Guest post by Jennifer Holly, Project Manager at AVA

Violence against women and girls takes many forms. Most commonly we talk about domestic violence, but sexual violence including female genital mutilation, forced marriage, so-called ‘honour’ based violence, stalking and harassment, trafficking, prostitution and child sexual exploitation are also woefully common experiences for women and girls. Estimates vary, but globally there is evidence that almost a third of women have experienced some form of physical or sexual violence in their lifetime.

For anyone who has worked in support services for women who have experienced abuse, the impact abuse – which encompasses physical and sexual violence but also a plethora of emotional and psychological abuse all aimed at coercing and controlling the victim – can have on a woman’s mental well-being is undeniable. Working in a refuge for several years, I personally sat with women while they cried, watched them jump as a door slammed somewhere in the house. I witnessed women dissociate and have flashbacks. I saw the scars of self-harm. I heard many women talk of wanting to end their life and know of two colleagues that have had to deal with the suicide of the women they were supporting.

Within mental health services, however, recognition of the association between experience of abuse and mental distress is emerging only very gradually. A relatively recent study of people using statutory community mental health services found that 69% and 61% of the women have a lifetime experience of domestic and sexual violence respectively. Despite such evidence, most women using mental health services are still not asked about abuse, far too many are prescribed pills to manage their distress rather than offered support around their traumatic experiences, and some will end up restrained in a psychiatric ward for expressing their distress through self-harming or attempting suicide.

These experiences of services go very much against what we know women say they need. In 2012 AVA conducted research with women affected by domestic and sexual abuse, mental ill-health and substance use problems. I asked one simple question: what do you want from services?

The first thing every single woman said was to be treated like a human being. To be treated with respect and as though they matter.

Secondly, they voiced a desire to have some level of control and choice over what happens in their lives. If we understand experiencing violence and abuse as a form of trauma, and understand trauma to be “an inescapably stressful event that overwhelms our coping strategies” (to quote Bessel Van Kolk, a renowned psychiatrist specialising in trauma), that leaves us feeling powerless and helpless, then any intervention that empowers and enables women to support themselves is on the right track.

Their third request was a call for support to be safe. Safe from others who want to harm them, but also safe inside themselves, by which they meant being supported to manage the emotional distress and turmoil they experience.

More recently we published a literature review about meeting the needs of women affected by multiple difficulties in their lives. This review found that the essence of a good service for women is one that is gender-sensitive and is trauma-informed. This means:

• Understanding women’s experiences and the social context of their lives
• Acknowledging adaptation and resilience rather than seeing symptoms and pathology (Judith Herman’s book Trauma and Recovery is a very good introduction to this topic)
• Understanding how trauma impacts on people – including how it affects the way the brain works – and leaves them to live ‘traumatised and traumatising lives” (again, quoting Bessel van der Kolk. His book The Body Keeps Score is fascinating and so informative)
• Building trust through consistent relationships
• Offering women a physically safe space
• Prioritising dignity, respect and acceptance
• Offering choice and control
• Working with women to build strengths

This is stuff we know. It is nothing new.

But it is important to remember. And it is important to reflect on each point. In busy lives with high caseloads and ever increasing frustration with the systems that seem to let us as workers down, do we all always provide an entirely gender-responsive and trauma-informed response to women? Wherever you are reading this from today, take a few minutes to really reflect on that question.

Finally, individual practitioners are not solely responsible for improving how violence, abuse and women’s experiencing of mental distress are addressed. Responsibility lies also with the organisations that deliver services, with those that design and commission services. Services need to be designed to support staff to do the best job they possibly can, with sufficient resources that make professionals and the women they work with feel valued.