Women who have lived through abuse, addiction, homelessness and mental health issues have been through so much. The resilience and the experiences that they bring are valuable and the skills they have can be turned into positives for themselves, their families and society as a whole.
In order to transition to the other side, and rebuild their lives, women need support and so many are not receiving it or are not able to gain access to suitable services to help them.
As a woman now in recovery from 26 years of addiction, who has been homeless a number of times - once with my two year old child where we stayed in parks in the day and crashed in random strangers' hostel rooms each night, who experienced domestic abuse and has been diagnosed with complex PTSD, I can vouch for this.
Mapping the Maze, a report from AVA (Against Violence & Abuse) and Agenda, the alliance for women and girls at risk, mapped support for women facing 'multiple disadvantage', those at risk of homelessness, poor mental health, substance misuse, offending and sometimes all of those things at once. Some parts of England and Wales have been left blank because they could not find a single service for women in that area. Often services addressed just one issue, like addiction, despite the fact that most women will rarely be dealing with just one thing at a time.
However, it is not just about how many services are available but also the quality of those services. As part of this research, women were asked what they wanted from and valued in services. There were several themes that emerged:
• The need for early intervention. Many women felt they had to reach rock bottom before they could access support. Women were asking for help and being told they were not in enough of a crisis. How can that be in the best interests of that person, their families and wider society? There need to be more one-stop hubs where women can access a full range of support when they need it, and that includes their children too.
When women do seek help, professionals can struggle to understand their situation and don't know what support is available. Recently a woman I know went to her GP about her mental health and the doctor doubled her dose of an anti-psychotic drug, in spite of her having a history of addiction and without exploring alternative therapies or what services might be available in her area. GPs need their own version of Mapping the Maze, a list of local resources to refer women to.
• The importance of time. Waiting lists for support are too long and the length of support is often too short. Women also wanted flexibility, with services having extended opening hours on evenings and weekends so they could access help when they needed it. There needs to be more follow-on support in the community when discharged from statutory services.
• Services that are trauma-informed are essential. Many women who face multiple disadvantages have experienced abuse and violence, leaving them with lasting undiagnosed trauma. The reason they may use drugs and alcohol is to cope with what they have experienced.
We need more gender-specific and trauma-informed services with a psychologically informed environment (PIE) "... one that takes into account the psychological makeup - the thinking, emotions, personalities and past experience - of its participants in the way that it operates." There needs to be an understanding of that history, looking holistically at the whole person, the woman's wider experience rather than just a series of labels: addict, depressive, offender. Women are getting re-traumatised having to keep retelling their story and recent experiences.
Many women start to build their lives in the area their treatment centres are in and start attending mutual aid meetings, gyms, adult education and making new healthier relationships. This lifestyle is often lost when women return home. Planned and supported aftercare for women who come out of treatment is vital so women don't find themselves back into the same situations they were in before they left, isolated and vulnerable.
• Women want to speak to women who sound like them, look like them and have lived like them. Women who have lived experience can support women currently going through similar experiences. Women can help make change by helping to create and run women's programmes; work on policies and be involved in commissioning services. But it is also about all women supporting women - professionals who come with their own lived experiences. A 'we-together' rather than 'us and them' approach. Women rated most highly the services where they felt staff were caring and they were related to as 'women' rather than as a 'service user'.
• Women-only support is vital. For women who have experienced abuse especially from men, mixed services for addiction and homelessness can be intimidating and scary. Many 'women-only services', e.g. women only hostels, have mixed staff and more needs to be understood about how this could impact on women and their need to feel safe.
Women can form relationships in mixed detox units, which can jeopardise their recovery. I have met women who are new to recovery or new in treatment arriving loved up with someone they have met in detox. Feeling "loved up" is like the new addiction - many women have left services or gone back out if new partners leave treatment or relapse.
• Early support for women and families. There is a need for a more holistic approach to support: the woman, the child, and mother and child relationship. What ultimately affects the mother will impact on the children. Services need to be joined up, adult services remain very siloed, and are not connected to child services. Collaboration is needed between these two services that will help to build more wrap-around support for women and their children. It is about keeping families together and it costs more to keep a child in care than it does to spend time and money on working with the family and trying to keep them together.
Services need to have a more holistic view and look at the women's wider experiences; what they have been through, are going through, and how they are dealing with it. Women don't really understand the impact all these experiences have on their mental, emotional and physical health. I didn't. Years ago, if somebody had said I was 'vulnerable', I would have told them to '**** off' - I wouldn't have identified with the word 'vulnerable', because at the time I was doing the best I could. We need to listen to women and put their needs at the heart of services, if we want to support and help women in rebuilding their lives and fulfilling their potential.
Pip Williams founded the Experts by Lived Experience Network (ELEN) and the UK & European Birth Mother Network - Foetal Alcohol Spectrum Disorders. She works as a consultant and trainer and volunteers at a women's residential treatment centre in London.