Supporting Survivors with Traumatic Brain Injuries

Concussions in the Spotlight: Supporting Survivors with Traumatic Brain Injuries

by Kirstin Scansen-Isbister for BWSS

Traumatic brain injuries (TBIs) can be extremely challenging, life-changing events.

They are also shockingly common among survivors of intimate partner violence (IPV). It is estimated that anywhere from 60% to 92% of survivors of IPV receive head trauma during the abuse they experience. While not every incident of head trauma results in traumatic brain injury, according to Brain Injury Canada, between 35-80% of women who are affected by IPV experience symptoms of TBI.

Yet, there remains a great deal of stigma surrounding a TBI diagnosis. Many people don’t have a fundamental understanding of what a brain injury is, what symptoms to look out for, or what steps to follow when a brain injury is suspected.

BWSS knows that survivors who have experienced TBI require supports from professionals who understand the unique challenges they face, and who will help them identify and overcome these obstacles on their journey to safety and healing.

Much of the public focus around brain injuries in Canada has been on their prevalence in sports. Many resources have gone in to preventing and treating brain injuries in athletes, and “Return-to-Play” treatment protocols centre the needs of athletes, primarily football or hockey players.

On May 16th, YWCA Metro Vancouver, with former NHL player Trevor Linden, launched its My Concussion Story campaign to raise awareness about traumatic brain injury amongst survivors of intimate partner violence.

According to statistics calculated by the YWCA and verified by SOAR (Supporting Survivors of Abuse and Brain Injury through Research), for every NHL player to experience a concussion, 7000 Canadian women, girls, and gender-diverse survivors of IPV suffer the same injury. This shameful statistic underscores how survivors of violence have been largely overlooked in the discussion about TBI.

Brain injuries amongst those who have experienced IPV are under-diagnosed, and survivors of violence who have experienced brain injuries are alarmingly misunderstood and underserved by medical professionals, police, and the legal system.


What are Brain Injuries?

Brain Injury Canada defines brain injuries in two categories: traumatic and non-traumatic.

Traumatic brain injuries are caused by an external force coming in contact with the face, neck, or head, which can include “blows, bumps and jolts” to the head. What are commonly known as concussions are, in fact, minor traumatic brain injuries (mTBI). However, the term “minor” is a misnomer, a designation that obscures the difficult reality that living with such an injury often entails.

For women and gender-diverse people in the physically- and emotionally-tasking process of leaving an abusive relationship, a “minor” traumatic brain injury can present major challenges and barriers to safety.

Non-traumatic brain injuries are “caused by something that happens inside the body, or a substance introduced into the body that damages brain tissues”. Examples of non-traumatic brain injuries can include stroke, encephalitis, and aneurysm. Non-traumatic brain injuries can also result when oxygen is unable to be transported to the brain- such as through strangulation. The resulting injury may be referred to as a hypoxic or anoxic brain injury, depending on the severity of the violence.


How does a Traumatic Brain Injury affect survivors of violence?

In our work supporting survivors who have experienced or are experiencing violence, BWSS knows firsthand the immense impact that TBI has on survivors’ ability to access safety.

Concussions are often referred to as “invisible injuries” since sufferers may look normal, despite experiencing debilitating symptoms.

Fraser Health’s Concussion Clinic notes that minor TBI can result in physical, cognitive, and emotional symptoms such as headaches, sensitivity to light and noise, insomnia, anxiety, depression, neurocognitive fatigue, inability to focus or concentrate, and dizziness, among many other symptoms. In most cases these are temporary, but can linger for months or years, affecting a survivors’ ability to navigate the complex systems of support needed to leave an abusive relationship. A survivors’ financial stability- and economic independence- might be precarious during this time, as they may need to take extended time off work to recover.

Rest is the cornerstone of TBI recovery and healing. Medical professionals who are versed in the treatment of TBI will likely suggest some form of passive recovery that includes prolonged rest and elimination or reduction of screentime on smartphones, laptops, and televisions. Treatment is best provided in the first day or two after injury, otherwise the severity of symptoms increases, as does healing time overall.

For someone recovering from a concussion, the need for quiet and darkness may be essential to overcoming excruciating symptoms.

Recovery from a minor traumatic brain injury is made far easier when someone has a network of support around them to rely on. For a woman in an abusive relationship, the abuser may have cut them off from family and friends- key supporters whose involvement in the recovery process might have been a determining factor in alleviating the severity of their symptoms and reducing the timeline of healing.

We know that abusers often restrict or attempt to restrict the movements of their partners. A controlling partner may prevent a survivor from seeing health care professionals who may be able to assist in brain injury recovery such as a physician, physiotherapist, chiropractor, or neurologist. While athletes may have the opportunity to fully rest, recover and heal before making the decision to play sports again, survivors in abusive relationships can be subject to repetitive trauma to the head, compounding their injuries further.

