Women's Mental Heath Matters recommendations

Aim

To embed women’s mental health into all policy, strategy and service planning at national level. 

What

1.1 Embed mental health in women’s health policy

a) Integrate mental health, trauma awareness and intersectional considerations into the development and implementation of all UK national women’s health strategies, including the forthcoming Women’s Health Action Plan in Northern Ireland and existing strategies in England, Scotland and Wales.

b) Ensure commissioning streams provide sufficient funding to enable the effective implementation of national women’s health strategies across the UK.

c) Ensure policies and their implementation reflect the needs of women with SMI, neurodivergence, and multiple intersecting disadvantages, including poverty, race/ethnicity and LGBTQ+ identities.

d. Introduce Women’s Mental Health Impact Assessments for all new national policies.

e.) Ensure appropriate psychiatric expertise informs national clinical guidance, particularly in relation to sexual, reproductive and hormone health and GBV.

1.2 Involve women with lived experience

a) Involve women with mental illness and/or trauma histories in the design, implementation and evaluation of national policies and local services.

b) Use trauma-informed frameworks to support collaboration and decision-making.

1.3 Deliver integrated, accessible health services for all women

a) Expand the existing Women’s Health Hub models in England, Wales and Northern Ireland (including within ‘neighbourhood health’ in England) through trauma-informed services that truly integrate physical and mental health care to ensure accessibility for women with SMI and/or trauma histories.

b) Local systems, in particular Integrated Care Boards (ICBs) in England and NHS Trust/NHS Boards, should routinely collect and report on demographic data, and compare this against local population data to identify and address inequity in access and outcome.  

c) Maintain dedicated funding for specialist women’s mental health services (e.g. perinatal mental health services) to protect against budget cuts.

d) Expand maternal mental health services to ensure they support women who have experienced child loss, including perinatal loss and child removal.

e) SMI health care checks should be expanded to address the inequity for women:

• i) Checks should be routinely offered to women with SMI and/ or contact with mental health services and a trauma history.
• ii)Checks should include key risk factors for poor health outcomes in women, alongside modifiable risk factors e.g. Routine enquiry into domestic abuse, pregnancy planning and contraception.

1.4 Strengthen prevention and public health approaches

a) Embed a public health approach to GBV within the implementation of all national health strategies.

b) Include mental and physical health checks at key life-course transitions, including puberty, pregnancy, post-partum and menopause.

Who?

• Governments across the UK (health departments, HM Treasury, Home Office)
• Local Systems
• National Health Services in England, Wales, Scotland and Health and Social Care (HSC) in Northern Ireland
• Public bodies with responsibility for developing and publishing guidance i.e. The National Institute of Care and Excellence (NICE) and The Scottish Intercollegiate Guidelines Network (SIGN).

Aim

Ensure that health systems actively prevent and respond to GBV, reducing its long-term impact on women’s mental health.

What

2.1 Improve ‘sexual safety’ for women in inpatient mental health services

a) Record, report and review all incidents of sexual harm within services. In England, serious incidents should be classified as Never Events. Reporting processes should not require categorisation of harm as ‘low, medium or high’, as this risks minimising both the physical and psychological impact.

b) Ensure all incidents of sexual violence (including harassment) in inpatient mental health services are reported as preventable patient safety incidents to the NHSE Learn from Patient Safety Events service (LFPSE), and equivalent systems in Northern Ireland, Scotland and Wales.  

c) Ensure robust scrutiny of this data, alongside clear action by organisations to respond to incidents and embed best practice.

d) Ensure the prevention and response to sexual violence is a key quality indicator for healthcare regulators (e.g. In England, the Care Quality Commission (CQC) as part of Fundamentals of Care), and is reflected within standards for safety and safeguarding

d) Phase out mixed-sex Psychiatric Intensive Care Units (PICUs) in the UK, in line with the joint RCPsych-NAPICU statement (link to this), supported by capital investment and demand management guidance. This should act as a foundation for moving towards single-sex accommodation across all inpatient mental health and learning disability settings.

2.2 Embed specialist support in health services

a) Commission the co-location of Independent Domestic Violence Advisors (IDVAs) in all secondary mental health settings to support safety and recovery. This should be supported by ring-fenced funding, and strong integration with third sector services and “by and for” specialist support organisations.

b) Integrate fully funded, sustainable, trauma-informed GBV interventions within primary care, building on evidence-based programmes such as IRIS.

2.3 Address suicide and violence links

a) Ensure a national focus on the interconnections between domestic abuse, trauma, suicide risk, and domestic homicide. This should include mandating local systems to develop a strong cross-sector response in relation to all domestic abuse related deaths.

b) Improve data collection, ensuring domestic abuse data is collected as part of the mandatory mental health dataset and training on compassionate routine enquiry is consistently embedded within all holistic psychiatric assessments.

