Inside Australia’s invisible crisis of domestic violence, concussion and brain injury
The next frontier of Australia’s concussion crisis isn’t on the football field, but in homes across the country, where victims of domestic violence are sustaining brain injuries at staggering rates.
In photos of her face taken the Saturday night she was knocked unconscious, Ashley’s* eye is swollen and purple, a dark bruise spilling from her lashline to her cheekbone. There’s blood dripping from a gash on the bridge of her nose towards her split lip. Her eyes appear red, as if she’s been crying. She looks scared, and sad.
Police had arrived at Ashley’s house that evening in 2021 on a domestic violence callout, after her abuser — an army-trained man much bigger than her — came to her home in Brisbane’s outer suburbs and refused to leave. While they were arguing in the front yard, she says, he whacked her in the head with a metal pole. The next thing she remembers is waking up at the bottom of her driveway, vomiting and in pain.
Later, an emergency doctor at the local hospital would diagnose her with a concussion, several fractures to bones in her nose and a perforated eardrum. But the police, who interviewed Ashley in the back of an ambulance, seemed to regard her unsteadiness and agitation as confirmation of her perpetrator’s account of what happened: he slapped Ashley, with his palm, in self-defence — and she also had a drinking problem. They applied for a domestic violence order against her, which she says she accepted because she didn’t want to go through a stressful fight in court.
“I think they just got it in their head that, ‘Oh, she’s had a couple of drinks, she’s gotten violent and this is the result’,” says Ashley, who is adamant she had three drinks over about eight hours that day. “The police officers repeatedly accused me of being drunk,” she later said in a statement for the court. “I was not drunk. I was concussed and suffering nausea, vomiting, disorientation and for a while unconsciousness from the blow I had to my head.”
It wasn’t her first brain injury, either. When she was 18, Ashley’s ex-partner, a “very violent” and controlling man, punched her in the head, fracturing her skull and perforating her ear drum. “One more hit to my head, the doctors said, and it would have been game over,” she says. “It took me a long time to get over it. I was very, very scared for my life for a long time.”
Australians are becoming increasingly aware of the risks and ramifications of brain injuries, with concussion in contact sports dominating media coverage and Senate inquiries in any given week. But the links between domestic violence and brain injury remain bafflingly under-discussed and the long-term consequences an invisible crisis — despite evidence suggesting victims are sustaining head injuries at staggering rates.
American and Canadian research suggests as many as three-quarters of female victims of domestic violence have suffered traumatic brain injury (TBI), with some experts estimating up to 20 million women in the US sustain TBIs through partner violence every year — 11 to 12 times the number experienced by athletes and military personnel combined.
And in 2018, the first major Australian study of brain injury and family violence found 40 per cent of victims attending Victorian hospitals over a decade had suffered a brain injury, though researchers said it was likely just “the tip of the iceberg” given how few victims seek medical care.
Still, many domestic violence workers aren’t trained in identifying TBI signs and symptoms, and few frontline services screen victims for potential brain injury — a missed opportunity, experts say, to connect them with medical specialists and improve their chances of recovering. Instead, women across the country are falling through gaping cracks in the health system, unable to access treatment for debilitating chronic symptoms that affect their mental health, their capacity to work and, crucially, their ability to leave abusive relationships.
Some experts also fear victims who experience frequent domestic violence may be at risk of developing dementia or even chronic traumatic encephalopathy (CTE), a degenerative brain disease that has been found in deceased football players, boxers and other athletes. Others find themselves colliding with the criminal justice system or in prison, having struggled to cope with their symptoms.
“I think there’s a lot of conversation about concussion in sport, and there’s been campaigns and … guidelines about when you should return to play,” says Michelle Fitts, a senior research fellow at Western Sydney University. “But we don’t seem to have those conversations about women who’ve experienced concussion repeatedly as a result of violence. We need to raise the profile and visibility of head injury in relationships as well … and educate the community about the potential long-term harm and disability you can cause someone.”
