Categories
Community Link Criminal Justice Women's Mental Health Network

Community Link – Roxanne’s story

Guest post by Penny Bennett – Community Link Manager

Roxanne is a woman in her thirties who has been to prison several times. We are talking in the little room that Wish uses to meet women who have been referred to our services.  She has been recalled to prison for a few weeks for a minor breach of her probation conditions. These can be nothing more serious than being late for an appointment.

Wish is a charity working exclusively with women, providing advocacy, counselling and support services for women in prison, hospital and the community. Wish provides specialist gender specific services and has worked for 27 years in HMP Holloway and other prisons.  Wish started by advocating for women’s needs in high secure hospitals including Broadmoor 30 years ago.

The public often think that people are in prison for doing something really bad, but we might remember that some acts such as suicide and abortion were once crimes and now are not. Many women who Wish support through the criminal justice system have committed offences which are related to their poor mental health, such as calling emergency services too often, self-harming in a public place or disrupting the flow of traffic when in distress. Unfortunately, there are not appropriate services or enough services to help these women.

Many other women are in prison because of an act that they have committed for a man, such as theft, drug dealing or importation. Some women were trying to defend themselves or seek “justice” after a rape or assault where the police have not prosecuted or protected them. Abuse, inequality and gender based violence feature largely, even occasional bullying by male solicitors. Imprisonment disrupts women’s lives, their children’s and ripples out to the wider community. Why are so many women remanded for non-violent offences? As Baroness Corston pointed out in her report in 2007, most women need therapeutic help rather than to be contained in prison.

Roxanne seems despondent and resigned to being released to the same situation as previously i.e. homelessness. It seemed unlikely the prison would be able to locate accommodation for her in the last three days before her release. With no local address, services cannot be set up before release.

I have a sense of Roxanne’s potential to do well in better circumstances as she listened carefully and responded well. I feel frustrated that the system within which we are working is so restrictive, constraining our abilities to help people, and stopping people from achieving their potential in life; also, at the pointlessness of recalling a woman to prison for a few weeks, and then releasing her to exactly the same situation. What a waste of money and squandering of a chance for a woman to reach her potential.

I thought to myself “What can I do for this woman, I only have half an hour with her, is there anything I can do?”  I had never met her before, this would be my only meeting with her. What can you do when you can’t do anything?

We discussed what she was going to do on her release. I talked her through her plan A and plan B. Did she have family or friends to go to, if no hostel was found in the next 3 days? Was she going to try not to use drugs? How would she look after her mental health and emotional wellbeing?

It is not always like this. Usually there is time to meet women several times, or many times over long time periods and develop rapport and a relationship. As Justine Howard, an advocate at Wish blogged, “having an advocate who spends time getting to know a woman helps them to feel cared for and safe.” “Safe” in this context means that a secure relationship, in which both parties know each other well, allows the gentle challenging of service users’ beliefs, in the knowledge that the relationship allows them to tolerate this. Women are also more likely to take positive suggestions on board as they have confidence in our motives for making these suggestions as Wish is a user-led organisation. A longer time period leads to a greater knowledge of the women themselves, how to engage them and what their aspirations are.

However, I take the view that every interaction between Wish and a service user is an opportunity for engagement, and I am keen to make the most of this brief contact with Roxanne. In short sessions like these it is important to develop rapport swiftly, and it is better to avoid discussing traumatic experiences that service users have been through, as they are then left unsupported to deal with the feelings brought up in the session; the discussion needs to be practical. Roxanne’s openness also means we can talk through her options and make an efficient use of the time available. She makes the very valid point that it will be hard for her to try to not use drugs, if the only option for accommodation on her release is to return to a circle of acquaintances who are also drug users. There is a major crisis in housing provision at the moment.

This is the work that I do with Wish’s Community Link Project; helping women to prepare for their release and assisting them through the transition period after release. Usually there is more time to work with women and Wish can provide counselling , but at other times practical discussion of options and information as well as emotional support is what is best in a short space of time. Wish can also help women deal with the stress of their trial, the impact of their sentence and other issues such as loss and trauma.