Recovery from a brain injury is a difficult process for anyone, but for survivors of IPV, the healing path can be fraught with crisis, isolation, and injustice.


Traumatic brain injuries and the family legal system

BWSS has long recognized that the family legal system can be volatile and re-traumatizing for survivors seeking justice.

Recent research out of the University of British Columbia Okanagan reveals the troubling relationship between TBI, IPV and family law. Ethicolegal considerations of screening for brain injury in women who have experienced intimate partner violence was conducted in collaboration with SOAR (Supporting Survivors of Abuse and Brain Injury Through Research), a “multi-disciplinary, community-engaged, non-profit initiative that explores the intersection of brain injury (BI) and intimate partner violence (IPV), and applies scientific evidence to increase awareness, and improve supports and services for survivors.”

The study highlights that in parenting disputes, such as child custody or access cases, a diagnosis of brain injury acquired through IPV can be used by the abuser’s legal counsel to argue against a woman’s parenting ability. In their interviews with 12 family lawyers, researchers asked participants to examine their legal strategy for a hypothetical case involving a woman who acquired a TBI as a result of IPV.

Researchers found that the lawyers “unanimously expressed their strategy as opposing counsel would include using a brain injury to argue the mother is unfit to parent, as their professional duty is to represent the best interests of their client.”

The legal system has long been stacked against survivors of IPV, and this research highlights how discrimination against survivors, including those with TBI, is built into the legal system itself. UBC Okanagan’s article profiling the research describes how, “current legislation and confidentiality laws surrounding health information leave these women vulnerable as the brain injury can be disclosed in court regardless of their preference, and also be critically examined and weaponized by opposing counsel.”

Now more than ever, judges, lawyers, court workers, and legal advocates need to understand the dynamics of IPV, especially as it relates to TBI.

There are effective ways to support survivors and manage symptoms of brain injuries that do not interfere with a survivors’ ability to parent their child. Survivors should never be punished by the legal system for having experienced violence at the hands of an abusive partner.


Responding to TBI

At BWSS, we believe that front-line service providers who support survivors of IPV should be able to recognize and respond effectively to a woman who may be suffering from a brain injury. However, more training is needed to equip front-line staff with the education they need to understand the signs and symptoms of TBI. Without these tools, it can be difficult for front-line professionals- even anti-violence professionals such as transition house or shelter workers- to provide effective and appropriate care to survivors of violence.

In a recent Vancouver Sun article, former Kelowna Women’s Shelter Executive Director Karen Mason reflected on her experience of providing services to survivors of violence without a framework of knowledge on TBI: “Thinking about women we serve who come across sometimes as oppositional, come across as difficult, forget to do chores in the shelter, forget appointments, seem to get angrier than some others,” said Mason. “What if these women have had a brain injury and we don’t know? And are there things we could be doing to serve them better?” Without sufficient training to recognize, understand, and serve survivors with TBI, front-line workers can miss opportunities to provide the best possible supports for survivors.


Next Steps: Traumatic Brain Injury and Intimate Partner Violence

Along with their partners, YWCA’s My Concussion Story campaign is calling for “more research on intimate partner violence and traumatic brain injury, increased education among front-line responders and direct investments towards supportive services for people who have experienced concussion because of intimate partner violence.” We couldn’t agree more that these are crucial next steps that need to be taken to ensure that survivors of violence are supported in their recovery journeys.

BWSS knows that reducing stigma by raising awareness about traumatic brain injury is incredibly vital.

TBI education and training for front-line professionals including medical professionals, police, judges, lawyers, legal advocates, and women’s support workers is essential to ensuring that survivors are treated fairly and justly within healthcare, legal, and anti-violence settings.

We want to ensure that increased awareness translates to tangible improvements to the ways that survivors fleeing violence are served. To maximize supports for survivors with TBIs, BWSS calls for the development of assessment and treatment protocols to meet the particular needs of IPV survivors who have experienced TBI. These may be informed by Return-to-Play protocols but are unique to the challenges that survivors face in seeking safety.

We also call for the development and expansion of specialized supports for survivors who have experienced TBIs as a result of intimate partner or domestic violence. Survivors of IPV who have experienced strangulation, for example, require specialized care and supports. At this time, survivors in the Lower Mainland can access the Strangulation Clinic, offered by the Fraser Health Authority in Surrey. Here, survivors receive assessment, documentation, counselling, and other treatment services for their injuries, but these services need to be available province-wide, and in rural, remote, and Indigenous communities as well.

At the end of the day, increased awareness of the relationship between intimate partner violence and traumatic brain injuries is crucial, but we need to prevent survivors from experiencing brain injuries in the first place. Ultimately, we need to prioritize the elimination of intimate partner violence and gender-based violence in our province through affordable housing, ensuring safety for survivors in the healthcare and legal systems, and sustained, long-term funding to anti-violence organizations.