The Disabilities Trust

Brain Injury and Domestic Abuse

The Disabilities Trust works alongside people with an acquired brain injury, autism, and/or learning or physical disabilities to help them live as independently as possible. Our high-quality services across the UK support people to move forward with their lives. These include: brain injury assessment and rehabilitation centres, hospitals, care homes, supported living accommodation, care in people’s homes and a school.

Through our Foundation, we also campaign, conduct research and pilot new ideas to amplify the voices of people who can’t access our core services. This includes those who are homeless and in the Criminal Justice System (CJS). From 2016-2018, in the first study of its kind in the UK, The Disabilities Trust provided a dedicated service to support the identification and rehabilitation of women with a history of brain injury, in HMP/YOI Drake Hall. This comprised staff training, the brain injury screening and provision of 1:1 support delivered through a Brain Injury Linkworker. From this work, we found that domestic abuse is a significant cause of brain injury amongst women in the CJS. As published in our ‘Making the Link’ report, 62% of the women we worked with sustained a brain injury through domestic abuse.

Why domestic abuse?

The distressing findings from our work in HMP / YOI Drake Hall illustrates the complex experience and vulnerability of women who have experienced the trauma of both brain injury and domestic abuse. Alongside other frequently reported vulnerabilities, such as substance misuse and unstable housing, the need to support women holistically, not just within the Criminal Justice System but beyond, is fundamental to improving these women’s lives. There is currently insufficient support available to survivors of domestic abuse and their needs tend to be treated separately by distinct mental health, substance use, criminal justice and housing or homelessness services. Support services, in addition, often lack the awareness, capacity or appropriate skills to work with women with a brain injury. Women who have experienced both a brain injury and domestic abuse may require additional, uniquely tailored support, which addresses both the trauma they have experienced and the symptoms of their brain injury.

Following the stark findings published in ‘Making the Link’, The Disabilities Trust carried out further analyses of the data collected at HMP/YOI Drake Hall through a domestic abuse ‘lens’ to further investigate any possible links between domestic abuse, brain injury, and health outcomes. Results published in ‘The impact of brain injury and domestic abuse; a further analysis’ showed those who had sustained their injury through domestic abuse had higher rates of self-harm (61%), mental health problems (41%) and were more likely to have committed violent crimes (46%) compared to those who had sustained their injury in other ways (e. g. road traffic accidents, etc).

To further the discussion on this often invisible area, The Disabilities Trust convened a roundtable in November 2019, where a panel of experts, including academics and representatives from leading domestic abuse charities and the NHS, were asked to discuss the needs of survivors who experience domestic abuse and may have sustained a brain injury. Experts were also asked how survivors with a brain injury could be better supported, alongside considering the gaps in awareness, research, practice and policy. From this discussion, The Trust published its ‘Brain Injury and Domestic Abuse: An Invisible Impact?’ report, successfully furthering the discussion with services, professionals and policy makers.

Following this work, we have recently undertaken an audit of acquired brain injury knowledge in practitioners (to be released 25th May 2021) who support survivors of domestic abuse. Practitioners working in domestic abuse services were invited to answer a short online survey to ascertain their perception of the prevalence of brain injury in those they support alongside their level of experience of, and understanding about, acquired brain injury. The results overwhelmingly showed that there is a gap in knowledge and understanding of brain injuries and the impacts on survivors’ lives.

Driving our work in this field are the voices of the women we worked with at HMP/YOI Drake Hall, who bravely shared with us their experiences of domestic abuse and their associated injuries, when our Linkworker service was independently evaluated by Royal Holloway, University of London. We believe that for successful, lasting and meaningful change to be implemented across service sectors for survivors with a brain injury it is imperative that the survivors’ voices are heard, listened to and acted upon throughout any research, policy development and service adaptations

Policy changes

Following campaigning from The Disabilities Trust, 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. Where police are attending a call out to a domestic incident, in the community, they could be accompanied with or shortly after visited by an Independent Domestic Violence and Abuse Advisor, who would be able to offer expert support to the survivor, including in relation to brain injury.

This commitment from the government will also introduce new standard questions to ensure all prisoners in England will be screened for acquired brain injury sustained through violence from April 2021. The Disabilities Trust 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 The Disabilities Trust and UK Acquired Brain Injury Forum (UKABIF) in a collaborative approach to highlight the need for this change.

Where next?

Research is still lacking into the prevalence of brain injury among survivors of domestic abuse in the UK, and how we can best screen for brain injury and support survivors. This is much needed to fully appreciate the real but ‘hidden impacts’ of a brain injury. Our aim is to work collaboratively with survivors of domestic abuse and the specialist practitioners who support them, to gather further evidence to drive forwards a change in policy and process. This work will seek to bring brain injury and its impacts to the forefront, ensuring its inclusion in training and holistic support for survivors nationally.

Providing a community response which is sustainable, alongside recognition from services of the complex and challenging nature of the problems in these survivors’ lives is critical. There is a clear need to develop appropriate pathways of support for survivors, alongside the introduction of screening to empower staff to conduct the screening and ensure women’s needs are met once identified and there are appropriate care pathways.

To work towards achieving these aims, The Disabilities Trust, with support from SafeLives are co-producing a research project with survivors, in order to understand the prevalence and impact of brain injuries in survivors of domestic abuse, alongside the interaction with other complexities, such as mental health. This research will gather the evidence to campaign for change and will drive the need for developing training provision and adaptive models to services. These will better equip service providers to be able to ask the right questions, understand the survivors needs and adapt their interventions in order to enhance engagement and recovery.

To read our new report, 'A Practitioners' Perception', click here.