‘You are my last hope’ is heard increasingly in many women and girls’ services. These small and medium organisations are now having to offer support for wider health and social needs alongside their specialist activity due to the shrinking of public services.
For women and girls’ organisations the pressure can be particularly intense as the burden of austerity continues to disproportionately fall on them, abuse and violence persist, mental health problems increase, and the challenges of poverty and poor social conditions mean more pressure on families.
At Leeds Women’s Counselling and Therapy Service we see hundreds of women every year who are desperate for support to improve life for themselves and their children. This week is Mental Health Awareness Week but while that is our primary focus, the women we see have a range of increasingly longstanding and complex needs including physical conditions, mental health problems, parenting challenges, ongoing abuse and violence, substance misuse, social isolation, homelessness, debt and poverty.
Even well-resourced services able to support women for longer than a few weeks can be overwhelmed when faced with just one individual woman struggling to manage several of these issues. But now many women and girls services are facing multiple such requests for help on a daily basis.
Small and medium-sized charities like us have a unique ability to reach marginalised and isolated people with personalised support, but they are struggling to know which way to turn as demand continues to grow, and public services that ordinarily respond to these issues continue to shrink. We are working hard just to keep our heads above the water – trying to keep our focus on beneficiaries to avoid flailing around in circles.
A significant proportion of women come to us during pregnancy – which can be a particularly vulnerable time, with one in five women experiencing a perinatal mental health problem. Anxiety and depression can lead to a range of additional challenges, particularly around employment or relationships. Stigma can make it hard to seek help or for family and friends to acknowledge the problem. Generic services, without a gender specialism, can unwittingly add to the strain through limited understanding of what might have happened to a woman that resulted in her being pregnant or why she may or may not want to continue with it. Previous traumatic experiences - such as sexual violence, domestic abuse, trafficking, or previous removal of children into care - can make it even more complicated.
The expertise we bring, understanding the specific needs and experiences of women and girls, is essential to help women rebuild their lives. But it is challenging and organisations like us are few and far between. That’s why Agenda’s Women in Mind campaign is so important – we need to see investment in mental health services but also need to see a greater priority given to women and girls’ mental health – especially for the most vulnerable.
Over the last 10 years holes in the ‘net’ of public services which previously caught and supported the most vulnerable have widened until the net is now more holes than substance. Services which previously sat alongside each other and occasionally overlapped now have wide gaps between them. And we are becoming exhausted with the efforts to help people from falling through them.
We know there are fewer services with roughly 26% cut from local authority budgets since 2010. We also know the NHS is struggling to meet demand. Staff in public services are looking to charities to support those who need help. Those services which remain are constantly looking at how to manage demand and resource – often the response is to raise access thresholds or introduce more eligibility criteria. This leaves more people - often those with more complex needs - searching elsewhere for help. One NHS staff member said to me recently, “I check your website to see if your waiting list is open first thing every morning and again after lunch every day”.
On top of this, the funding environment for women’s and girls’ charities has changed rapidly. The current picture is complex and uncertain. There is less money available from traditional sources – small local authority grants have become large contracts subject to full tendering processes, which are out of reach of all but the largest charities with dedicated business support functions.
Charitable funding is reducing – the Big Lottery Fund has less money to distribute. Alongside this, the competition has increased and now comes from a wider pool: large charities are widening their geographical reach and their remits, including going into gender specific work as they search for funding. Small and medium charities too are looking further afield in order to stay sustainable. But many are going under leaving beneficiaries looking elsewhere for support.
There also seems to be a shift in emphasis among funders towards prevention, with less direct contact with those in need and communities expected to help themselves. While this work is vital, this shift leads to the reduction of funding focused on recovery and wellbeing, meaning those living with the long term consequences of trauma and abuse are being left without support.
The answer is probably as complex as the problem. Certainly some local authorities, including Leeds are working creatively and smartly to address health inequalities and improve wellbeing. Progressive funders such as Lloyds Bank Foundation are promoting and supporting small and medium sized charities to diversify their funding and embrace new ways of supporting their missions. For women and girls’ services it will be the passion and commitment of those involved and our allies that is our best bet for survival.
Tessa Denham is CEO of Leeds Women’s Counselling and Therapy Service. The service is a member of Agenda, the alliance for women and girls at risk