Debbie Hewitt, a solicitor at Women’s Legal Service Queensland who obtained police body-worn camera footage of Ashley’s callout, says the attending officers believed her abuser slapped her in self-defence even though “his story wasn’t credible”. “I think one police officer in particular became more inclined to believe his account … when he put that view to [Ashley] while she was in the back of the ambulance … and she got angry at him. I think that was the turning point; he saw her as belligerent and uncooperative — and then you can see him reframing the whole incident around her being the perpetrator.”
But the officers’ assumption that Ashley was drunk — not concussed — was “pivotal” to their “reframing” of what happened, Ms Hewitt says. “We see a lot of women who are misidentified by police as the perpetrator … it may be because they’re concussed … or there’s hypoxic brain injury from strangulation,” she says. “The trauma of the violence is [also] distressing and may mean they behave differently to how police expect victims to behave. But I would think there are a lot of cases where concussion, head injuries, is exacerbating it.”
Shaken brains
Brain injuries are often described as “invisible” injuries: other people can’t “see” them, but their impacts can be devastating. Usually they’re caused by the brain moving suddenly within or against the skull after a blow to the head or body, in some cases resulting in a loss of consciousness.
The initial impact can cause bruising and swelling, while the forces that shake and stretch the brain can damage neurons, triggering chemical and metabolic cascades and tissue damage over days or weeks. This can disturb the brain’s delicate circuitry and generate symptoms like fatigue, headaches, slowed thinking and difficulty concentrating, noise and light sensitivity, dizziness, insomnia, anxiety and depression.
Until relatively recently, though, less severe brain injuries — particularly concussion, the most common traumatic brain injury — were dismissed as minor mishaps that resolved quickly and without complication. Mounting evidence now shows they can have serious consequences and require careful management, especially for the significant minority of patients who don’t recover within the “typical” few weeks.
For those who sustain multiple brain injuries, the stakes are raised: researchers at the Universities of Oxford and Exeter recently found people who suffered three or more concussions had much poorer cognitive function which got successively worse with each one after that.
Still, it’s unclear how many people in Australia are sustaining brain injuries as a result of domestic violence, a gendered issue experienced by more women, and more severely, than men. Partly it’s because concussions — of which there are an estimated 170,000 every year — are not systematically tracked. And most of the research focuses on sports-related concussion, even though it makes up just 20 per cent of mild TBI, with the majority a result of falls, motor vehicle and bike accidents, and assaults.
Small clues, though, point to a potentially massive problem: A 2021 report on domestic violence-related hospitalisation over nine years found head injuries were the most common injury leading to a hospital stay, with intimate partners responsible for the majority of admissions and women much more likely to be injured than men. And a 2017 case analysis of women and girls hospitalised for assault found 69 per cent were attacked in their home, with the majority of injuries to the head and neck area.
But not everyone goes to hospital, or even to a GP, for diagnosis. “We really don’t know the extent of brain injury as a result of domestic violence in Australia — it’s one of the key things we should be trying to find out,” says Sarah Hellewell, a senior research fellow in neurotrauma at the Perron Institute and Curtin University. “We don’t know how often it’s happening or even what kinds of injuries people are getting.”
We don’t know, for instance, how often hypoxic or anoxic brain injuries from strangulation happen at the same time as TBI, Dr Hellewell says: “But I think we can expect that they happen quite frequently when victims are being choked and hitting their head against something as well.” We also don’t know what victims’ recoveries look like, she says, “particularly whether they’re having ongoing injuries in the context of fear and stress, and how that can influence the pathology and recovery”.
These questions become more urgent in light of several studies showing that women are more susceptible to concussion and take longer to recover than men, for reasons scientists are still trying to understand.
But like many other health issues, women’s experiences of brain injury remain disturbingly understudied — mostly on the basis that female sex hormones can complicate medical research. As Katherine Price Snedaker, the founder and executive director of PINK Concussions, told Forbes in 2019: “If brain injury is the ‘invisible illness’ of our time, then within this invisible injury, women have been the invisible patients.”
