Most of Illawarra-based psychiatrist Karen Williams's referrals are people experiencing depression or anxiety. As she works to uncover the underlying reasons for their illnesses she often finds a history of abuse and violence.
"So many women have experienced such horrific things and a lot of the time they don't even recognise that the events that have happened to them could potentially have long-term consequences."
Dr Williams is urging the New South Wales Government to adopt a concussion protocol for family and domestic violence victims.
"When a sports player suffers a head injury there is a precise protocol to follow," she said.
"But that is not happening to victims of family and domestic violence.
"So we need a protocol that identifies a woman that presents with an unexplained head injury, or an injury that may potentially have been caused by a partner, so she can be asked questions and provided treatment for a potential brain trauma."
Psychiatrist Karen Williams is leading a push to see a specific domestic violence concussion protocol introduced.(ABC Illawarra: Tim Fernandez)
South Coast Private Hospital Psychiatrist Karen Williams is leading a push to see a specific domestic violence concussion protocol introduced.(ABC Illawarra: Tim Fernandez)
In August, NSW Labor MP Anna Watson organised a video conference for Dr Williams with the NSW Attorney-General to press for the policy change.
"I actually don't think it will be that difficult, I think not having a protocol means that people just don't think about it," Ms Watson said.
"I recently asked an emergency doctor about it and they said, 'We don't have specific protocol for those women, true, but we have to have one for sports people because they are very likely to go back out on to the field and are likely to be in a high-risk situation again'.
"I said, 'Well, you are sending these women back home to their abusers aren't you?' and there was a pin-drop silence."
Forty per cent of victims suffer brain injury
Brain Injury Australia executive officer Nick Rushworth said much more understanding was required about head trauma.
"The public awareness about brain injury as a result of sporting activity concussions is incredibly high," he said.
"But the awareness about the potential for brain injury for domestic and family violence is equally low."
A 2018 study found 40 per cent victims of family violence sustained a brain injury.(ABC News: Elena De Bruijne)
In 2018, Brain Injury Australia released the first study of its kind in Australia looking at the prevalence of brain injury in victims of domestic violence.
It found that 40 per cent of victims of family violence who attended Victorian hospitals over a 10-year period sustained a brain injury.
The study found that 31 per cent (5,007) of family violence cases were children under the age of 15, and 25 per cent (1,252) of those victims sustained a brain injury.
A literature review also provided evidence that brain injuries were seldom diagnosed in female victims of intimate partner violence, despite the fact that more than 80 per cent of those who attended hospital had facial injuries.
Mr Rushworth said the result was "all tip and no iceberg".
"What it didn't capture was the number of brain injuries sustained by women and children in the community that would not have gone anywhere near a hospital setting," he said.
Mr Rushworth says "in each and every context" of women and children presenting for domestic and family violence services and support more questions need to be asked.
"They should be asked a couple of key questions for the purposes of further testing assessment and specialist referral," he said.
More research, resources needed: brain specialist
Brain rehabilitation specialist Steven Faux from St Vincent's Hospital and University of New South Wales said there needed to be broader thought about the causes of trauma.
Steven Faux hopes to see more attention paid to the psychological and social aspects of brain trauma.(ABC News: Elena De Bruijne)
"Research we have conducted indicates around 15 per cent of people will suffer on going symptoms three months after a mild concussive illness," he said
"There is also a cumulative effect of mild traumatic brain injury and traumatic encephalopathy can be caused down the track."
He says while it is a complex field he believes it needs more resources.
"It is high time that the government starts to pay attention to some of the psychological and social aspects to trauma," Dr Faux said.
"It would be very good to develop resources, toolkits and research into the cause of trauma from domestic and family violence."
Government must move quickly: MP
Ms Watson is also calling on the NSW Government to act.
Anna Watson is demanding the NSW Government introduce specific domestic violence concussion protocols by the end of the year.(ABC Illawarra: Tim Fernandez)
"In 2020, if we can't identify that these women need medical assistance, then something is very, very wrong here," she said.
"There are protocols in place for athletes and sports people, it would be very easy to lift that set of protocols.
"There might be a few questions that need to be changed but there is no reason it can't be done."
NSW Attorney-General Mark Speakman said he thanked Dr Williams and Ms Watson for their time and was seeking further advice.
In a statement, NSW Health said it was redesigning its violence, abuse, and neglect services:
"To enhance the capacity of the public health system to provide 24-hour, trauma-informed, and trauma-specific integrated responses to sexual assault, child physical abuse and neglect, and domestic and family violence," it said.
"A medical and forensic model will include clinical guidance on screening and imaging for suspected concussion/head trauma."
ABC Illawarra/ By Kelly Fuller