Practice blog

Donna Covey is CEO of AVA, a leading charity committed to ending gender based violence and our expert partner for this Spotlight. In her blog marking World Mental Health Day and the start of our series, Donna describes why responding to the mental health needs of survivors of domestic abuse is essential, and outlines the progress being made within the domestic abuse sector.

“When you experience domestic violence, your body runs on adrenaline. When you leave that relationship you can feel withdrawn, tired, like you can’t cope, lonely and abandoned. There is no safety net to catch you and it can be easier just to return”

This quote from a survivor shows why speedy access to the right mental health support is as important to a woman's long term safety as a refuge place. Yet all too often, women survivors of domestic abuse are denied the support they deserve.

Most survivors experience mental ill health as a result of domestic abuse. Domestic abuse is the most common cause of depression amongst women; abused women are four times more likely to experience depression than non-abused women[1]. Almost two thirds of domestic abuse survivors experience post-traumatic stress disorder (PTSD) – more than twice the rate experienced by soldiers in combat[2]. Around two thirds of women using mental health services have a lifetime experience of domestic abuse[3].

Yet despite this, mental health services  are poorly equipped to support survivors of domestic abuse, and women are still turned away from refuges because of their poor mental health.

Like everyone else experiencing poor mental health, survivors of domestic abuse face long waiting lists. As one woman told us:

“I said to mental health, how long will it be before someone gets in touch, well, we’ll send a referral through, oh alright then I’ve just tried to commit suicide. You send the referral through, in the meantime who’s going to speak to me? Oh nobody? Okay, well hopefully I’ll be alive when you call next.”[4]

The limited services offered by a cash strapped NHS, where mental health services have been disproportionately cut despite lip service to parity of esteem, means that what is available is often limited to a few weeks’ CBT – often on a group basis, unsuited to supporting a woman experiencing the trauma and shame that is a legacy of domestic abuse.

Despite the high proportion of women with experience of domestic abuse who have poor mental health, evidence shows that mental health professionals feel ill equipped to ask about domestic abuse and respond to disclosures. Work by Diana Rose and colleagues found that many mental health professionals did not see enquiry about domestic abuse as part of their role or within their competence[5].

For many survivors, substance use becomes a necessary coping mechanism, and a number of studies have found that the majority of women in drug and alcohol services have experienced domestic abuse[6]. Yet many NHS mental health services won’t treat a woman’s depression until the substance use stops. And substance use services for women are few and far between. Work by AVA, in partnership with Agenda, found that less than half of all local authorities in England and only five unitary authorities in Wales (22.7%) report substance misuse support specifically for women[7]. Most of these were limited to a weekly women’s group within a generic service, and an equally common type of support for women affected by substance misuse in England was a substance misuse midwife, with this being the most common type of support reported in Wales.

The Department of Health funded AVA to work intensively with two mental health trusts to improve their response to domestic abuse. This project PRIMH (Promoting recovery in mental health) involved training staff, reviewing policies and developing a whole trust response to domestic abuse. The independent evaluation carried out by King's College London found significant increases in the following:

• knowledge about domestic and sexual violence
• reported knowledge about why a patient might not disclose domestic and sexual violence
• what questions to ask to identify potential new cases of domestic and sexual violence
• what to say/not to say to a patient experiencing domestic and sexual violence
• confidence levels in using referral pathways for men, women and children

We are committed to sharing this learning more widely through our BARTA consultancy, as well as the Health Pathfinder project looking at an integrated approach to Health and domestic abuse, together with SafeLives and a number of other partners.

In the Violence Against Women and Girls sector, there has been real progress in developing services that are trauma informed, providing women with the prospect of emotional as well as physical safety. One example is work carried out by Solace Women's Aid, supported by AVA, to develop psychologically informed environments[8], and the outcome of that project can be found here. Unfortunately, pockets of good practice are increasingly being overshadowed by both cuts and a shift to generic provision, which means that women experiencing poor mental health are still finding it hard to access refuge and other services, especially when they are using substances to cope.

There are also brilliant voluntary sector organisations providing trauma informed gender aware support, but they too are under-funded and this is far from a national network. We are proud to be founder members of the  Women's Mental Health Network, alongside many of these providers.

We also know from our work with practitioners that when it comes to Marac and other multi-agency forums working on domestic abuse, statutory mental health services are all too often  the ‘empty seat at the table’.

It is no surprise that a woman who has been subject to abuse and control from the person who is supposed to love her the most ends up traumatised, experiencing depression, anxiety or PTSD, and using substances to cope with the trauma and the shame.

It is shocking, but not surprising, that the right support is not available for these women who deserve it, acting as a massive barrier to their long term recovery. We welcome the opportunity to work with SafeLives to shine a spotlight on this important issue. As always, the last word goes to a survivor:

“I don’t call it mental health, I call it ‘symptoms of abuse’, because to me that’s what it is”

Follow our Spotlight on domestic abuse and mental health for blogs, podcasts, guidance and more over the coming weeks.