‘It’s not just all in your head’
The lack of progress in this space has been perplexing Eve Valera for more than 20 years. An associate professor in psychiatry at Harvard Medical School and a research scientist at Massachusetts General Hospital, Dr Valera’s interest in brain injuries and domestic violence was sparked while she was volunteering at a battered women’s shelter during graduate school. There, she noticed many of the symptoms often attributed to the trauma of abuse overlapped with those of brain injury.
“Some of these women are hit in the head with hammers or stomped on with work boots or thrown down stairs and off porches,” she says. “And I was like, they’ve got to be sustaining brain injuries.”
When she discovered there were almost no studies on the issue, she decided to pursue her own. The paper Dr Valera published in 2003 is still cited widely: of 99 women from local shelters she interviewed, three-quarters reported sustaining at least one brain injury as a result of partner violence, including through strangulation, and more than half had sustained multiple.
Yet none of the terrorised women arriving at shelters were being screened for brain injury and referred for medical care — instead, their behavioural and cognitive problems were being put down to “depression” and “PTSD”.
“We have to recognise that women are sustaining brain injuries, that it’s not just all in their head … it’s not psychological,” Dr Valera says. “There are consequences to these brain injuries that women and others need to understand. If you think of the resources shelters provide, they may have a social worker, a therapist, somebody with some legal experience. But there’s no neuro-rehab, no one’s thinking about anything like that. And if, say, 50 per cent of the women going into shelters are experiencing brain injuries, isn’t that a problem?”
It’s one reason why frontline workers need to ask careful questions about head injury and strangulation, Dr Valera says: “Because women won’t necessarily offer it up, they won’t necessarily think it’s important.” It also allows victims to seek a diagnosis, and treatment. “At least in my experience, people find it relieving to be diagnosed with brain injury and given information about their symptoms.”
Some will also have very different life courses if they understand what is at stake: “If you get out of the relationship, if you sustain no more brain injuries, maybe things will [improve] — the brain can heal,” she says. “But … we know that if you continue to sustain brain injuries your brain doesn’t have a chance to heal.”
First Nations women get second rate care
Buried within the research on brain injury in Australia is a startling statistic, from a 2008 study by researchers in Adelaide: Aboriginal women experience head injury — including traumatic brain injury — due to assault at 69 times the rate of non-Indigenous women. Yet almost two decades later, still too few Aboriginal women are getting adequate treatment and, according to Michelle Fitts, not enough is known about their needs.
“Most of the research has been done with metropolitan-based, non-Indigenous patients and … patients who have experienced moderate or severe brain injuries”, not milder injuries like concussion, Dr Fitts says. The research gap is especially confounding considering Aboriginal women experience disproportionately higher rates of violence from men of all cultural backgrounds — and homicide — than non-Indigenous women, and poorer responses from police.
First Nations women in remote communities typically have to travel long distances to access medical services for TBI, Dr Fitts says, while a lack of local specialists means getting a diagnosis is difficult unless women are flown out for emergency care. This can limit the kinds of support they’re able to access and disadvantage legal matters. As one frontline worker in a remote region told Dr Fitts and her colleagues last year:
“You get their medical histories and their police records, and they’ve just been basically pummelled within an inch of their life, for all of their life … and you just look at the totality of it and go, how does this person even function at any level?” But without a diagnosis, they said, “You then have problems … convincing a court that there is a disability at play here which is an important factor to be taken into account when sentencing them or when a determination is made.”
Still, many frontline workers haven’t completed brain injury training or education, Dr Fitts says, and often don’t recognise their signs and symptoms. “I think once people know about it, it’s like a light-bulb moment where they’ll go, ‘Ah ha, I see this now in some of my clients’ — where previously they may have attributed their behaviour to mental health or drugs and alcohol or a combination of those things. It may also be — or it may just be — the traumatic brain injury.”
