Mental health services across England are failing women by not asking about experiences of domestic abuse, according to new data published today by Agenda, the alliance for women and girls at risk.

"It’s clear that existing guidance isn’t enough to ensure women are given the chance to share their experiences – a change in the law is needed to make sure we’re not missing opportunities to help."

The findings – based on results from Freedom of Information requests – show that more than a third (15) of NHS mental health trusts that responded (42 of 58) have no policy on ‘routine enquiry’ about domestic violence and abuse – in spite of National Institute of Health and Care Excellence (NICE) guidelines.

Mental health services should be asking about domestic abuse in recognition of the high rates of violence and abuse experienced by people who access them. This is especially true for women. 38 percent of women who have a mental health problem have experienced domestic abuse.

The evidence in the report points to a postcode lottery in the support mental health services are providing to survivors. One trust said they asked just three per cent of patients about domestic abuse – when guidance says they should be asking everyone.

Agenda’s report, 'Ask and Take Action: Why public services must ask about domestic abuse', is supported by a group of charities, practitioners and other leading experts, and argues that while some health services are already required to ask about domestic abuse, this should be happening in a much wider range of public services if we are to truly protect women and offer appropriate support.

One million victims

Some 1.3 million women experienced domestic abuse last year in England and Wales alone.[3] Research shows 85 percent of survivors sought help five times on average from professionals in the year before they got effective help to stop the abuse. Four out of five victims never call the police, but many will visit their GP as a result of the abuse they’re experiencing. All public services could play a crucial role in recognising and responding to signs of abuse.

A recent National Commission of leading experts warned of the potentially devastating consequences for women who don’t get the support they need from public services because the signs of abuse are not picked up by professionals. Without support, many go on to develop mental health problems or use drugs and alcohol to cope.

Agenda is calling for the Government to amend the Domestic Abuse Bill to put a duty on all public authorities to ensure staff across the public sector are making trained enquiries into domestic abuse.

Jemima Olchawski, Chief Executive of Agenda, says: “Women who have experienced domestic abuse come into a contact with a wide range of services – both while they are facing abuse and in the years that follow.

"Whether it’s a local GP, jobcentre or mental health service, staff across our public services should be trained to ask about domestic abuse and act appropriately. If not, we’re putting women at risk."

"It’s clear that existing guidance isn’t enough to ensure women are given the chance to share their experiences – a change in the law is needed to make sure we’re not missing opportunities to help."

"The Domestic Abuse Bill is our moment to make sure this happens. The Government have made a commitment to make domestic abuse everyone’s business – this is their chance to deliver."

Chlo is a survivor and campaigner, who was a peer researcher for the National Commission on Domestic and Sexual Violence and Multiple Disadvantage and now works for a domestic abuse charity. She was a teenager when she first started to experience domestic abuse.

She says: "I was in mental health services when it started, but no one talked to me about my relationship or picked up the warning signs. It was police that first suggested what I was experiencing was domestic abuse. It hadn't even occurred to me that's what it was until then, I didn't know about emotional abuse or coercive control. After that, I was referred to victim support and eventually he was convicted."

"I know that for other women experiencing abuse, it doesn’t always happen like that. The peer research showed that despite everything women are resilient and still try to engage with services, but often it's the services who are ‘hard to reach’ or difficult to engage with, not the women themselves."

One survivor said: "No one even bothered, even when I went to hospital when my tooth got knocked out, even then they never even bothered to refer you."

Agenda is calling for:

• The Domestic Abuse Bill to include a duty on public authorities to ensure frontline staff make trained enquiries into domestic abuse[1] and can provide survivors with pathways to support that takes into account the trauma they have experienced.
• That this duty is backed by sufficient funding. Agenda supports calls from the violence against women and girls (VAWG) sector for meaningful investment in specialist services. This must include funding for training for public sector workers to make enquiries and identify and respond to domestic abuse in a safe and supportive way. This needs to be coupled with investment in proper referral pathways and specialist support so that survivors can get the help they need.
• That all public services respond appropriately to disclosures of domestic abuse. This means treating people in ways that are sensitive to the trauma they have experienced and ensuring that public services collect information and use it to improve the services they provide.

The #AskAndTakeAction campaign is calling for the Domestic Abuse Bill[2] to put duty on public authorities to ensure frontline staff make trained enquiries into domestic abuse. It is supported by a broad range of charities, practitioners and other leading experts.


In support of the campaign, Chair of the National Commission on Domestic and Sexual Violence, Baroness Armstrong of Hill Top, said: "I am pleased to support Agenda’s campaign to ensure trained staff in our public services are asking about domestic abuse."

"As Chair of the National Commission on Domestic and Sexual Violence and Multiple Disadvantage, I heard from women across the country about the devastating impact of domestic abuse."

"For far too many, the legacy that trauma leaves is poor mental health, problems with substance use, homelessness, or a criminal record. Women who shared their experiences as part of the Commission told me that services let them down."

"Time and again the signs of abuse were not picked up by professionals, and too often women were bounced around or even turned away from services. We need concerted action across public services so that trained staff are able to identify survivors and respond accordingly, ensuring they get support."

Donna Covey CBE, Chief Executive, AVA (Against Violence and Abuse), said:
"It is hard for women to recognise when they have experienced domestic abuse. And it can be even harder to talk about it, or ask for help. Where women have experienced other forms of disadvantage, such as substance use, mental health or homelessness, this can make the problem worse. The only way to break this cycle of silence is to make sure that wherever a woman goes for help, she meets practitioners who are able to ask about abuse with skill and compassion. Only then can we begin to transform the response to domestic abuse in the UK."

Lucy Hadley, Campaigns and Public Affairs Manager at Women’s Aid, said: "Domestic abuse is everyone’s business, so it’s highly concerning that Agenda have uncovered a patchwork of practice by mental health services when asking about domestic abuse and responding to survivors."

"The landmark Domestic Abuse Bill must go beyond the justice system alone, and deliver the changes survivors and their children need across all public services. Asking about abuse is a critical first step, which must be underpinned by specialist training and systems change within all public services – from health to housing, immigration and welfare – to ensure every survivor gets the right response, first time." 

Jessica Asato, Head of Public Affairs and Policy at SafeLives said: "We welcome this report from Agenda. We know that four out of five victims of domestic abuse don’t call the police, so it’s vital that the other professionals around them have the knowledge, training and confidence to be able to ask the right question at the right time."

"Survivors tell us every day about the difference it made to them when an empathetic, trustworthy professional asked the question and gave a supportive response. If a person is experiencing domestic abuse and takes the courageous step to tell someone – whether it’s a GP, a social worker, a Housing professional or anyone else – they should be heard, believed and supported to become safe. We want that for everyone; whoever you are, wherever you live."

Sophie Corlett, Director of External Relations at Mind, the mental health charity, said:
“We know that a large proportion of women and girls coming into contact with mental health services either have experienced, or are experiencing, abuse. Domestic abuse can significantly increase the likelihood of developing both common mental health problems, such as anxiety and depression, and severe and enduring mental health problems such as schizophrenia or bipolar disorder.

“A thorough understanding of a woman’s experience of trauma can hugely improve the quality of mental healthcare that they receive and avoid services inadvertently re-traumatising them. Women must be asked the right questions and properly supported by those charged with their care.”