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Public services that are trauma-informed provide better support for women who have been through traumatic events, but making the transition to this approach can be challenging for many organisations, according to a report published today by Centre for Mental Health and Agenda, the alliance for women and girls at risk.

A sense of safety explores how trauma-informed approaches are being implemented by a range of public services, including mental health services, women’s centres and women’s prisons. It finds that of the services looked at, those taking a holistic approach to supporting women’s needs were best able to make the change to becoming trauma-informed. But, in many organisations it is a long-term process that means changing longstanding ways of working. In others it is made difficult by the environment they are working in or by funding constraints. For many services, short-term and fragile funding, based on targets of volume of service delivery instead of outcomes and quality of the service limited their ability to be innovative and adapt to a truly trauma-informed approach.

A sense of safety calls for all public services to be gender- and trauma-informed. Being trauma-informed means that a service recognises trauma as an important element of a woman’s story and recovery and seeks to empower, build trust and meet her needs respectfully and safely.[1]

While traumatic events can happen to anyone, women experience higher rates of violence and abuse in intimate relationships and are more likely than men to experience poor mental health as a result. Over half of women with a mental health problem have experienced violence and abuse.[2] Despite this, few public services recognise or respond to trauma among women.

The report finds that for services, the transition to being trauma-informed requires ongoing commitment and leadership. It means changing the way staff work with women. It finds that the women’s centres that it looked at were more likely to be trauma-informed than most other services. For services that do adopt a trauma-informed approach there are tangible benefits, not least with increased levels of engagement with women.

One woman when asked about her support from a Women’s Centre that adopted a trauma-informed approached said: “…The staff are amazing; they make you feel safe and as though you can trust them because they actually show an interest…”

A sense of safety calls on the next government to take action to help public services to make the transition to being trauma-informed. This should be included in the next NHS Mandate and future NICE guidelines for health and social care. And bodies like the Care Quality Commission and Ofsted should inspect how well public services are gender- and trauma-informed.

A full list of recommendations is available in the report. They also include:

  • All public service commissioning bodies adopt trauma- and gender-informed commissioning principles for the services.
  • The Department of Health and Social Care and its arm’s length bodies in England, and equivalent bodies in Northern Ireland, should look to developments in Scotland and Wales to support progress towards trauma- and gender-informed public services.
  • The Department of Health and Social Care should lead a research and development programme in England to consolidate the evidence base and produce guidance and resources for a trauma-informed approach.

Centre for Mental Health chief executive Sarah Hughes said: “There is now clear evidence that women who experience trauma in their lives are at a high risk of mental health difficulties that can last a lifetime. Every public service and the people who work in them need to be attuned to this and seek to practise safely. Making this change will not be easy, particularly in services where women’s freedom and choice are restricted. But we cannot ignore the evidence of the benefits of being trauma-informed and the risks of carrying on as we are.”

Jemima Olchawski, chief executive of Agenda, the alliance for women and girls at risk, said: “It’s vital that services take into account women’s specific needs and experiences, especially the impact of trauma and abuse.

“Over a million women in England alone have experienced extensive violence and abuse as both a child and adult. Too often, they struggle to get the help they need from services that fail to understand the impact this can have.  How can we begin to help women recover if we don’t respond to what they’ve been through?

“The Women’s Mental Health Taskforce published by the Government last year encouraged all services to adopt gender and trauma-informed principles. This report shows there is still a long way to go before that becomes a reality.

“That is why the next government must take action and implement trauma-informed care as a priority. Only then will women get the support they need to rebuild their lives.”

About trauma-informed services

Trauma-informed practices move from asking “what is wrong with you?” to “what has happened to you?” They understand and respond to the high prevalence of trauma and its effects, as well as understanding that experiences of trauma can lead women to developing coping strategies and behaviours that may appear to be harmful or dangerous

From Engaging with Complexity (2019)

Key components of trauma-informed services

  • Trauma-informed services put people before protocols
  • The service does not try to make women’s needs fit into pre-specified boxex
  • The service creates a culture of thoughtfulness and communication, and continually learns about and adapts to the individual using their service
  • The service is willing and able to engage with complexity
  • Trauma-informedness is a process and not a set of procedures.