Compounding the problem is that Aboriginal women often won’t access hospital or support services for complex reasons that can be traced back to settler colonisation. For another recent study, Dr Fitts and her team interviewed dozens of women and frontline workers in Queensland and the Northern Territory to better understand the barriers, which include a lack of awareness of brain injury symptoms, controlling partners stopping women from seeking help, and a fear of the violence escalating if they do.
But the most influential factor is a legitimate fear their children will be removed by protection agencies. As one woman in the study explained: “We won’t report when there is domestic violence. If there is any words that come from the woman that [her] children were there, children are considered at risk and so they are taken.”
A pathway into prison
Not that Indigenous women in big cities have it any easier. At Elizabeth Morgan House, a family violence service for Aboriginal women in Melbourne, case managers say women with suspected brain injuries struggle to access treatment largely because there are no public concussion rehabilitation programs in Victoria.
Instead, their symptoms affect their ability to work, care for family and leave violent relationships, while some use drugs or alcohol to cope with their pain and trauma, which can be a pathway into prison.
“Often our women have suffered years of abuse and a brain injury could have been acquired at any time, or more than once in the life of that relationship,” says Kellyanne Andy, the service delivery manager at Elizabeth Morgan House. “Many Aboriginal women are also misidentified [by police] as drunk or drug-affected when slurring their words instead of suffering the after-effects of assault due to racist stereotypes.”
Yet, again, few clients have been diagnosed, and often the best staff can do is give those with symptoms an information pamphlet and point them to a GP. “Many women are in survival mode after an incident of abuse; they need to ensure their children are safe … and their basic needs are covered,” Ms Andy says. “It means checking for long-term injuries, especially unseen brain injuries, is not a priority, or even considered.”
For staff supporting women in prison, the lack of affordable treatment options is particularly frustrating. Evidence suggests between 33 per cent and 80 per cent of women in prison have suffered brain injuries, frequently the result of domestic violence. But hardly any are screened or treated behind bars, workers say, so many continue struggling with symptoms after being released, sometimes only for the cycle to repeat.
“I saw a client in prison the other day who was diagnosed with an intellectual disability 10 years ago — in her words, she’s suffered a few ‘head knocks’ from violence,” says Angela, a case manager at Elizabeth Morgan House. “And she could say, ‘I’m not the same person, I’m not feeling right in my head, but people won’t listen to me’. She can’t get any treatment or have her concerns taken seriously … It’s frustrating because these women’s lives could be so different if they were diagnosed and supported to recover well.”
Hundreds of stories of hope
Many of Glynnis Zieman’s patients have been punched in the head, hit with weapons, pushed into walls or down stairs, or strangled — over the years she’s heard hundreds of disturbing stories.
“Despite how many people I’ve seen in these scenarios, there are times I have to come back to my office and just close the door for a little while,” says Dr Zieman, a neurologist and medical director of the Domestic Violence Brain Injury Program at the Barrow Neurological Institute in Phoenix, Arizona. “It’s a lot to hear what one human can do to another.”
Just about the only clinic of its kind in the United States, Barrow’s DV program launched in 2012, after a social worker on staff realised many of her homeless clients had suffered head injuries. Ten years and 700 patients later, the philanthropically funded program’s referrals are only increasing, Dr Zieman says, largely thanks to workers at local shelters, who are trained in screening clients for brain injury and pointing them to Barrow, where their treatment costs are fully covered.
There are two key features distinguishing domestic violence victims from concussion patients in the general population, Dr Zieman says. The first is the sheer number of injuries many abused women sustain. “It’s not like they have one injury and they’re given the opportunity to recover like an athlete would,” she says. “They have an injury … and then they keep getting injured. And so it becomes a chronic process which can lead to severe symptoms over time.”
The second feature is their vulnerability. TBIs affect patients’ ability to think clearly — a dangerous situation for women experiencing domestic abuse, a hallmark of which is coercive controlling behaviour.
