– Katharine Sacks-Jones, Director, Agenda
Women in mental health services are often vulnerable. Struggling with mental health issues makes life harder for any of us. But in many cases women accessing psychological help have additional vulnerabilities.
Research suggests that around half of women with mental health problems have experienced sexual or domestic violence. For women with the most severe mental illness, the links with abuse are even more pronounced. And for women who face the most extensive abuse there is a greater risk that mental ill health will be tied up with other forms of vulnerability, including substance misuse, homelessness, and time spent in care.
Women who face this complexity of need require services which are able to respond appropriately and sensitively to them. Female-only spaces are often essential for them to feel safe enough to engage with their experiences therapeutically. Taking a trauma-informed approach can help avoid re-traumatising women and build the trust crucial to recovery. Routinely asking women about their experiences of violence and abuse accompanied by the right support can be the first step to women talking about what has happened to them.
But our research, shows that these kind of approaches simply aren’t being considered in most areas. A freedom of information request we sent out earlier this year to all mental health trusts in England found that only one trust who responded had a women’s mental health strategy. None of the rest have comprehensive strategies on how to respond to women’s needs – whether that’s through service planning or care delivery.
Some mention gender in a list of characteristics which might be relevant when assessing individual need, but none state what those gendered needs might be. One trust stated that they didn’t even have an equalities policy for service delivery, as their equalities policy for recruitment and staff was sufficient.
Even more striking, over half of trusts who responded had no policy on routine enquiry. This is despite clear NICE guidelines. Of those who did have a policy on routine enquiry, many weren’t training their staff on it, and even more had no processes for how to support women who disclosed.
Mental health teams should not just be relying on equality and diversity impact assessments or bare-bones safeguarding policies to provide the support women need as we found with our FOI. Comprehensive strategies, guidance, and training are essential.
The NHS is under enormous strain and early intervention is increasingly difficult as tightening belts and service cuts mean only the most needy can be treated. At the same time there is a drive towards individualised patient care. But delivering individualised care to women means being able to recognise the specific needs women have, and offer targeted support.
Without such support, women can spiral from expensive crisis to crisis. Many will cycle repeatedly through community mental health services, crisis houses, and A&E, struggling with the combined health effects of mental illness, self-medication through substance abuse, and self-neglect. It’s not just the responsibility of mental health services to support these women, but such services are a crucial piece of the puzzle.
That’s why we launched our Women in mind campaign, calling for the soon to be appointed Mental Health Equalities Champion to have a focus on women’s mental health and their vulnerabilities and champion a gender-focused approach across the treatment spectrum. We want a clinical lead and a strategy for women’s mental health in every local area, including consultation with female patients about what they need. And every female mental health patient should be asked by trained staff about her experiences of abuse and violence as standard. This ‘routine enquiry’ should be accompanied by proper support for any abuse she has experienced.
By shifting the focus of support to recognise the differences between men and women, mental health services could have a significant effect in reducing the burden of mental illness on both women and men, with targeted approaches. As the female suicide rate tips upwards, now is the time to act for women’s mental health.