Fundamental processes for a trauma-informed service

  • Listening – Enabling women to tell their stories in their own words
  • Understanding – Receiving women and their stories with insight and empathy
  • Responding – Offering women support that is timely, holistic and tailored to their individual needsChecking – Ensuring that services are listening, understanding and responding in a meaningful way.

About Agenda

Agenda, the alliance for women and girls at risk, works to ensure that women and girls facing abuse, poverty, poor mental health, addiction and homelessness get the support and protection they need. We campaign for systems and services to be transformed; to raise awareness across sectors; and to promote public and political understanding of the lives of women and girls facing multiple disadvantage

[1] Centre for Mental Health and Mental Health Foundation (2019) Engaging with Complexity.

[2] Agenda (2016) Hidden Hurt.


Vulnerable women and girls are being repeatedly restrained in the face-down position in mental health units, according to new figures from Agenda, the alliance for women and girls at risk, which is part funded by the Barrow Cadbury Trust.

The research found that girls admitted to Child and Adolescent Mental Health Services (CAMHS) in England were more likely to be restrained face-down than boys.

Adult women patients were more likely than men to be repeatedly restrained face-down.

The findings also show that other forms of physical restraint were widespread – with one in five women and girls having been restrained. In some trusts this figure was as high as three quarters.

This is despite the fact that more than half of women who have mental health problems have experienced abuse. So not only is being restrained frightening and humiliating it also risks re-traumatising women and girls.

Agenda is today calling for an end to the use of face-down restraint, which can also be physically dangerous, and for other forms of restraint to only ever be a last resort.

The alliance instead wants women and girls’ particular needs, including their history of trauma, taken into account in mental health services.

The alliance’s research – as part of its Women in Mind mental health campaign – showed that:

  • Girls were restrained face-down more than boys (180 girls – or 8.1 per cent of female patients – versus 72 boys, just 5.7 per cent of male patients).
  • Girls were restrained face-down nearly 2,300 times, compared with fewer than 300 incidents of boys being restrained in this way.
  • Girls were more likely to be restrained face-down repeatedly – with some trusts reporting an average of more than a dozen face-down restraints per female patient.
  • In adult services, more than 6 per cent of women (nearly 2,000) were restrained face-down more than 4,000 times.

These figures also exposed the huge regional variations in the use of face-down restraint, with some trusts using it very little or not at all, while some used both physical and face-down restraint on a regular basis.

Read the full report

In recent years the spotlight has focused on those experiencing so-called multiple disadvantage ie those who are homeless, have drug and alcohol problems and who commit crime and are deemed to place the greatest burden on the public purse.

Significant investment has been made in the development of innovative approaches to engage with this very marginalised group of people to enable them to make positive change in their lives. Women do not, however, feature heavily in this programme of work.  This is not because they experience fewer problems in their lives, but rather the difficulties they struggle with are different. These stem from lives punctuated by violence, abuse and trauma resulting in severe mental ill-health, problematic substance use, involvement with children’s services, hidden homelessness and offending behaviour. Support for women affected by such complex and interlinked problems is hard to find.

Agenda, an alliance of more than 70 organisations campaigning for women and girls at risk, and AVA (Against Violence and Abuse) are working together to map what service provision there is for women facing multiple disadvantage across the country.

The predominant message is that regardless of the type of service, it’s how support is delivered that is key to engaging with this vulnerable group of women.

Key findings from the report include;

  • The quality of relationships between women working in and using services is often what women value most.
  • The importance of having an understanding of women’s lives, particularly to what extent experiences of trauma and abuse are commonplace.
  • The importance of working from a strengths-based empowerment model.
  • The need to provide a physically and emotionally safe space, which can only be achieved in a women-only environment.
  • The need for holistic provision that reflects women’s individual needs and how they are often interlinked.
  • The importance of specialist support for some groups such as Black and Minority Ethnic (BaME) women.

Read the Full report or Executive summary