“So if someone is not functioning at their best … that can be used as a tool to enable further injury and abuse, because victims can’t … [necessarily] defend themselves and … navigate themselves to safety,” Dr Zieman says. “So it goes both ways in that brain injuries are a consequence of domestic violence but they’re also a tool to continue it over time.”
At their first appointment, patients — about 95 per cent of whom are women — are asked about their most troubling symptoms and history of head injury and strangulation. A crucial part of this session is education, Dr Zieman says, particularly given many patients have never seen a doctor or understood why they feel so unwell — and no, it’s not because they’re “broken” or “delusional”. “Many of them have gone for years thinking that they’re dumb or crazy,” she says. “We hear that all the time, because their abuser told them that.”
And although domestic violence victims struggle with all the usual concussion symptoms, in Dr Zieman’s experience they tend to have more severe depression and anxiety. “The mood symptoms are very significant,” she says. “And often they affect each other — the situation they’re in may have caused PTSD or anxiety, and then the brain injuries make them more prone to those, and so it becomes this chronic process.”
She also suspects some patients may be dealing with more serious cognitive decline suggestive of CTE, which can only be diagnosed post mortem. A progressive disease attributed to the harm of repetitive head knocks, its symptoms overlap with several other conditions and can include memory loss, poor impulse control, severe depression and suicidality — though some people seemingly show no signs of illness at all.
“We hear stories where people are hit every day, so it’s hard to argue that there wouldn’t be an increased risk for [CTE],” Dr Zieman says. But she’s also quick to stress that most abused women won’t get dementia or CTE, and any who do will likely benefit from treatment and support.
As for treatment, Barrow’s approach is similar to mainstream concussion rehab programs that aim to address symptoms with a range of therapies and practitioners: physiotherapists, psychologists, optometrists. Women who have been strangled and sustained hypoxic brain injury sometimes require additional imaging of their neck and specific care — some, for instance, have trouble swallowing or speaking. But hypoxic injury generally resembles TBI, Dr Zieman says, and “just adds to the chronicity and severity of their symptoms”.
The magic ingredient, however — a major reason the majority of patients recover — is their social worker, who helps women sort out housing, employment and child custody issues, among others. “Our social worker is still the most instrumental person in the program,” Dr Zieman says. “Because … I can give patients all kinds of explanations for their migraines, but if they don’t know where they’re sleeping next week, their priority is somewhere else.”
It’s strange, then, that given how successful it is, Barrow’s DV program remains a rarity not just in the US, but globally. Dr Zieman believes one challenge is that the people who tend to be interested in this issue work in domestic violence services, which usually don’t have in-house medical expertise, or the funds to acquire it.
Instead, concussion clinics need to tailor their programs for victims of abuse, she says: “We’ve said from the beginning, we don’t want to be the only one doing this. Our advantage here was that we had the medical side already established, we had all the resources. Really, all we had to do was find the funding.”
Australia’s concussion care desert
For advocates in Australia, Dr Zieman’s clinic is a pipe dream. In Sydney, Nick Rushworth, the chief executive of Brain Injury Australia, is frequently contacted by women experiencing debilitating brain injury symptoms who mistakenly believe concussions only happen in sport.
“If you’re beaten around the head — or if you’re severely shaken, if you lose consciousness — you might think about that as a concussion,” he says. “But you may not necessarily connect the injury itself with the symptoms you’re now living with.”
Mr Rushworth began working in this space after he realised DV victims with concussions weren’t getting the same care and attention as elite sports players. “Many victim-survivors … with traumatic brain injury don’t have the luxury of choosing if or when to return home,” he says. “Yet there’s clear evidence, from decades of research, that if the brain isn’t allowed sufficient time to repair and recover, and another injury is [sustained], then the effect on the person can be cumulative.”
