We must address the links between brain injury, domestic abuse and women in prison

According to government data, at least 57% of women in prison or under probation supervision are victim-survivors of domestic abuse. The actual figure is likely to be much higher, due to well documented barriers to disclosure. The importance of gender specific, trauma responsive programmes of support is gradually becoming recognised.

Organisations such as One Small Thing are leading efforts to demonstrate how a justice system which recognises, understands, and responds to trauma (such as experience of domestic abuse) can provide an alternative, more compassionate way to support justice experienced women in the community.

An important aspect of trauma responsive practice includes the appropriate identification and treatment of those with lived experience of domestic abuse, who may be suffering with the hidden effects of brain injury.

Due to a lack of awareness amongst justice professionals and no routine screening for acquired brain injuries (ABI), the cognitive, emotional and behavioural effects can often be misunderstood or misdiagnosed as other conditions.

The consequences of brain injury can have a detrimental impact on a survivor’s journey through the criminal justice system. They can impact on interactions with Police Officers, understanding of the Court environment, engagement with interventions, ability to cope within a Prison setting, transition back into the community, engagement with Probation, compliance with Community Order/Licence conditions and susceptibility to exploitation.

In 2018, Brainkind (previously The Disabilities Trust) conducted a ground-breaking study at HMP Drake Hall which highlighted that 64% of women had reported a history indicative of brain injury caused by domestic violence. Brainkind built on these findings in their most recent Too Many To Count report, which revealed that 1 in 2 people who have experienced domestic abuse in England and Wales in this study may be living with a brain injury.

This compares to the prevalence of traumatic brain injury in the general population of the UK which is approximately 1 in 8. Furthermore, 75% of people in this study disclosed that they had been held at least once in a way that prevented them from breathing.

Concerningly, some victim-survivors may not recognise the potential serious, long-term impact of trauma to the head, neck or face. This, along with factors such as controlling and coercive behaviour by a perpetrator, may result in them not accessing medical assessment. This can result in victim-survivors not linking symptoms with a possible head injury.

In the context of domestic abuse, the effects of brain injury may create additional barriers that impact a survivor’s ability to leave an abusive relationship. For professionals, this may also impact safety planning.

Moreover, injuries can also accumulate over repeated incidents of abuse. Non-fatal strangulation or suffocation, resulting in hypoxic and anoxic brain injury (i.e. total or partial oxygen deprivation to the brain), is a particularly prevalent, insidious, and often invisible mechanism of brain injury for victim-survivors of domestic abuse.

In recognition of the above, Headway – the brain injury association has developed a range of resources for professionals, and developed ‘Intimate Partner Violence (IPV) and brain injury training’ through its Justice Programme.

Headway also provide a free Brain Injury Identity Card scheme, recognised and endorsed by the National Police Chief’s Council, Police Scotland and Police Service of Northern Ireland. Each card is personalised, helping the card holder to explain the effects of their brain injury and request specialised criminal legal assistance. The charity also provides confidential advice, signposting and support to survivors, family members and professionals through the Headway Helpline.

The United Kingdom Acquired Brain Injury Forum (UKABIF) are spearheading efforts to raise the profile of ABI through collaborative working and established a domestic abuse working group as part of the Acquired Brain Injury Justice Network in January 2024. The populations of interest to the group include both victim-survivors of, and perpetrators of, domestic abuse who are in contact with the criminal justice system and may be affected by ABI.

The Centre for Women’s Justice are also working with women with lived experience of domestic abuse and the criminal justice system to press for reforms in law and practice, to end the unjust criminalisation of victim-survivors of gender-based violence.

Proactive steps taken by the government include:

  • Flagging acquired brain injury as a potential health need requiring specialist support in Domestic Abuse Protection Notices/Orders guidance for the police;
  • The introduction of Section 70 Domestic Abuse Act 2021, which introduced Non-fatal strangulation or suffocation as a specific offence.
  • Funding IFAS – Institute for Addressing Strangulation, who in partnership with Safelives and Bangor University, raise awareness of strangulation and the associated risks.

However, additional partnership working between domestic abuse and brain injury charities, healthcare and justice professionals, experts by experience, and government bodies will be crucial to take this work forward. Only then can we establish a trauma informed, gender specific approach to addressing the link between brain injuries sustained through domestic abuse and justice involved women.

Charlotte Curness is the Justice Programme Manager for Headway – the brain injury association and member of the ABI Justice Network.