Holding handsFGM survivors with complex mental health needs may be slipping through the support net provided by frontline services, a report has claimed.

The final evaluation report in the £2.8 million, 6-year Tackling FGM Initiative (TFGMI) hailed the programme’s contribution to understanding the links between mental health, FGM and prevention efforts, but called for research to understand whether current service provision meets the complex needs of survivors.

The TFGMI funded a range of community-based organisations in about 40 local authorities to explore and develop best practice in preventing FGM; with several of the organisations developing projects to meet the mental health and emotional needs of survivors.

In the final TFGMI evaluation report it said: “The TFGMI as a whole has arguably made a real contribution to understanding the links between mental health, emotional support and FGM. Current evidence suggests that there is often a strong mental health need and that there needs to be better support linking women into care if they have complex mental health needs.

“Several projects have included ‘pre-work’ where women develop an understanding of mental health services before attempts are made to link them into care. The referrals often come through outreach and not from other frontline services. This strongly suggests that there is a strong need to build on these models of care for women affected by FGM.”

The report highlighted three organisations working with the mental health needs of FGM survivors – the Dahlia Project in north London, NESTAC in Rochdale, and ECYPS in Enfield – and concluded that, while the government has recognised that FGM survivors may have complex psychological needs, more investigation is needed to assess whether these needs are being met.

The report was launched alongside TFGMI’s Communities Tackling FGM in the UK: Best Practice Guide. The guide identified the following best practice for mental health service providers:

Mental health and emotional support as well as counselling should be provided in multiple languages

Individuals providing mental health and emotional support as well as counselling should be culturally competent and have a strong understanding of FGM and the way that various identities – e.g. gender, race, ethnicity, migration history – can affect how women understand and relate to their experiences of FGM

Individuals providing mental health and emotional health support as well as counselling should be adequately trained to provide these interventions. They should have the relevant qualifications to enable them to take on this work

Prior to providing mental health and emotional support organisations should have established referral pathways including to accessing specialist physical health support and to intensive psychotherapy

In order to meet the needs of individual women an intake assessment that asks about language, route of migration and risk and needs assessment, among others, is essential

It is important to provide holistic support services; including the provision of practical support with issues women are facing e.g. housing, immigration etc.

The report warns that lack of funding remains the single greatest threat to the government’s ambition of ending FGM in the UK. “Even in areas where local authorities, public health colleagues, police and others highly valued FGMI partners, when asked about future funding intentions it was not evident that funding needs had even been considered,” the report said.

“This may be because of the lack of clarity on where FGM ‘sits’ and who should be funding it (local authorities, Health and Well-being Boards, public health or clinical commissioning groups), as well as the impact of the cuts of local budgets.”