Domestic Abuse Bill

Written evidence submitted by The Disabilities Trust (DAB96)

Domestic Abuse Bill Written Evidence

The Disabilities Trust

The Disabilities Trust

1. The Disabilities Trust is a nationwide charity offering specialist community-based and residential support for adults with acquired brain injury, complex physical or learning disabilities and for people with autism, including those in education. Working alongside those supported by The Disabilities Trust, their families and friends, local authorities, health authorities, housing associations and other organisation, The Trust provides leading-edge services, meeting the needs of people with complex and challenging disabilities.

Introduction

2. The Disabilities Trust welcomes the opportunity to respond to this call for evidence on the Domestic Abuse Bill. The Domestic Abuse Bill is a welcome opportunity to deliver lasting positive change for women and girls who experience extensive violence and abuse and may go on to face multiple and overlapping disadvantages throughout their lives.

Acquired Brain Injury

3. A Brain injury is acquired either by sustaining a blow to the head (often called traumatic brain injuries or TBI) or by having an illness that causes brain injury. It can happen through road traffic accidents, assaults or falls. It can also be caused by illness, such as encephalitis, a brain haemorrhage, a stroke (also called cerebrovascular accident or CVA) or a brain tumour. Survivors of abuse commonly suffer blows to the head and strangulation, which may cause a brain injury.

4. In the vast majority of cases, an initial brain injury leads to some change in the person's level of consciousness. There is often a period of time where the person is completely unconscious, or in a coma.

5. Brain injuries are also referred to as a ‘hidden disability’ as they can result in a range of cognitive, behavioural, emotional and psychological symptoms which aren’t immediately obvious and often go undiagnosed. Symptoms can include (but are not limited to) poor memory, lack of concentration, slowness to process information, emotional dysregulation, anxiety and depression and fatigue, all of which may hinder a women’s ability to engage with support services1.

Brain Injury and Domestic Abuse

6. Whilst research in the UK is immature, there are some international studies examining the role of domestic abuse and traumatic brain injury. For instance, a study conducted in the United States examined men and women (95% of the sample were women) who had been referred to a traumatic brain injury clinic from either a domestic abuse or women’s shelter. Researchers found 88% had sustained more than one brain injury. Moreover, only 21% reported visiting a physician or medical professional after their injury2. This study indicates that not only may traumatic brain injuries be common amongst those suffering from domestic abuse, but it may also be difficult to estimate how many women are affected as fewer than a quarter sought medical attention.

7. Previous research conducted by The Disabilities Trust at HMP/YOI Drake Hall, from 2016 to 2018 found 64% of female offenders reported a brain injury. Of 100 women, the leading reported cause was domestic abuse (62%)1. In light of these findings, The Disabilities Trust conducted additional analysis of its data and found that of those with a traumatic brain injury, 40% also had a mental health diagnosis. Women with a brain injury were also seven times more likely to have a mental health diagnosis compared to those without a brain injury3. These findings further illustrate the complex experience and vulnerability of those who have experienced both domestic abuse and a traumatic brain injury.

8. There is currently insufficient support available to this group of women 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.

9. For instance as a result of a brain injury:-

- Survivors may experience poor memory and struggle to retain the information given to them by support services.

- Survivors may experience slowness to process information given, particularly if lots of information is presented at one time.

- Survivors may struggle to make decisions or struggle to control their impulses.

- Importantly, survivors may have a ‘lack of insight’ wherein some people overstate or understate their abilities or needs based on their understanding of their brain injury.

10. In November 2019, The Disabilities Trust hosted an expert roundtable to discuss the needs of women who have experienced both domestic abuse and a brain injury. The roundtable also covered how these women could be better supported, alongside considering the gaps in awareness, research, practice and policy. The event was attended by representatives from leading domestic abuse charities, academics and representatives from NHS England.

11. Recommendations, which were derived as a result of the roundtable, included:

· The need for collaboration between experts in domestic and brain injury to bring the discussion forward

· A critical need for further research on the prevalence, impact and causality of brain injuries amongst those who have also experienced domestic abuse

· Further research and development of sensitive, and trauma informed brain injury screening methods

· Training and awareness raising initiatives for all professionals who engage with survivors about brain injury4

12. Women experiencing multiple disadvantages are likely to come into contact with a range of publicly funded services. These services often don’t have the required skills or capacity to support them, and frequently fail to recognise the impact of a brain injury. Whilst the Domestic Abuse Bill is a fundamental step in transforming the way in which we respond to domestic abuse, the current bill omits brain injury and its negative impacts.

13. 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.

Key Recommendations

14. The Disabilities Trust recommend the non-statutory commitments include:

· the introduction of appropriate brain injury screening at the first point of engagement with services for survivors

· the provision of appropriate brain injury training for all domestic abuse services and public services

· the provision of brain injury support

· mandatory brain injury screening for all female offenders at the first point of their engagement in the Criminal Justice System.

15. In turn, The Disabilities Trust will continue with its ambitions to further understand the link between traumatic brain injury and domestic abuse. This includes additional research, in collaboration with experts in domestic abuse and understanding the experiences of those with lived experience.

16. For further information, please contact The Disabilities Trust at foundation@thedtgroup.org or on 01444 237268.

June 2020

References:

1. The Disabilities Trust. (2019). Making the Link: Female Offending and Brain Injury. Available at: https://www.thedtgroup.org/media/163462/making-the-link-female-offending-and-brain-injury-final.pdf

2. Zieman, G., Bridwell, A., & Cardenas, J. (2017). Traumatic Brain Injury in Domestic Violence Victims: A Retrospective Study at the Barrow Neurological Institute (P6. 160)

3. The Disabilities Trust. (2019). The Impact of Brain Injury and Domestic Abuse: A Further Analysis. Available at: https://www.thedtgroup.org/media/163732/the-impact-of-brain-injury-and-domestic-abuse-a-further-analysis.pdf

4. The Disabilities Trust. (2020). Brain Injury & Domestic Abuse: An Invisible Impact. Available at: https://www.thedtgroup.org/media/163863/brain-injury-domestic-abuse-an-invisible-impact-final.pdf

 

Prepared 18th June 2020