First Nations women don't always access health care after head injuries from family violence. Here's why

Please be advised this article contains details of family violence.

Aboriginal and Torres Strait Islander women are 69 times^[1] more likely than non-Indigenous women to be hospitalised with head injuries due to assaults.

But some Aboriginal and Torres Strait Islander women don’t access^[2] health care and support services after head injuries from family violence. Our research^[3], published this week, explored some of the reasons why – and how these barriers can be overcome.

We found fear of child removal, poverty, coercive control and low awareness of traumatic brain injury related to family violence^[4] can all impact on when and how Aboriginal and Torres Strait Islander women access health care and support services^[5].

Read more: First Nations women are 69 times more likely to have a head injury after being assaulted. We show how hard it is to get help^[6]

What is traumatic brain injury?

Traumatic brain injury is caused by^[7] a blow, jolt or bump to the head. Non-fatal strangulation^[8] can also lead to brain injury as the brain is deprived of oxygen.

Traumatic brain injuries vary from mild to severe, and can cause a range of behavioural, emotional, physical and psychological symptoms, including^[9]:

• poor memory
• dizziness
• headaches
• lack of concentration
• slowness to process information or make decisions
• emotional dysregulation, such as inability to control anger
• anxiety and depression
• lack of insight, where the person with the injury does not realise the effect of their injury.

The experience of brain injury^[10] is unique to each person.

The degree of recovery is largely determined by the nature and extent of the injury as well as the level of engagement in rehabilitation. For moderate to severe^[11] traumatic brain injury, recovery is most rapid in the first six months after the injury.

Even mild traumatic brain injury can have long-term impacts^[12] on wellbeing, parenting capacity, relationships and day-to-day living.

Recovery can be maximised by providing education about the short- and long-term management of symptoms as well as the involvement of family in the rehabilitation and recovery phase.

Listening to First Nations women

To find out why Aboriginal and Torres Strait Islander women don’t always access services^[13], we completed interviews and focus discussion groups with 28 women and 90 service provider professionals in Queensland and the Northern Territory.

Our study focused on Aboriginal and Torres Strait Islander women, as their voices are often silenced^[14] when it comes to women’s safety.

Read more: 'She was the most important person to us' – R. Rubuntja's story shows society is still failing First Nations women^[15]

Fear of child removal

In results similar to those from family violence studies, women told us they avoided health care or minimised the amount of information they shared with health professionals to reduce the risk of contact with child protection authorities. One woman told us:

We won’t report when there is domestic violence. If there is any words that come from the woman that [her] children were there, children are considered at risk and so they are taken.

Some women told us their children had been removed following reporting and seeking support following family violence.

Risks of further violence

Sometimes women were prevented from accessing health care by manipulation and coercive control. This included partners preventing them accessing a working phone or transport.

One service provider said:

A lot of users of violence I guess employ such a level of control and coercion that sometimes women are prevented from seeking medical treatment, or attempts to seek medical treatment, or disclose violence, including assaults to the head. It might actually make the situation worse.

Women prioritise competing demands

Community-based service providers recognised the strength and resilience of women in continuing their roles caring for children and other family members after experiencing family violence.

Service providers told us their clients were often also managing financial and housing worries. One service provider told us:

When a woman arrives here, the most important thing is rest, food, and finding that space to just sit with what’s happened, and then medical attention. I don’t always hear women prioritising medical attention in the first instance. I think that rest definitely, and even hunger, on a real, basic survival level.

Read more: Explainer: what is traumatic brain injury?^[16]

Awareness of brain injury

Community members and leaders we spoke to had low levels of awareness, knowledge and recognition of the long-term damage violence can have on the brain. One community member said:

We didn’t know about this brain injury.

Another participant said:

I didn’t go to the hospital. I had a bit of [a] headache, didn’t think it was serious enough to [go] and get checked, it [headache] went away. It happened many times. One time I black out, wasn’t aware of the lasting harm that can cause.

So what are the solutions?

There are a range of opportunities to address several of these barriers.

First, service providers (including within child protection systems^[17]) need to ensure women receive compassionate care, referrals and links to support services for traumatic brain injury in a meaningful, timely and appropriate way.

There are strong calls^[18] to have community-controlled organisations deliver child protection services – with many potential benefits to families and communities.

We also need to resource communities to design, implement and evaluate traumatic brain injury prevention and early intervention solutions.

Community-wide and school-based education were among some of the recommendations from community members to help people recognise the signs of traumatic brain injury and the importance of seeking help.

Other strategies to improve access to services include placing supports such as social workers outside of acute, hospital settings – for example, in GP clinics^[19] and Aboriginal Community Controlled Health Services.

Finally, front-line staff and university students need high-quality training and education about traumatic brain injury and family violence^[20], how it presents in parental behaviour, case management and referral pathways.

Any practical solutions must be implemented through local partnerships with Aboriginal and Torres Strait Islander peoples to ensure the measures are community-led, culturally safe and provide an overall benefit, without doing further harm.

Read more: New research reveals harrowing stories of murdered Indigenous women and the failure of police to act^[21]

If this article raises issues for you or someone you know, contact 1800 RESPECT^[22] (1800 737 732) or 13YARN^[23] (13 92 76). In an emergency, call 000.

Jody Barney is a co-author on the journal paper on which this article is based. The authors thank the project team, advisory group and participants who shared their time and knowledge.

References

1. ^{^} 69 times (www.mja.com.au)
2. ^{^} don’t access (www.tandfonline.com)
3. ^{^} research (www.tandfonline.com)
4. ^{^} family violence (www.indigenousmhspc.gov.au)
5. ^{^} access health care and support services (www.anrows.org.au)
6. ^{^} First Nations women are 69 times more likely to have a head injury after being assaulted. We show how hard it is to get help (theconversation.com)
7. ^{^} caused by (www.archives-pmr.org)
8. ^{^} Non-fatal strangulation (doi.org)
9. ^{^} including (pubmed.ncbi.nlm.nih.gov)
10. ^{^} experience of brain injury (synapse.org.au)
11. ^{^} moderate to severe (www.braininjuryaustralia.org.au)
12. ^{^} long-term impacts (www.ncbi.nlm.nih.gov)
13. ^{^} access services (www.tandfonline.com)
14. ^{^} silenced (theconversation.com)
15. ^{^} 'She was the most important person to us' – R. Rubuntja's story shows society is still failing First Nations women (theconversation.com)
16. ^{^} Explainer: what is traumatic brain injury? (theconversation.com)
17. ^{^} within child protection systems (doi.org)
18. ^{^} strong calls (www.familymatters.org.au)
19. ^{^} GP clinics (www.tandfonline.com)
20. ^{^} education about traumatic brain injury and family violence (www.ncbi.nlm.nih.gov)
21. ^{^} New research reveals harrowing stories of murdered Indigenous women and the failure of police to act (theconversation.com)
22. ^{^} 1800 RESPECT (1800respect.org.au)
23. ^{^} 13YARN (www.13yarn.org.au)