It’s one of the reasons he’s interested in CTE and dementia, which in Australia afflicts almost twice as many women as men and is the leading cause of death for women. “The prestigious Lancet Commission on dementia prevention [in 2020] added traumatic brain injury as one of three new modifiable risk factors for dementia,” Mr Rushworth says. “But that hasn’t yet filtered through to dementia research.”
Sarah Hellewell agrees domestic violence victims have an “under-appreciated high risk” of developing neurodegenerative diseases but are unlikely to be screened for them, as some professional athletes are. “It’s the kind of thing where if they start to have some cognitive decline and they go to their GP, whether they have a history of domestic violence probably isn’t part of the questioning.” she says.
Mr Rushworth also thinks it’s “surprising” that traumatic brain injury doesn’t seem to capture as much attention among DV advocates as non-fatal strangulation, which can cause hypoxic brain injury due to a lack of oxygen and is a red flag for serious harm and homicide.
“Of the one or two deaths that occur every week as a result of domestic violence, a primary cause would be brain death from assault or external force applied to the head,” he says. “And that might be at least one reason why traumatic brain injury, alongside anoxic-hypoxic brain injury from strangulation, deserves more attention in a policy and service delivery sense than it’s currently getting.”
As for what kind of attention it’s getting? Relatively little. People with persistent concussion symptoms often face two major hurdles, Mr Rushworth says. The first is that finding a GP with experience managing brain injury, let alone domestic violence, “is pretty much a lottery”, so patients will often bounce between doctors and specialists trying and failing to address their symptoms. Particularly if their MRI or CT scan comes back clear, patients are often “proverbially patted on the head, told to go home and hope for the best”.
The second hurdle is Australia’s lack of brain injury clinics offering multidisciplinary rehabilitation programs — widely considered to be the gold standard for treatment because they holistically target symptoms with coordinated, personalised therapies.
There are a handful of brain injury clinics at hospitals in major cities but many cater only for patients with severe injury, and none offer specific programs for victims of abuse. It’s why many experts suspect the dearth of TBI rehab services in Australia, particularly in the public health system, is a major reason why few domestic violence services screen for brain injury.
“There’d be nothing more sterile or unproductive than … implementing screening tools in family violence [services] when there’s nowhere to send someone who screens positively — there’s no services and support available for them,” Mr Rushworth says. “At the moment, outside a couple of boutique exceptions, it’s really only EDs and GPs. There are some concussion and mild TBI clinics popping up here and there, but nothing much else.”
(Dr Valera feels differently: “Knowledge is power,” she says, “And knowing that one is dealing with a brain injury can change how women are perceived and how they perceive themselves.”)
In New South Wales, public brain injury rehabilitation programs prioritise moderate and severe injuries over mild TBI, while local clinicians say units that accept concussion referrals are under-resourced — meaning patients often wait months for an appointment. Ideally, Mr Rushworth says, those programs should be expanded so they can accommodate all concussion patients with persistent symptoms, as well as cater for the specific needs of people with DV-related brain injury.
But governments are reluctant to fund more clinics, Mr Rushworth says, because of a fear “the floodgates will open” — that the sheer number of people needing treatment will “overwhelm” the system.
It’s why Brain Injury Australia is focusing on providing “specialist education and training for GPs”, he says. “And we’ve got plans afoot in Victoria to do that, too — to get GPs together, talk about concussion not only in a sporting context, but in other contexts as well.”
A doctor who encounters domestic violence victims with persistent concussion symptoms most days in their hospital clinics agrees more specialist resources and training are needed. If patients’ injuries are identified early and they’re given a “holistic” rehabilitation plan, most will have a “good prognosis”, says the doctor, who was not authorised to speak publicly.
But few are able to access that kind of care, and some are reluctant to report what’s happening: “The women I see are often very high-functioning, in senior professional roles, who have to be able to problem-solve and think rationally. So they won’t necessarily want to disclose the cause of their injury or its impacts. But their anxiety and fatigue can be crippling.”
