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Post-mortem analysis of Queensland NRL great Paul Green found he was suffering from a severe brain disease related to head knocks, chronic traumatic encephalopathy (CTE), before he took his life in August.

It was one of the most severe forms of CTE doctors had seen, shining a light once again on the long-term effects of concussions. 

Although there’s plenty of media surrounding sports-related CTE, experts want brain injuries sustained through domestic violence to also be given prominence. 

In 2015 an estimated three women were hospitalised every week with traumatic brain injuries due to domestic abuse, and 40% of victims hospitalised after family violence sustain a brain injury. 

A silent pandemic

In 2018, Brain Injury Australia released a study examining Victorian hospital data across 10 years to identify family violence-related cases and found a prevalence of brain injuries in 40% of women surveyed. It also found that 25% of children aged under 15 in family violence cases had sustained a brain injury.

Brain injuries can be caused by blows to the head, strangulation and poisoning. 

Brain Injury Australia executive officer Nick Rushworth says this data is the tip of the iceberg: “The vast majority of women and children who sustain brain injuries as a result of domestic and family violence don’t go anywhere near a healthcare setting.”

The report made four recommendations for the Victorian government, including developing and distributing information resources and adding screening questions to family violence risk assessments for brain injuries. 

These risk assessments are essential: CT scans are expensive and, as Rushworth says, providing one to everyone who sustained a head injury would “bankrupt Medicare”. What is needed is community education so that victims and frontline responders know what to look for. 

He says not enough has been done to respond to the report, especially given that the incidence and prevalence of domestic violence haven’t changed.

Why the focus on sports? 

Just 20% of acute post-concussion states in adults is sports-related. Most come from falls, car and cycling accidents, and violent assaults.

It took a long time for sports concussions to be taken seriously. But much of the attention since has focused solely on sport: in 2019, the Coalition government announced $50 million for traumatic brain injury medical research, noting that injuries can arise from “concussion from sport, to more serious injury following a road accident or an elderly person having a fall”. No mention was made of victims of domestic violence.

An extra $4 million was announced last year for research projects into new approaches for the prevention, diagnosis and treatment of sports-related concussions. And another $5.7 million was announced in 2020 to examine the long-term impact of concussions in children.

“Best practice [methods to] return to training, let alone competitive play for a concussed sports person, now only takes place after that sports person is genuinely asymptomatic and after all their symptoms have cleared,” Rushworth says. 

“But victims of domestic and family violence seldom have the luxury of choosing when to return home.” 

What’s being done about it?

The current 10-year national plan to end violence against women and children, released last week, is the first to discuss brain injuries among victim-survivors. But as it notes: “More research is needed to inform response and recovery efforts to be able to identify and treat traumatic brain injuries.” 

Australia’s National Research Organisation for Women’s Safety is conducting a study of Indigenous women living with traumatic brain injuries. They experience head injuries at a rate 69 times higher than other Australian women. The report is due to be released in December 2023. 

The Monash Gender and Family Violence Prevention Centre has received $1.9 million from the National Health and Medical Research Council to research brain injury in intimate partner violence.

Studies have found women are more susceptible to concussions and take longer to recover than men. The impacts of a concussion can last months, causing headaches, depression and brain fog, and traumatic brain injuries can cause life-long disabilities, especially if left untreated. 

CEO of Full Stop Australia Hayley Foster says aside from initial consultations, governments have yet to introduce proper training for frontline responders.

“This [is] very highly gendered in the sense that the response that you have … in sports [is a] completely different response than if you get it through an acquired injury, from strangulation or fatal strangulation, or minor concussions. It’s a massive, massive issue, but we have not seen traction on improvements,” she says.

While the national plan was a good first step, Foster says, “we don’t want just lip service. We really do need tangible acts and action to address those inequities.”

Gender-based violence is estimated to cost the economy $26 billion a year.

In a world first, the national plan has made a specific commitment to recovery, acknowledging the disability and life-long impacts that exposure to domestic violence can have on women and children. Both Social Services Minister Amanda Rishworth and Foster hope brain injuries will be a focus of recovery.

If you or someone you know is affected by sexual assault or violence, call 1800RESPECT on 1800 737 732 or visit 1800RESPECT.org.au. For anyone seeking help, Lifeline is on 13 11 14 and Beyond Blue is on 1300 22 4636. The Kids Helpline is 1800 55 1800. In an emergency, call 000.