Too often, women are failed by the services and systems intended to support them. That was the finding of the National Commission on Domestic and Sexual Violence and Multiple Disadvantage, run by the charities AVA (Against Violence & Abuse) and Agenda, which recently published its report.
Prevalence of domestic abuse in mental health service users
Mental health was one of the key areas for concern. 60–70% of women accessing mental health services will have experienced domestic abuse*. I was one of 13 peer researchers (women with lived experience) who interviewed others about their experiences of abuse, mental ill health, addiction, and related issues.
"My current care coordinator is very good at working in a trauma-informed way, helping me understand I’m not just being difficult when common distractions don’t work or not not trying hard enough when I spend days in crisis over trauma I think I should have moved on from. These are normal responses considering my history and that I’ve never had the opportunity to process things emotionally."
Mental health was the dominant narrative across all our interviews, with women often referring to the impact of abuse on their self-worth and describing traumatic responses such as fear, loss of sense of self, self-harming, and self-medicating. One woman told us: "They put doubt in your mind and fear and you learn not to trust people. Lack of confidence, low self-esteem. So, it’s hard for you to socialise with people and you are fearful."
Despite this, we found long waiting lists, short-term therapy, lack of consistent practitioners, and failure to address intersecting needs often lead to experiences of frustration and trauma being amplified rather than addressed. The commission also reported barriers including thresholds that mean women’s needs are either not ‘high enough’ or too severe to get help, and a lack of trauma-informed, strengths-based services. These problems are not unfamiliar.
My difficulties in accessing NHS support
Learning about so many women’s experiences as a peer researcher encouraged me to reflect on my own experience with NHS mental health services.
After a six month waiting list, it was clear my problems were too complex for the service I was referred to. One worker told me frankly (and apologetically) they could only offer six or twelve weeks of therapy, whilst in his opinion and given my history, I would do better with 12 or 18 months. So I waited longer whilst services went back and forwards arguing over who should take me – too ill for one but not ‘ill enough’ for another. Waiting and uncertainty is always difficult but when you’re suffering with a debilitating mental illness, coping with the fall out of an abusive relationship, and trying to maintain a semblance of a normal life, it can be nearly unmanageable. Every rejection makes you feel like you’re too demanding, too difficult, or guilty, like a better or stronger person wouldn’t have these problems. These are feelings survivors of abuse already know too well.
I was suicidal and in A&E multiple times during this period, so maybe that contributed to the more intensive service taking me on. It will be over 2 years from first seeking help for my mental health problems to starting therapy and in that time I’ve had to repeat my story to at least 15 different professionals.
One big problem where I live seems to be the unavailability of mental health services, especially longer-term therapy or any form of psychotherapy: generally what is needed for survivors of abuse or complex trauma. This part of services is very well protected (read: made impossible to access) requiring a minimum of 3 different assessments with different practitioners. You must convince them you are so unwell as to need intensive support managing daily life but also well enough to attend weekly appointments and engage in challenging therapeutic work, it seems. All types of therapy have waiting lists ranging from six months to a year.
A few months ago, I went through one of my worst mental health crises. In A&E, doctors said I didn’t need to be seen and one implied my family shouldn’t have stopped me when I was suicidal. I was told to call a phone number, who told me to call another number, who told me to go back to A&E. When I pointed out I was being sent in circles, each person insisted someone else had been ‘commissioned’ to deal with this. Unsurprisingly this didn’t make me any better and the crisis continued.
"Most vulnerable women are being repeatedly failed by multiple services"
I used to think my experiences were just unusual bad luck. But what our interviews and the commission’s report show is that the most vulnerable women are being repeatedly failed by multiple services. My circumstances actually made it comparatively easy to access support. For many of the women we interviewed, intersecting problems such as mental illness and substance misuse, fears of having children removed, or repeated abuse leading to more distrust could, and sometimes had, made it impossible.
The women we spoke to were incredibly resilient and their strength overcoming adversity inspiring. In the words of the commissioners: “women with this set of experiences, when given the right support, do not just survive, but thrive”. Yet, the barriers they continue to face in so many contexts are unacceptable. Ultimately, it is the services who are hard to reach and difficult to engage with, not women themselves.
Every woman who has experienced trauma or abuse deserves recovery. The situation where those facing multiple disadvantage are turned away, made to jump through hoops to get help, or have their experiences invalidated by uninformed workers and systems cannot be allowed to continue.
- See more: Mental health services 'should always enquire' whether domestic abuse has occurred
- See more: The resilience narrative obscures the wider causes and solutions for children's mental health
- See more: Do you identify as having a disorder, or as having survived something?
A call for trauma-informed approaches
Our peer research report, Hand in Hand, calls for all services to be trained in understanding the impacts of abuse and creating trauma-informed approaches.** And, for the importance of a trusting relationship built on understanding and empathy to be recognised as vital to women’s engagement.
My experience of NHS mental health services has improved a lot recently. My current care coordinator is very good at working in a trauma-informed way, helping me understand I’m not just being difficult when common distractions don’t work or not not trying hard enough when I spend days in crisis over trauma I think I should have moved on from. These are normal responses considering my history and that I’ve never had the opportunity to process things emotionally. I’ve been given the option of starting therapy with someone I’ve already met, so no more introductions and getting passed from person to person. When staff demonstrate empathy, or even share examples from their own lives, it can be hugely validating and decrease the distress that comes with not feeling heard.
By sharing some of my experiences, I hope I’ve demonstrated how much difference these things could make.
The commission is clear that austerity and funding cuts have exacerbated the barriers faced by women in all areas. Proper funding is desperately needed to make mental health services more available. Managers and service commissioners must, however, listen to the voices of those with lived experience.
They must understand the long-term repercussions of making services inaccessible to women facing multiple disadvantage and until they do we must not stop talking about it.
The author is a peer researcher for the National Commission on Domestic and Sexual Violence and Multiple Disadvantage, run by AVA and Agenda, the alliance for women and girls at risk.
* Trevillion, K, et al (2012) Experiences of Domestic Violence and Mental Disorders: A Systematic Review and Meta-Analysis, PLoS One,
** Read the full report here.