Domestic abuse affects an estimated 1.3 million women each year, with many cases of domestic abuse beginning or escalating during pregnancy. It's important that we understand how this impacts women's maternal mental health and their ability to access support.
of domestic abuse cases begin during pregnancy
of women in Refuge’s services are pregnant or have recently given birth
Women who experience domestic abuse are twice as likely to experience depression
Improving our responses to make specialist perinatal mental health services, universal services and all essential services trauma-informed cannot wait.
There is a gap in consistent professional enquiry and curiosity about domestic abuse. There is also a gap in knowledge about the role of health professionals and their responsibilities regarding domestic abuse, signs of abuse and links to trauma.
Ensuring that domestic abuse is a mandatory field in health care records including national datasets would drive improvements to routine inquiry and enhance understanding of the prevalence, and association with mental health including during the perinatal period.
There is a relatively recent initiative giving patients the legal right to access their NHS records. Whilst overall this is welcomed, the group highlighted concerns about the risk that perpetrators will gain access to these notes and where disclosures have taken place, risks to women, babies and children could escalate. There is a need to understand how health professionals across universal services, specialist perinatal mental health teams and beyond are recording disclosures.
There is good evidence for the effectiveness of IDVAs (Independent Domestic Abuse Advisors) - employed by, or seconded to, a range of healthcare settings - in improving the health outcomes of service users. There are, however, no current national funding streams for healthcare-based IDVA interventions. As a consequence, the level of IDVA provision in healthcare settings varies across the country and across healthcare services. In addition, funding for healthcare-based IDVAs is often insecure and insufficient. Healthcare services have also identified some issues regarding how to successfully implement IDVAs, including having adequate space for IDVAs to speak to clients confidentially.
More evidence is needed around what healthcare services can do, in particular perinatal health services, to ensure the success of IDVA interventions. With respect to other interventions, there is much less evidence for programmes such as brief domestic abuse advice, short-term counselling and nurse case management in preventing and reducing domestic abuse.
Research by Dr Kylee Trevillion at King’s College London is looking at how healthcare services can ensure the successful implementation of IDVA programmes, particularly within a maternity services context. Through the RIVA study, Dr Trevillion will generate guidance for healthcare services and recommendations to commissioners across perinatal health services, including mental health.
There are a number of reasons why the existence or impact of domestic abuse on perinatal mental health might not be acknowledged or responded to appropriately:
This list of barriers (not exhaustive) indicates more systemic issues in statutory services, such as patriarchal structures and the burden of judgement on mothers suffering from domestic abuse and mental ill health is often entrenched. This is especially prevalent for disadvantaged groups including those experiencing poverty, discrimination and trauma which can often be manifested in homelessness, addiction, contact with Criminal Justice System (CJS) and social services. Services tell us they are supporting families with increasingly complex needs, including domestic abuse.
For these needs to be met, we require a wide-scale trauma-informed perspective.
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