Nobody ever turned up to a substance misuse clinic in need of support solely for substance misuse, says Pip Williams, who spent 26 years living with alcohol and drug dependency. At the same time, she grappled with mental health issues, an abusive relationship, homelessness and periods of losing her children to care.
“When you’re a woman with multiple issues you face a choice: we have to deal with what’s killing us first – is it substance misuse or is it domestic violence,” she explains. “Support for those things can only be accessed in silos; there needs to be a place where woman can get holistic help for it all – and before they reach crisis.”
Now in recovery, Williams has gone on to found a support network for pregnant women at risk of having children with foetal alcohol spectrum disorders. She has contributed to Mapping the Maze, a report by Against Violence and Abuse (AVA) and Agenda, the alliance for women and girls at risk. The report highlights the confusing and fragmented nature of provision in local authorities across England and Wales – with some areas having a range of services for women, and others having none at all.
Gathered through FOI requests, here are some of the report’s most troubling findings:
Women are bounced between services
Only 19 out of 173 local authority areas in England and Wales have services for women that address all the following issues: substance misuse, mental health, homelessness, offending and complex needs. Nine areashad no evidence of any of these services for women whatsoever.
The vast majority of services available across England and Wales address single issues – so women are bounced between services, having to repeat their stories multiple times and are often unable to get the help they need.
Support with substance misuse isn’t tailored to women
Women make up around a third of people accessing drug treatment services – with that figure increasing to nearly 40% for alcohol services, according to the National Drug Treatment Monitoring System.
But only just shy of half of all local authority areas in England have support services specifically for women experiencing substance misuse, according to the Mapping the Maze report. In Wales only 22.7% of authorities are home to localised support of this kind.
Substance misuse midwives accounted for more than a third of substance misuse services found, feeding into a wider finding that more than a quarter of all support for women facing multiple disadvantage is for pregnant women or those with a young baby.
Women are commonly invited to join a weekly women’s group, housed within a generic substance misuse service. The report argues that this tends to be an add-on rather than at the core of formal recovery programmes, with one woman interviewed for the report saying she felt these groups were “something to tick a box rather than something [organisations] are committed to”.
The report also notes that it is disappointing that only only ten of the 129 residential rehabilitation services listed on Public Health England’s website are solely for women.
Resistance to providing gender-specific mental health support
The report notes that 104 English local authorities and five Welsh unitary authorities providesupport for women experiencing mental health problems, with the voluntary sector playing a huge role in delivering these services.
More than half (55%) of mental health support identified in the report was aimed at pregnant women and new mothers.
Anecdotally, providing gender specific support for women who don’t fall under maternity or perinatal is met with “notable resistance” from several clinical commissioning groups. A typical response was that “all commissioned services are for men and women equally”.
Donna Covey, director of AVA, would like to see a change in mindset. “We know that delivering the same service for everyone doesn’t deliver equality of outcomes,” she explains. “To be effective, services needs to be trauma-informed and women specific. Central government needs to take the lead in making sure that these women get the support they need to rebuild their lives.”
Mapping the maze
AVA and Agenda have created an interactive map, pinpointing where specialist support is available for women affected by substance use, mental ill-health, homelessness and offending. It will also help to identify gaps in provision, and both organisations are encouraging voluntary organisations, commissioners and public service professionals to use the map as a resource.
Covey says many local authority commissioners have a poor understanding of what women experiencing multiple disadvantage want and need and don’t appreciate the importance of women-specific services.
The report makes a number of recommendations for commissioners and other professionals to address this, including:
- Speak to women with lived experience and directly involve them in the commissioning process.
- Promote a trauma-informed culture. Recognise that many women experiencing multiple disadvantage will also have experienced gender-based violence.
- Be gender aware – specialist services are generally more effective than generic ones – and know that provision of specialist women’s services does not breach the Equality Act 2010.
- Build longevity and flexibility into tenders. Helping women with complex lives in unlikely to fit neatly within short-term targets.
- Practice joint commissioning and commission across localities. Commissioners should also ask bidders to demonstrate how they will ensure ease of access to services.
Sign up for your free Guardian Public Leaders newsletter with comment and sector views sent direct to you every month. Follow us: @Guardianpublic.
Looking for a job in central or local government, or need to recruit public service staff? Take a look at Guardian Jobs.