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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.