Barriers to Accessing Mental Health Services – Report and Our Response

Nottingham Women’s Centre ran a focus group to collect the experiences of survivors of sexual violence and/or domestic violence who have accessed mental health services in Nottingham. The aim of the focus group was to identify the key barriers accessing mental health support after surviving domestic and/or sexual abuse in order to improve our services and shape our policy and campaigning work.

Our response to the key findings and recommendations from the report can be found towards the end of this blog. We’re asking other mental health service providers to also respond, please email [email protected] for further information.

Key findings

1. There can be long waiting times to access NHS mental health services. 

Some women waited up to six months for counselling and specialist sexual violence counselling.

2. Mental health services can be poorly advertised. 

Some mental health services are not well advertised and finding out how to access those services can be very challenging. This resulted in some women only becoming aware of the support that’s available once they are in crisis, even if the support is available in their neighbourhood and takes self-referrals.

3. There’s a lack of support for women in crisis. 

One woman was sent 150 miles away from Nottingham for emergency mental health support as there were no available beds locally. Most women experienced inadequate support from Crisis Teams and felt there was poor support after being discharged from inpatient mental health care.

4. Women’s Centres can help women report domestic violence and sexual violence and build confidence through volunteering. 

Women’s Centre can help identify DV/SV and support women to report. Further volunteering and training opportunities within the women’s sector were deemed an important part of some women’s journeys to healing and empowerment.

5. Isolation can stop women from reaching out for help. 

Isolation, anxiety, and/or depression were highlighted by nearly all the women as a major barrier to reporting; they can make women feel unable to leave the house, make contact with strangers or try anything new. This can make some Mental Health Support services inaccessible and stops some women from reporting abuse.

6. Peer support groups 

Peer support groups were identified as highly effective methods of support, from the initial helpline support to in-person support groups and ongoing volunteering opportunities.

7. Historical mistrust of Police and social services

There is some mistrust of Nottinghamshire Police and social services relating to historical mistreatment, although there’s an acknowledgement that Nottinghamshire Police and mental health services in general have considerably improved in recent years.

8. Disability, age, and drug addiction can be barriers to accessing mental health services 

Disabled women can struggle to access mental health services as they are isolated, older women can feel embarrassed or worried to ask for help. Drug addiction can be a major barrier to accessing the support that’s necessary for recovery and empowerment.

9. Services didn’t always understand carers/supporters

Some women felt that some mental health services were not equipped to support women with caring or ‘supporting’ responsibilities. For example, they felt mental health support professionals did not understand when they had to change their appointments at short notice because of the person they cared for/supported.

Key recommendations based on findings

Invest in mental health services to reduce waiting times for talking therapies

Nearly all the focus group participants reported a delay in accessing talking therapy, which was a key part of their recovery. Women wanted further investment in talking therapies and mental health services in general, and they wanted the services to be better advertised so it’s easier to access talking therapies before crisis point.

“Listen to us rather than make the decision for us, we don’t get any say”

Continue to work to build trust with women through meaningful consultation with service users, transparent practices and acknowledgement of how things have gone wrong in the past.

“Network support makes all the difference”  

Continue funding and developing specialist peer support groups in relation to domestic violence and sexual violence, and continued development of volunteering opportunities as part of the recovery and empowerment. Isolation can be a major barrier to accessing support and help; Women’s Centres were flagged as a key part in women’s journeys from abuse to empowerment.

“Start early”

There’s was a lot of support for investing in early prevention. Working in schools “preparing girls to say no and preparing boys to respect girls”. The women wanted children to be taught what abusive and unhealthy relationships look like, how to deal with emotions and they wanted girls to have their self-worth built at school.

Nottingham Women’s Centres’ response to the Recommendations

Invest in MHS to reduce waiting times for talking therapies

Renew aims to address the gap in services between women assessed as too ‘complex’ for primary mental health support such as IAPT (Improving Access to Psychological Therapies) services but also not considered high risk enough for referral to secondary mental health services.  Women are often referred to these services, with waiting times for each, only to discover that their needs do not match the service criteria.

Even when appropriately referred, women are often waiting up to 18 months for treatment to start.

Waiting time for a Renew counselling assessment is approx 8 weeks, clients are then allocated and typically offered a first counselling appointment within 4 weeks, sometimes faster if the client has flexible availability.

Renew is aware of these difficulties in accessing services for all women but in particular those experiencing multiple disadvantage.  We have made a number of changes our referral processes and service provision to reflect this.