I gave her the telephone numbers of Streetlink, Wish and a local women’s centre. I spent some time building up her sense of self-worth, emphasising her potential, that she was intelligent, young, that her chaotic lifestyle had not yet left its mark on her and that she could work towards changing her life. “If you don’t make this effort, there is no guarantee anyone else will do it for you.” This was perhaps the most useful thing I could do for her in the brief time we had together, and she went away appearing to be more positive. I don’t know what happened to her; however she has not come back into prison, which is a good thing.

Categories
Gender Specific Advocacy Women's Mental Health Network

Gender Specific Advocacy and why it works

Guest post by Justine Howard, Wish Advocate working in the North West

Advocacy word cloud

Wish gender specific advocacy service was developed in recognition that generic advocacy services are unable to meet the needs of many women. Women have told Wish that prior to receiving a gender specific service they have either not engaged or did not feel listened to; leading to disappointment and further frustration.

The Wish model of advocacy is pro-active and is process driven rather than outcome driven. Women tell Wish that having an advocate who spends time getting to know them, actively listening, being transparent, who is non-judgemental, empathetic and able to maintain boundaries helps them to feel cared for and safe. A number of women say that they recognise that they continually test boundaries and inform Wish that it helps them feel safe knowing that the Wish advocates will maintain boundaries. Women also inform Wish that they appreciate the fact that the advocates ‘go the extra mile’; this helps them feel cared for. The emphasis is always about empowering women and responding to their individual needs.

Frequently what women raise is not the crux of the problem, therefore spending time exploring what is raised is imperative. Many of the women are impulsive therefore it is important that they have time to talk through issues and look at what are the possible actions and the probable outcomes prior to taking an issue forward. The women report that confidentiality is important to them, but also that regular clear communication regarding the limitations of confidentiality both verbally and in writing is vital. A number of women have told us that their previous experience has been that they have been informed of the limitations of confidentiality when they first meet with an advocate, however this is not revisited. Understandably, women have ended up feeling let down in the past if the communication was not clear or they were unable to recall the information and later believe that the advocate had not maintained confidentiality.

Being mindful of ward dynamics is also important to maintain relationships with the women, therefore the Wish advocacy service ensure equity of service. Wish has worked successfully with a number of women from BME [Black and Minority Ethnic] groups. A woman from Bengal was struggling to communicate therefore Wish arranged an interpreter and developed a system of communication with thumbs up, thumbs down with pictures to ascertain which things were an issue.  The pictorial format was helpful, and the woman and Wish advocate were able to identify a number of issues. The woman wanted paan as it was part of her traditions and culture to chew on the betel leaves. The Responsible Clinician initially said this could potentially interfere with her medication but later agreed that the woman could have a small amount following meals. The women Wish work with are unique; all women have common experiences of inequality but women are not a homogeneous group.

The feedback we receive from women suggests that the gender specific advocacy service is making a difference.

It’s good to be really listened to

I have never been into a CPA [Care Programme Approach] meeting before.  I feel safe now as I know that you will support me through it

Knowing that I was seeing you each week helped me; you have been there during my bad times and good times.  I like the fact that I can speak to you even if I don’t have any issues to raise.  It’s good just to update you on what is going well for a change

I appreciate all the support and understanding

Even though I kept saying no you were determined to get me to speak to you.  I glad you did

People normally give up on me but you didn’t

Lastly I would like to say that it is a privilege working with women.

Categories
Women's Mental Health Network

Violence Against Women – what it means for mental health

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.

Categories
Women's Mental Health Network

What key issues did our focus groups identify?

To support the development of the Women’s Mental Health Network, Wish has held 5 focus groups with 30 women from diverse backgrounds and they have identified the following 10 areas that are key campaigning issues:

Women meeting in cafe

1. Prison

There are very few women in prison who pose any risk to society. The majority of female prisoners are victims of serious trauma. These women should not be locked up in facilities designed to silence and disempower them; they should be supported and rehabilitated in a system that responds to women’s specific needs.

