Domestic violence victims suffer in silence from brain injury

We know the damage it can cause footballers — now brain injury is emerging as an unseen consequence of domestic violence, as Lauren Novak reports.

• Read below: Calls for more brain injury abuse research

She has a headache that just won’t go away, and she’s constantly forgetting things.

It can be hard to concentrate and sometimes she feels dizzy for no reason. It’s probably just stress, she thinks, or lack of sleep. She should really see a doctor, but she’s too busy holding the family together and her partner wouldn’t let her go anyway.

Even if she were able to get to an appointment, she’d have to think of something to say when the doctor started asking questions. Anything but the truth about the vicious slaps he gives her that rattle her brain. The knocks to the head when he pushes her into the wall. The times she can’t breathe with his hands around her neck. So she doesn’t go — and it only gets worse.

This is the real experience of many women living in violent relationships.

Medical and women's safety bodies in South Australia have identified brain injury as a hidden consequence of domestic violence and are warning many victims go undiagnosed because they do not seek medical help.

They liken the problem to the effects of repeated concussion on AFL footballers and report that more women are presenting to hospital with head injuries caused by abuse at home. They want research to determine the extent of the problem and a greater focus on brain injury when assessing risks posed by family violence.

“We know the impact of multiple head injuries on footballers. They’re taking that much more seriously now,” Women’s Safety Services SA executive manager strategic projects Megan Hughes says.

“But who else is walking around without knowing that they’ve got a brain injury? Women and children experiencing family violence.”

Ms Hughes says she has helped women who’d had their “heads banged into the ground, been king hit, over and over again” but most don’t go to hospital so as to avoid explaining the cause of their injuries.

Flinders University Professor Sarah Wendt recently interviewed a woman in regional SA who was punched in the head and strangled by her partner, but recovered alone.

“If you’re being shaken a lot, or thrown up against a wall, or he pushes you and you have a bad fall or you knock your head, women can endure multiple forms of violence over time,” she says.

“The result can be lots of headaches, not being able to sleep, having memory loss. ”

It can also hold a woman back when she finds the courage to leave the relationship, making it more difficult to “find a house, manage your finances or your children’s behaviour”, Professor Wendt says.

Katrina Dee is the Director of Youth and Women's Safety and Wellbeing Division. Picture: Dylan Coker

“Sometimes it can be misinterpreted as stress. If you’ve got a minor brain injury you might not have the capacity to recognise that.”

It can also be difficult to reveal to a doctor that “your brain injury is caused by your partner hitting you or strangling you,” she says.

But medical professionals are starting to acknowledge the problem.

Australian Medical Association SA president William Tam says neurosurgeons are noticing “a perceived increase” in patients with head injuries related to domestic violence.

Repeated injuries could lead to post-traumatic encephalopathy “similar to what footballers can get if they have repeated concussions”, he says.

A recent report by Brain Injury Australia found 40 per cent of 16,300 family violence victims who attended hospital in Victoria over a decade had sustained a brain injury.

About 30 per cent of the attendees were children aged younger than 15 and one in four of them had a brain injury.

The director of SA Health’s Youth and Women’s Safety and Wellbeing Division, Katrina Dee, says research on the prevalence in SA would be helpful, but medical professionals could already “start incorporating some of this research into our training”.

In November the Women’s and Children’s Hospital introduced the “Ask, Assess, Respond” protocol which requires staff to ask every patient aged 16 or older about safety in their relationship.

Ms Dee says the policy was introduced there first because pregnancy was a time of heightened risk in abusive relationships, but other hospitals will join over time.

Health Minister Stephen Wade says death and “life-changing” disability are a “real risk” of domestic violence. He says the State Government has pledged to build a new facility for brain injury patients which would offer improved care and recovery.

Human Services Minister Michelle Lensink says the State Government has contributed $121,000 to further the work of Australia’s National Research Organisation for Women’s Safety. However, she admits there is “more work to be done” to improve risk assessments and policies.

Calls for more research into brain injury from domestic violence

More women are presenting to hospital with brain injuries caused by domestic violence assaults, prompting calls for research into the extent of the problem and better screening to diagnose victims.

Peak medical and women's safety bodies have identified brain injury as a hidden consequence of domestic violence but warn many women and children go undiagnosed because they do not seek medical help.

They liken the problem to the effects of repeated concussion on footballers and say it is time to recognise the long-term damage being done behind closed doors. This can include symptoms such as memory loss, confusion, headaches and fatigue, which can prevent women from leaving an abusive relationship, or delay their recovery.

Megan Hughes, of Women’s Safety Services SA, said she had seen countless cases of head trauma caused by assaults or strangulation, but many victims never sought treatment because they were threatened or controlled by their abusers.

“There is a high likelihood that we are not seeing half of what the problem is,” she said.

Australian Medical Association SA president William Tam said neurosurgeonsreported “a perceived increase” in patients with head injuries related to domestic violence.

Previously, patients may have “attributed it to a fall, or say they slipped”, he said.

Associate Professor Tam said repeated head trauma damaged nerves and brain tissue and could lead to “shearing injuries” like those seen in contact sport. A recent report by Brain Injury Australia found 40 per cent of family violence victims who attended hospital in Victoria over a decade had sustained a brain injury.

Advocates want research to determine the extent in SA and a greater focus on brain injury when assessing risks to those experiencing family violence.

SA’s Women’s and Children’s Health Network recently introduced a protocol requiring health workers to ask patients about safety in their relationships.

Health Minister Stephen Wade said the State Government had committed to building a new facility to treat patients with brain injury.

Human Services Minister Michelle Lensink said the Government contributed $121,000 to a federal research body producing evidence to inform policies on curbing domestic violence.

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