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THE number of women being hospitalised for head and neck injuries after being assaulted by a partner is just the tip of the iceberg when it comes to domestic violence in the Hunter, according to the region's support services.
The Australian Institute of Health and Welfare will release its report Family, domestic and sexual violence in Australia: continuing the national story 2019 on Wednesday, which presents new data on children and other vulnerable population groups - including a finding that one in six women and one in nine men experience physical or sexual abuse before 15 - and provides new analysis on the risks, prevalence, support services and outcomes of violence.
AIHW spokesperson Louise York said the report shows that even though overall violence from any person has declined, rates of partner and sexual violence have stayed relatively stable since 2005.
Bureau of Crime Statistics and Research figures for domestic violence-related assault show the five year trend and average annual percentage change from January 2014 to December 2018 is stable across the Hunter's local government areas, except for Maitland, which saw an increase of eight per cent and Singleton, with an increase of 10.2 per cent.
Yet, the AIHW said, the number of people accessing services including police, hospitals, child protection and homelessness support due to family, domestic and sexual violence continues to rise.
Carrie's Place Domestic Violence and Homelessness Services chief executive officer Jan McDonald said her team was "as busy as we have ever been, if not more".
"If we look at the intersection of homelessness and domestic violence, they are getting slammed every day," Ms McDonald said.
"The need that exists is way more than our capacity to respond and is never ending.
"The demand continues at a high level and there is no relief in sight.
"We are flat out and feel like we hardly ever make progress.
"Our workers have amazing outcomes with individual clients but there's two or three to fill that space as a woman moves out of the service.
"There are six women in the mix every time a woman vacates the refuge."
Ms McDonald said public awareness about support services like Carrie's Place and willingness to report violence continues to grow.
She said high demand for services aside, it was difficult to confirm whether the incidence of domestic violence was stable, increasing or decreasing, because you "never know what the [real] starting point is".
"We find the average time people take to ask for assistance is eight to ten years," she said.
"Based on what clients tell us only 50 per cent or less that come to us have had any contact with the justice system. BOCSAR draw their stats from the justice system.
"They only look at stats where there's been a police call that has resulted in a charge and been prosecuted."
She said every time a general duties police officer in the Lower Hunter - excluding Newcastle and Lake Macquarie - attends a domestic violence-related incident they record it in a system accessible to Carrie's Place workers.
"We contact every victim of violence and for the past three years the numbers have been around 3100 per annum, so that's eight a day, every day of the year," she said.
"We have ads, campaigns and White Ribbon Day but we need our leaders to be talking this up as the country's number one issue.
"For 50 per cent of the population, one in three are not safe every day of their life. It's not okay at all."
Victims of Crime Assistance League chief executive Kerrie Thompson said her team had seen a 35 per cent increase in the number of women disclosing domestic violence and seeking help in the past year, but not all had reported it to police.
She said of particular concern was a rise over the past 18 months of reports of non-fatal strangulation or choking and head and neck injuries, which were now the two most common forms of physical violence reported to her organisation.
"It's gone from in the past people saying 'He pushed me, shoved me, kicked me' to 'He grabbed my throat straight away and put pressure on' and them blacking out for a minute or going unconscious," she said.
"That can have huge ramifications health-wise that are ongoing.
"To us this shows offenders are really wanting to have ultimate control over someone's ability to move, or leave a situation.
"The intention is there to take them out.
"What's the next level after that? Is it death? Is he going to kill her?
"We have a lot of head injuries as well, where people say they were dragged around by their hair.
"They have had their heads banged into walls, doors, the floor, door handles."
The AIHW report said the rate of hospitalisation of women who had been assaulted by a partner rose at an average of 2.8 per cent per year between 2002-03 and 2016-17, from 27 to 38 hospitalisations per a 100,000 population.
The rate rose 23 per cent between 2014-15 and 2016-17 from 31 to 38 per 100,000.
In contrast, the rate for men between 2002-03 and 2016-17 remained relatively stable from 5.3 to 6.6 hospitalisations per 100,000.
Of the hospitalisations of women who had been assaulted by a partner in 2016-17, 67 per cent involved assault with bodily force and 63 per cent were for treatment of injuries to the head and/or neck including seven per cent due to brain injuries.
For women of all ages, head and/or neck injuries were the most common injuries inflicted by a partner.
Ms Thompson said there were many women affected who wouldn't seek medical attention for their injuries.
"A lot of people when they have been choked say the ambulance or police said 'We'll take you to hospital' and they said 'Don't worry about it. I'm here, I'm breathing, I can swallow, I can talk'," she said.
"In the heat of the moment between police interviews and statements they say 'I'm okay' - most women would say that.
"People are reluctant to go to hospital, they want to go to sleep or back to the kids.
"We have to do a lot of education with clients around possible longer term implications.
"We always recommend to our clients if they disclose that they go straight away to a general practitioner just to have that check up and have it documented."
Ms McDonald said acquired brain injuries were "not like a gash from a wound, it could be just one characteristic that changes" over time.
"Maybe they can't remember things or can't sleep properly," she said.
"We know women experiencing head and neck injuries have a far higher recovery time and far lower chance of full recovery."
She said when police attending a domestic violence-related incident record head and neck injuries it could mean victims are determined as being 'at serious threat' instead of 'at threat' and needing crisis support within 24 instead of 48 hours.
"These forms of violence put them in high risk categories.
"They're more likely to be murdered and to have long term serious harm."
Hunter New England Local Health District manager of violence, abuse and neglect Melissa Johnstone said the district welcomed the focus the report brought to the topic of domestic and family violence.
"Hunter New England Health recognises the devastating impact of domestic and family violence on the health and wellbeing of victims/survivors and the disproportionate impact of this violence on women," Ms Johnstone said.
"As highlighted in the AIHW report, the 2015 Australian Burden of Disease study found that intimate partner violence contributes 1.6 per cent to the burden of disease for women aged 25-44 and that partner violence was causally linked to depression and anxiety disorders, early pregnancy loss, homicide and physical injuries, suicide and self-harm and alcohol use disorders.
"Hunter New England Health has strengthened a number of available services which work directly with people who have experienced domestic violence, as well as the training of all Health staff.
"We have employed an additional five Violence, Abuse and Neglect Social Work roles across the District to improve responses to people who have experienced domestic violence and present to Emergency Department, along with working toward establishing a 24/7 integrated counselling, medical and forensic response service.
"Domestic violence routine screening is also performed by a number of key health services, to support victims of domestic violence in identifying and accessing support services."
Ms Johnstone said in addition to ongoing annual NSW Health funding for specialist violence, abuse and neglect services, the state government had invested an extra $10 million funding each year from 2017/18 to strengthen its services for victims of sexual assault, child abuse and neglect and domestic and family violence.
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