilitating women with a history of brain injury in HMP/YOI Drake Hall. From this work, we found that domestic abuse is a significant cause of brain injury amongst women in the CJS, with 62% of the women we worked with indicating they had sustained a brain injury through domestic abuse.

These findings can be read in Making the Link and The Impact of Brain Injury and Domestic Abuse: A Further Analysis.

It was shortly after this that we convened a roundtable in November 2019, published in Invisible Impact, where a panel of experts (including academics and representatives from leading domestic abuse charities and the NHS) came together to discuss the needs of survivors who experience domestic abuse and who may have sustained a brain injury.

We discovered gaps in detailed knowledge from the brain injury and domestic violence sectors regarding how best to support survivors. We also discovered a lack of screening for brain injuries and an absence of specialist training.

In the same year, we audited acquired brain injury knowledge in practitioners who support survivors of domestic abuse, with support from a leading domestic abuse charity, SafeLives. A Practitioner’s Perception revealed that 81% of practitioners we spoke with had no training in brain injuries, and 62% felt mostly unprepared to identify symptoms of brain injuries.

Creating real change
Following campaigning from Brainkind, based on our research findings, new statutory guidance will recognise that survivors of domestic abuse may have sustained an acquired brain injury for the first time. Domestic abuse protection orders – designed to protect victims from all forms of domestic abuse – will now consider acquired brain injury as part of the range of needs any survivor may have.

When police are attending a call-out to a domestic incident in the community, they could be accompanied or shortly after visited by an Independent Domestic Violence and Abuse Advisor, who would be able to offer expert support to the survivor, including about brain injury.

This commitment from the government will also introduce new standard questions to ensure all prisoners in England will be screened for an acquired brain injury sustained through violence from April 2021.

Brainkind’s findings were put forward by Chris Bryant MP, who has long campaigned for recognition of the needs of those with a brain injury and has worked with Brainkind, and UK Acquired Brain Injury Forum (UKABIF) in a collaborative approach to highlight the need for this change.

What next?

As brain injury experts, Brainkind has sought to work in partnership with survivors, domestic abuse organisations and charities in the UK and the US to understand the breadth of complexities and issues in this area. Our current piece of national research, ongoing and due for completion in 2023, is in collaboration with survivors of domestic abuse and the specialist practitioners who support them across the UK.

We are looking into the prevalence of brain injury amongst survivors of domestic abuse and how we can best screen for brain injury in a way that supports survivors.

Our team is working hard to gather further evidence to drive a change in policy and process, to bring brain injury and its impacts to the forefront of national discussion and action, ensure its inclusion in training and provide holistic support for survivors nationally.

Citations

• Colantonio, A. and Valera, E.M. (2022) “Brain Injury and intimate partner violence”, Journal of Head Trauma Rehabilitation, 37(1), pp. 2–4. Available at: https://doi.org/10.1097/htr.0000000000000763.
• Haag, H., Jones, D., Joseph, T., & Colantonio, A. (2019). Battered and Brain Injured: Traumatic Brain Injury Among Women Survivors of Intimate Partner Violence: A Scoping Review. Trauma, Violence, & Abuse, 1524838019850623.
• Kim, G., Kim, H., Fletcher, J., Voelbel, G., Goverover, Y., & Chen, P. et al. (2022). Differential Impact of the COVID-19 Pandemic on Health Care Utilization Disruption for Community-Dwelling Individuals With and Without Acquired Brain Injury. Archives Of Rehabilitation Research And Clinical Translation, 4(1), 100176. https://doi.org/10.1016/j.arrct.2021.100176
• Living With Abuse – Domestic Abuse Statistics (2021) LWA. Available at: https://lwa.org.uk/understanding-abuse/statistics/
• Manoranjan, B., Scott, T., Szasz, O. P., Bzovsky, S., O’Malley, L., Sprague, S., Perera, G., Bhandari, M., & Turkstra, L. S. (2022). Prevalence and Perception of Intimate Partner Violence-Related Traumatic Brain Injury. The Journal of head trauma rehabilitation, 37(1), 53–61. https://doi.org/10.1097/HTR.0000000000000749
• Nemeth, J. M., Mengo, C., Kulow, E., Brown, A., & Ramirez, R. (2019). Provider perceptions and domestic violence (DV) survivor experiences of traumatic and anoxic-hypoxic brain injury: Implications for DV advocacy service provision. Journal of Aggression, Maltreatment & Trauma, 28(6), 744–763.
• Office for National Statistics. (2022) Domestic abuse in England and Wales Overview: November 2022, Domestic abuse in England and Wales overview – Office for National Statistics. Office for National Statistics. Available at: November 2022
• Sardinha, L. et al. (2022) “Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018,” The Lancet, 399(10327), pp. 803–813. Available at: https://doi.org/10.1016/s0140-6736(21)02664-7
• Valera, E. M., Joseph, A. C., Snedaker, K., Breiding, M. J., Robertson, C. L., Colantonio, A., Levin, H., Pugh, M. J., Yurgelun-Todd, D., Mannix, R., Bazarian, J. J., Turtzo, L. C., Turkstra, L. S., Begg, L., Cummings, D. M., & Bellgowan, P. (2021). Understanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions. The Journal of head trauma rehabilitation, 36(1), E1–E17. https://doi.org/10.1097/HTR.0000000000000652