  • Simple, user led referral system – We no longer accept referrals from professionals and agencies, instead advocating signposting and self-referral. Women are welcome to attend the centre with a support worker if this makes access easier.  This is designed to improve waiting times but also to reduce cancellations and DNA’s Women take more ownership of their engagement with us when initiated by them and are more likely to engage.
  • Responding to need – We are flexible in our approach to need and offer a triage system. Clients who are experiencing crisis or have long histories of high risk and or/multiple disadvantage are offered short term work with experienced therapist while on the waiting list for long term counselling.  We are also able to offer them holistic support through wider services at the centre and respond immediately to crisis with caseworker support where needed.  Women can access supportive and therapeutic groups, courses and activities and drop in at any time.  We also have an access fund available on a discretionary basis which aims to address barriers women have in accessing counselling i.e. childcare, travel costs
  • Increased capacity – To address the high number of women seeking mental health support we have increased the counselling team, employing a large team of counsellors both paid and volunteer, with varying levels of approach and experience, allowing us to allocate according to need and manage higher risk clients. Many of our clients are seeking support whilst on waiting lists for other services such as NSVSS and Personality Disorder Network. We have increased our paid staff from one to three, allowing us to support a growing number of volunteers to safely work with the more complex presentations we are encountering due to the pressure on NHS services and resultant waiting times.

 “Listen to us rather than make the decision for us, we don’t get any say”

Renew offers Humanistic counselling which differs greatly from the Cognitive Behavioural approaches which are available through GP referral such IAPT services.  We aim for this to be a transparent and collaborative process from the start which welcomes feedback and client involvement.  We ask for feedback as part of our assessment process, during the counselling process and at the end of counselling.

Whilst being mindful of research fatigue and ethical practice, we offer a number of ways in which clients can participate in evaluation of our services.  Alongside NWC’s general service user feedback, Renew collects distance travelled measures and the opportunity to give case studies and ‘story based’ feedback.  We encourage a culture of accountability to our clients with robust complaints procedures and prompt response to enquiries. 

We aim to have a centre wide group – ‘Friends of NWC’ which will be a vehicle for regular feedback on our performance and a place where women have used Renew can effect change to the service.

“Network support makes all the difference”  

  • We deliver several peer support groups at the centre aimed at multiple disadvantage and mental health. While not exclusively DVSA focussed, the majority of our participants have experienced DVSA and have been signposted to us from other projects within the centre or from DVSA services.
  • We have good relationships with DVSA agencies and referral/signposting takes place in both directions, in line with our holistic approach to women’s needs.
  • We recognise the effects of isolation on mental health and are flexible in the ways that women can access our services. Our peer support coordinator offers one to one meetings prior to groups when appropriate to help settle anxiety and overcome barriers.  We signpost to wider NWC services for wraparound support wherever possible.
  • Our Peer Support and volunteer counsellors are offered regular DVSA training
  • We value lived experience and actively promote growth and development through peer support volunteering and an extensive volunteer programme

 “Start early”

  • Renew offers services to women aged 18 and over. We have good relationships with the Stronger Families Team who signpost women to our service upon completion of their programme which supports positive parenting and awareness of the effects of DVSA on children

Case study

This story shows a woman’s journey from being in an abusive relationship to full recovery. This woman is now in full-time employment, feels empowered and happy again:

“I was unemployed, living with an abusive partner, and feeling that I was” going crazy”.

I had had depression in the past, but had stopped my medication some months before moving in with him, as I felt that I had recovered.

I was new in Nottingham and had no friends, therefore I registered with a new GP and explained that I couldn’t understand what was happening with my mental health.

After a few questions, he just suggested to give me some antidepressants. I didn’t accept and I self-referred myself to talking therapy with Insight, but the waiting time after the initial assessment was long. Again, they weren’t able to identify what my real problem was.

Doing some internet research, I found the Women’s Centre address, and one day I just walked in and started crying not being able to talk.

However, they gave me the space and time to calm down and talk about my feelings. Within the same day, the helped me understand that I was being psychologically abused and signposted me to Women’s Aid.

I had a case worker who was very supportive and helped realised that I had to leave my partner. She was also very good at warning me that the violence could increase as I would try to leave him. Indeed, I had to report him to the Police for hitting me, and the Police escorted me to the flat we were living in, so that I could take my things safely.

The Women’s Centre allowed me to join some activities, which helped me not to feel completely alone and isolated.

I did some talking therapy and a few months later I could do long term counselling at the Women’s Centre.

This was the key to my recovery and I can only talk about it thanks to all that process of healing and empowerment.”

What are you thoughts? Do you have any experiences or insight you would like to share? Or can your organisation respond to the recommendations? Get in touch with our Representation and Policy Officer for further information or to get involved: [email protected]