2. Police

Cuts to psychiatric services mean that police officers increasingly end up dealing with mental health crises. This tends to involve unnecessary physical restraint, which is particularly traumatic for vulnerable women for whom it is likely to trigger flashbacks of past abuse.

3. Hospitals

Hospitals should be places of safety and support for anyone in distress, but women often feel unsafe, ignored and judged on mental health wards and when waiting in A&E.

4. Domestic Violence

Domestic violence affects an enormous number of women, yet many victims feel that services and professionals don’t take it seriously. Reporting domestic violence is extremely difficult and often dangerous; not taking a woman’s story seriously could put her life at risk.

5. PTSD and Complex Needs

Women with PTSD and complex needs are being failed by the current psychiatric system, which focuses on ascribing labels and prescribing medication rather than giving women therapy that would take their life experience and past trauma into account.

6. Housing

There are not enough safe women’s only housing options, which means that victims of domestic violence struggle to find a home where they feel secure and are not afraid.

7. Children

The social services needlessly remove children from their mothers every day. They often take a pessimistic approach to mental health conditions, disregarding the possibility of recovery, and underestimating the lifelong harm of separating a child and a mother.

8. Counselling, Advocacy and Support

It is very difficult for anyone to access any form of talking therapy through the NHS at the moment. It is particularly difficult for women to access gender-specific, women-only services where they feel safe, comfortable, and able to talk openly about their experiences.

9. Staff Attitudes and Behaviour

Across the system staff lack understanding of and respect for women’s distress. Women feel that they are not listened to, not treated equally to men, and sometimes not even treated as people.

10. Male Staff and Support Workers

In prisons and hospitals male staff can be thuggish, intimidating and inappropriate towards women. This is entirely unacceptable and totally undermines women’s chances of rehabilitation and recovery.

Next, we will invite 5000 women to choose the top 3 issues from these 10, and the 3 that they choose will be the first things that we campaign to change. Over the next few months, we will be using this blog to keep you updated on the WMHN so please follow, share and support our progress.

Categories
Women's Mental Health Network

What will the Women’s Mental Health Network do?

Wish and other third sector organisations have spent years developing gender specific services that meet women’s needs. There is policy in place that directs statutory services to do the same, but the gender-specific recommendations are not followed through in practice. For women to have any hope of getting the support that they require, this has got to change. Services have to understand that women need to be treated differently; they need to see that providing better, cross-sector, gender-specific support will make a huge positive difference.

Wish is therefore joining together with a diverse group of partners to create the Women’s Mental Health Network, a user-led campaigning platform that allows women to say what needs to change in statutory service provision, and to drive these changes forward. The partners come from a range of sectors, and the network aims to embrace all aspects of diversity in order to represent the various areas of difficulty that women face.

Current partners include:

Wish – A user-led women’s mental health organisation driving forward consistently gender-specific services within the mental health and criminal justice systems. Wish is the lead organisation in the partnership

 

 

National Survivor User Network (NSUN) – a service user led network connecting people with mental health needs to shape services and policy

 

Against Violence and Abuse (AVA) – a charity working to end gender based violence and abuse

 

 

St Mungo’s – a charity supporting homeless people

 

 

Revolving Doors Agency (RDA) – a charity working to improve services for people in repeat contact with the criminal justice system

 

 

 

 

Women in Prison (WIP) – a national charity supporting women in the criminal justice system

 

 

 

 

Imkaan – a black feminist organisation which addresses violence against women and girls

 

 

 

 

People First (Self Advocacy) – a campaigning and self- advocacy organisation run by and for people with learning difficulties

 

The WMHN’s focus is to improve women’s experience of using statutory services in a range of settings, such as hospitals, prisons, drugs and alcohol, housing, and social services, by influencing them to become more gender-specific. Everything we do will be women-led and designed to give women a strong and powerful voice.

