Acquired Brain Injury
The latest (20 February 2026) publication in HMI Probation’s Academic Insight series examines the prevalence of Acquired Brain Injury (ABI) and links to domestic abuse in justice-involved women. The report “Acquired Brain Injury: An invisible consequence of domestic abuse for women in the justice system” is written by by Dr Hope Kent and Professor Stan Gilmour and makes the point that Acquired Brain Injury is an often hidden and poorly understood consequence of domestic abuse.
Physical assaults are often targeted at the head, face, and neck, and non-fatal strangulation is increasingly recognised as both a common feature of domestic abuse, and severe in its neurological impact. The resulting brain injuries can be significant in their consequences; impacting survivor’s memory, attention and concentration, speech and language skills, impulsivity, and vulnerability to mental health difficulties including suicidality and substance use.
However, because brain injury can occur with or without physical disability, these difficulties are often misattributed or misunderstood in justice settings as being behavioural issues, non-compliance, or mental health difficulties.
A consequence of domestic abuse
The authors start by explaining and defining Acquired Brain Injury (ABI). ABI is a spectrum condition, meaning that the consequences can vary widely from milder symptoms which may resolve completely within a number of weeks, to very significant lifelong impairment. Some of the main symptoms are highlighted in a helpful infographic reproduced below.
Prevalence
The authors share findings from a number of recent studies which “indicate that almost all women in contact with the justice system have experienced domestic abuse, and that ABI is a significant consequence – affecting the majority of justice-involved women”.
Despite this high prevalence, prison and probation officers rarely receive training on ABI, and many have misconceptions about what an ABI is and how it might affect the individuals they are working with.
Impact
Although most of the research on the outcomes in the justice system for people with ABI is with populations of men, the authors say there is sufficient evidence for justice-involved women with ABI which shows a consistent pattern:
- they face significantly more challenges both in custody and on probation
- they are more likely to have co-existing trauma, mental and physical health difficulties, and substance use difficulties
- they are more likely to have repeated contact with the justice system.
The review also lists some of the common additional barriers faced by women with ABI including that they are more likely to have substance use difficulties, diagnoses of mental health difficulties, significant histories of trauma, and to have attempted suicide, and they are more likely to reoffend.
It is important to note that ABI therefore often co-exists with, and can compound, existing adversity. For example, someone with mental health difficulties may find accessing support more difficult if they have an ABI; memory and executive function difficulties can impact their ability to firstly remember appointments, and then to arrange transport to get there. As a result, they may be judged as ‘unmotivated’ to access treatment or assessed as not complying with the terms of their probation supervision.
Studies suggest a number of helpful practical advice for probation officers working with women with ABI including:
- repetition of key points,
- having meetings in a quiet space free from distractions,
- making sure appointments are put into calendars with electronic reminders,
- and scheduling briefer and more frequent appointments.
All these actions are likely to improve the ability to engage with supervision.
Recommendations
The publications shares a helpful framework produced by the brain injury charity Brainkind. The framework includes three key points:
- ASK It is important to ask appropriate questions about brain injury to establish whether this is something that may be having an impact – including questions that are sensitive to injury through non-fatal strangulation, and appropriate for survivors of domestic abuse.
- UNDERSTAND Staff should have a sufficient understanding of the key symptoms that usually present as a result of brain injury.
- ADAPT Staff should feel confident to adapt their practice as a result.