Commit to a national suicide prevention strategy that truly reflects the risk factors for suicide in women

Who

Governments across the UK (health departments, HM Treasury, Home Office), National Health Services in England, Wales, Scotland and Health and Social Care (HSC) in Northern Ireland, Local Systems, Psychiatric workforce, Health regulators (i.e. the CQC in England, HIW in Wales, HIS in Scotland and RQIA in Northern Ireland)

Aim

Ensure mental health services are trauma-informed, women-centred and responsive to life-course needs.

What

3.1 Deliver trauma-informed care

a) Ensure all mental health services adopt trauma-informed principles, including safety, choice, collaboration and empowerment. Effective delivery will require clear system-level implementation, guidance and accountability frameworks, and prioritised by leaders at both national and local levels.

3.2 Provide specialist trauma pathways

a) Establish trauma-specific services for women who have experienced GBV. Access to these services must be monitored and those experiencing intersectional, and therefore additional disadvantage, should be prioritised.

3.3 Targeted physical health pathways for women in inpatient and learning disability settings

a) Develop clear local pathways that provide timely intervention to meet the physical health needs of women whilst in these settings. These pathways should integrate specifically sexual and reproductive health, obstetrics and (uro)gynaecology services.

b) Ensure services consider key life experiences, including motherhood, menopause and chronic illness.

3.4 Embed clinical safety guidance

a) Implement Non-Fatal Strangulation and Suffocation (NFSS) guidance across all mental health services, with appropriate training to support effective implementation. Services should also ensure accessibility for all women, including consideration of caring responsibilities, menstrual health and experiences of domestic and sexual abuse.

3.5 Regulatory oversight and quality assurance

a) Ensure regulators assess the adoption of trauma-informed approaches as a core element of service quality.

3.6 Research and evidence generation

a) Prioritise data collection on issues that affect women’s mental health eg. Mandatory collection of domestic abuse as part of the mandatory health dataset

b) Routine disaggregation of health data and research to ensure safe and effective care for women and inform national policy and strategy in women’s mental health

c) Invest in key gaps in women’s mental health in research which is representative of women’s real lives.

Who

• National Health Services in England, Wales, Scotland and HSC in Northern Ireland
• ICBs
• Health regulators (i.e. the CQC in England, HIW in Wales, HIS in Scotland and RQIA in Northern Ireland)
• Research funding bodies (including UK Research and Innovation, Health and Care Research Wales, the National Institute for Healthcare and Research, the Wellcome Trust and charitable funders)
• The psychiatric workforce. 

Aim

Ensure women with SMI and/or trauma histories receive equitable, integrated physical and mental healthcare.

What

4.1 Embed trauma-informed approaches across systems

a) Ensure trauma-informed frameworks are implemented across health and related public services to support integrated care for women with co-occurring mental and physical health conditions.

4.2 Life-course health checks

a) Ensure routine NHS health checks are delivered at key hormone and life-course transitions, including reproductive milestones and menopause, and include specific assessment of mental health.

4.3 Equitable access to screening

a) Establish national targets and trauma-informed pathways to improve uptake of breast and cervical cancer screening among women with SMI and/or trauma histories.

Who

• Governments across the UK (health departments)
• National Health Services in England, Wales, Scotland and HSC in Northern Ireland
• UK National Screening Committee (UK NSC)
• Local systems
• The psychiatric workforce.

Aim

Build a sustainable, competent health workforce equipped to deliver trauma-informed, integrated care.

What

5.1 Grow and retain the psychiatric workforce

a) Expand psychiatry and mental health training capacity, and address bottlenecks across medical education and training pathways.

b) Implement flexible working arrangements and career pathways to improve recruitment, retention and progression of women within the workforce.

5.2 Education and training across the healthcare workforce

a) Ensure workforce training includes trauma-informed approaches, compassionate routine enquiry, and integrated mental–physical healthcare.

b) Ensure training is developmentally and culturally informed and addresses intersectional disadvantage.

5.3  Safe and inclusive workplaces

a) Implement clear, system-wide action to address key workforce issues affecting women, including sexual harassment and sexual violence, domestic abuse (including support for those staff impacted by GBV), pregnancy, menopause, child loss, infertility, staff as carers. This should be supported by accountable leadership and the sharing of best practice.

b) Adopt and Implement College standards on sexual safety, disability, retention and tackling racism.

5.4 Support women carers

a) Identify and support women carers through policy and service frameworks, recognising the mental health impact of caregiving responsibilities. 

Who

• Governments across the UK (health and social care departments)
• Medical School Deans and teaching leads
• Employers including NHS provider organisations.