We have already held focus groups with 30 women to identify 10 areas that are key campaigning issues. The next step is to reach out to 5000 women and ask them to identify the top 3 issues that we need to campaign to change. We will reach these women through channels provided by 53 organisations, including additional partner organisations, to ensure an inclusive approach in developing the Network.

After women have told us what is most important to them in service provision, we will develop, pilot and evaluate user-led campaigns with women. These campaigns will be designed to improve and drive forward the provision of gender-specific statutory services, and we will take them forward at a national level. These campaigns will change aspects of statutory services and put gender-specific policy into practice, so that women’s mental health is acknowledged at the point of service delivery, and women get the services they want, need and deserve.

Categories
Women's Mental Health Network

Introducing the Women’s Mental Health Network

Setting up and launching the Women’s Mental Health Network has been a long term aim of Wish, and we are almost there!!!

Wish, is the only national, user-led charity working with women with mental health needs in prison, hospital and the community. For 30 years we have been at the fore of providing long-term, gender-sensitive services, and supported women to have their voices heard at policy level. I have been associated with Wish for 15 of those 30 years, and as a researcher, I could see the fragmented and circular journey women experienced in and through the system; and quite frankly what an unfair deal they were getting, especially considering the billions that are ploughed into mental health, and other associated statutory services, each year.  Most statutory services do not meet women’s needs in a gender-specific way, the multi-strand services that women come into contact with: mental health services, social services, prison, drugs and alcohol, the police and the courts … are not on the same page, in any way, about the gender-specific needs of women.  And frustratingly, although the policies are in place directing services to better meet the needs of women, it is just not happening, as there have never been resources allocated to make change happen; instead there is more research and more policy but very little happening on the ground to improve women’s experience of services. In fact many say that most statutory services undermine women’s recovery through neglect and mistreatment. There are many shocking stories to back this up, including:

  • A woman being allowed to lie in her own urine as a punishment for incontinence and being scared to speak up in case she was punished further
  • A women divulging the most heart rending story which triggered her self-harm – and being given a different cocktail of drugs
  • A woman being refused respite when she felt unsafe, and ending up in prison … again

The list is endless …

Photo by Michael Coghlan via Flickr

Many of the women with complex needs that Wish and other partner organisations work with have had traumatic and abusive beginnings, and lives with few opportunities. They have received little support to address the issues that they have experienced, which has resulted in them developing a range of self-harming behaviours.

And of course, the less women are listened to the more they are silenced by the system.  The Women’s Mental Health Network, a partnership of organisations from a range of sectors, aims to break that cycle of silence for these women who are unable to make their voices heard at an individual level, by giving them a collective voice across sectors. The network will provide a platform for them to speak out and to drive forward change.

It is a long, hard journey for women who have to tell their stories time and time again to services that do not listen to them.  For many women, Wish and similar third sector organisations have been the only solid support that they have been able to rely on. Third sector organisations work hard to enable and empower women, and support them to turn their lives around. Unfortunately, these organisations are not only poorly funded, and not recognised for the services they deliver or the value they bring, they are also undermined by statutory services. It is therefore crucial that statutory services improve.

The Women’s Mental Health Network have held 5 focus groups with 30 women from diverse backgrounds and they have identified 10 areas that are key campaigning issues, including inappropriate physical restraint by male staff, which acts to re-traumatise women; services and professionals not taking reports of domestic violence seriously putting women at risk; across the system staff lacking understanding of and respect for women’s distress; and not being treated in a humane way.  The next step is to consult with at least 5,000 women so that they can confirm the top 3 priority areas in which to drive forward and effect change.

In the early autumn we plan to launch the Women’s Mental Health Network. We have decided to launch it through music, the universal language, which we think will be much more inspiring, relatable and empowering than a government launch. We are therefore seeking a high profile female singer who is passionate about women’s rights, and who can promote a strong women’s voice for equality. Do you know someone? Are you someone? Get in touch! And please support the Women’s Mental Health Network and make our voices heard – become a member now!