‘I still have no feeling under my eye’
So why has such a vulnerable population — such a significant health issue that too often leads to unemployment, social isolation and an increased risk of suicide — been so neglected? Despite knowing how urgent the problem is, governments have done seemingly little to address it.
Two major reports in which NSW Health was involved raised serious concerns about the lack of attention to domestic violence and brain injury: Time is of the Essence in 2020, and a project report by Domestic Violence Service Management in 2018. Both described a lack of brain injury screening in frontline services, a lack of awareness of symptoms and long-term consequences among GPs and domestic violence workers, and a lack of public rehabilitation services, among other issues.
A NSW Health spokesperson told ABC News the department’s programs “align with the recommendations” of these reports. NSW Health has also committed to developing the Domestic and Family Violence Crisis Response which “responds holistically” to victims’ needs. The service will develop clinical guidance and referral pathways for brain injury and strangulation, the spokesperson said, as well as pathways for responding to head trauma for victims accessing NSW Health services.
Meanwhile, in Victoria, the 2018 report by Brain Injury Australia — which found 40 per cent of family violence victims attending hospital had sustained a brain injury — appears to have been sitting on a shelf, gathering dust.
The report, which was commissioned by the government in response to the Royal Commission into Family Violence, made four recommendations, including that the government develop brain injury resources for victims, perpetrators and the family violence sector; add screening questions to risk assessment tools; and pilot a brain injury service to support diagnosis and rehabilitation. Five years later, advocates are still waiting for meaningful change.
While Victoria’s family violence risk assessment framework, the MARAM, was updated in 2019 to help frontline workers identify brain injury, the usual bottlenecks appear. If workers suspect a victim may have a brain injury, they’re advised to “support” them in accessing “specialist neuropsychology care via a referral from their GP” — which depends on GPs having relevant experience and victims having the money to pay for specialists.
But as far as Brain Injury Australia is aware, the government has made no progress on the other three recommendations, and its attempts to check on progress with ministers have gone unanswered.
A government spokesperson told ABC News: “We know how devastating the impacts of concussions and acquired brain injuries can be — that’s why we are working closely with health services, corrections and family violence support services to ensure there continues to be a range of treatment and rehabilitation options for Victorians” — though it’s unclear what the options are for people with mild TBI. “Alfred Health and Austin Health both offer multidisciplinary care for Victorians with severe ABIs who require specialist subacute services as part of their rehabilitation.”
In Queensland, where a couple of government-funded concussion clinics have recently opened, Julie Sarkozi, practice director at Women’s Legal Service, says police officers responding to domestic violence also need training and education in how trauma can affect the brain. Victims will sometimes appear angry, confused or be slurring their speech — not necessarily because they’ve been drinking.
“Trauma-informed training should take those things into consideration,” she says. “And on top of that, being mindful the person you’re talking to may have experienced a brain injury — a concussion — or been strangled, therefore officers need to ask particular questions … and also know how to triage them.”
Ashley, for one, wishes police had asked more questions on the night she was knocked out before concluding she was the aggressor. If she’d breached her domestic violence order, she could have ended up in prison, and she’s still worried her police record could become a problem down the line.
“It’s hard for any woman or man to ask for help again after having a bad experience with the police,” she says. “We should be able to feel safe when police are around as that is their line of duty. But in more cases around the world that’s just not the case … Sometimes it’s worth listening, and thinking carefully about what has happened before making the wrong decision.”
But if her criminal legal risks have been manageable, her health issues threatened to derail her. For months after she was assaulted, Ashley endured a long list of concussion symptoms for which she’s never been treated. “I had massive, severe headaches that were just constant, every single day,” she says. “There were mornings where I’d wake up so nauseous I’d just run to the bathroom and vomit … and some nights I couldn’t sleep.”
And though her depression is starting to lift, still today her headaches, fatigue and light sensitivity affect her quality of life and ability to do her physically-demanding job — sometimes the pressure in her temples is so intense it feels as if her head is going to explode. “And I still have no feeling under my eye,” she says. “When I touch it, it feels numb.”
