14th November 2018
Jo Sharpen has worked for AVA - Against Violence and Abuse since 2006, managing the children and young people’s project and then as policy manager. Prior to this she worked for the Institute of Psychiatry as a researcher and then at Eaves Women’s Aid for several years, in a refuge. As well as working for AVA she is also a freelance consultant, researcher and online counsellor.
“Some people think that a trauma-informed environment is putting a plant in a room!”
- Woman with lived experience
A generally accepted definition of trauma is ‘an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.’ Domestic abuse is clearly a form of trauma, made all the more complex due to the fact that it is planned yet unpredictable and takes place in the context of a relationship.
Research shows a significant overlap between experiences of abuse, substance use issues, and mental health. Up to a half of women with dual diagnosis of mental health and substance use issues have experienced sexual abuse. Between 60-70% of women using mental health services have a lifetime experience of domestic abuse. Women who have experienced domestic and sexual abuse are 3 times more likely to be substance dependent than non-abused women. These figures demonstrate a clear need for a more trauma informed approach to supporting women experiencing domestic abuse and multiple disadvantage. However, as this Spotlight series shows, access to gender specific, trauma-informed mental health services is often lacking for survivors of abuse.
“They don’t look below the surface as to why you are using. When a crisis hits, it’s never just about one thing. We need a service that deals with all our issues, not in silos.”
In our recent report, in conjunction with the Make Every Adult Matter coalition, Agenda, and St Mungo’s, ‘Jumping Through Hoops’ we spoke to survivors of abuse and multiple disadvantage who told us that statutory mental health services were the most difficult to access. Women told us that if they missed appointments, cases were often closed and they would need to be re-referred. Our report concluded that ‘non-engagement is therefore seen as a refusal of services, not a common symptom of mental health, trauma and complex needs, when sometimes attending appointments can feel overwhelming and frightening’.
These sentiments were echoed in our recent research for the National Commission into women facing domestic and/or sexual violence and multiple disadvantage. Our peer researchers, all women with lived experience of these issues, interviewed 29 other women with similar lived experience and found that mental health was the overall dominant narrative across all interviews and surveys, regardless of experience, age or any other individual characteristic. Combined with long waiting lists, short term therapy, a lack of consistent practitioners and constantly having to re-tell their stories, women’s experiences of abuse and trauma were compounded and the experience of trying to access support was re-traumatising in itself.
The women we interviewed for both reports were very clear that practitioners needed to develop a more trauma informed approach. Past experiences of trauma and complex needs can sometimes lead to conditioned behaviours, which serve as a psychological defence or coping strategy for women but may feel very difficult to understand for an untrained worker. In fact, some practitioners admitted that they found some women’s presenting behaviours difficult to understand and respond to. One specialist complex needs worker with Women’s Aid described her relational way of working whereby she takes time to sit, talk and listen. “Simply having a cup of coffee with someone, makes them feel human. You get told more, you may find out stuff before the more relevant service due to creating an informal, trusting, person-centred relationship.”
Services that embrace ‘resilience over pathology’ are ones that women are much more likely to use and feel supported by. A shift from ‘what’s wrong with this person?’ to ‘what happened to this person?’ is the essence of this approach. The Mapping the Maze report highlights the important role the voluntary sector plays in supporting women’s mental wellbeing, with 43% of women’s mental health services identified being run by the voluntary sector, who offer specific women-only support services. However, these vital services and a trauma informed understanding cannot just be the role of the voluntary sector. There are often challenges to partnership working, but the ‘Jumping through hoops’ report shows how co-ordinated approaches, rooted in trusting relationships with informed and trained practitioners, are critical to developing genuine, meaningful support for women who have experienced trauma.
For more details of AVA’s training on creating trauma-informed services, please visit our website.
Follow our Spotlight on domestic abuse and mental health for more blogs, podcasts, guidance and more.
Go to our Pathfinder mental health profile for blogs and guidance on the mental health sector response to domestic abuse.
 Royal College of Psychiatrists (2002) Co-existing problems of mental disorder and substance misuse (dual diagnosis): an information manual
 Trevillion, K, et al (2012) Experiences of Domestic Violence and Mental Disorders: A Systematic Review and Meta-Analysis, Plos One, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530507/
 Rees, S., Silove, D., Chey, T., Ivancic, L., Steel, Z., Creamer, M., Teesson, M., Bryant, R., McFarlane, A.C., Mills, K.L., Slade, T., Carragher, N., O’Donnell, M & Forbes, D. (2011). Lifetime Prevalence of Gender-Based Violence in Women and the Relationship With Mental Disorders and Psychosocial Function. Journal of American Medical Association, 306:5, 513-521