Mental health services for marginalised women

Mental health services for marginalised women

Violence against women and girls is a cause of international concern and estimates suggest that 1 in 3 women will experience physical and sexual assault in their lifetime.

A group of four adults standing in front of a painted wall
Geraldine (second from left) with trainee facilitators Jane and Sandra, and a member of the local community Download 'Geraldine Esdaille_Blog.jpg'
"Discrimination pervades our mental health system and influences the way we are treated and diagnosed." - Geraldine Esdaille, Fellow

This violence varies across settings but includes domestic violence, sexual assault, rape, female genital mutilation, trafficking, sexual harassment, so-called honour crimes, forced marriage and stalking. For example, 1.3 million women in the UK were victims of domestic violence and abuse in the year 2017-18, and women victims accounted for 88% of all rape offences recorded by the British Crime Survey during the same period.

There is much evidence to suggest that these traumatic events are linked to the causation of stress disorders in women, and that sexual assault such as rape and childhood sexual abuse are more likely to cause Post Traumatic Stress Disorder (PTSD). Furthermore, it has been found that alcohol and drugs are used as a coping mechanism by women who have experienced such events, and there are strong links between domestic violence, problematic substance use, and subsequent mental distress. 

Some years ago, as a result of domestic violence, I came into contact with several services and agencies. The way I was treated led me to ask questions of the providers, other service users, and the wider community. Unfortunately, despite increasing attention and government commitment to addressing mental health issues, substance use, and domestic abuse, there remained a distinct lack of engagement with these services from Black women in the areas of Manchester where I grew up.  

In areas predominantly populated by Black people, I noticed that not many Black people were using those services, and; through my own experience, I understood why. In some instances, larger, white-led organisations, with little cultural awareness, were funded to do specialist work in Black communities, leaving some Black women labelled as hard to reach, difficult to engage with, or as not asking for help. In addition, Black-led, grassroots organisations were left fighting for survival because they lacked the capacity to compete for funding. 

In 2018, I travelled to America on a Churchill Fellowship to gain insight into how Black communities deal with the overlapping issues of mental health, substance misuse, and domestic violence. I visited New York, Chicago, Tennessee, and Atlanta. My research involved gathering information through interviews with community members and frontline staff, focus groups with specialist services, delivering workshops, touring community facilities, and conducting work placements in statutory and community organisations. 

I spent time in several community-based services and one afternoon, when I sat with a practitioner from a prominent grassroots initiative for women of colour, I asked if there was a domestic violence course that was written by Black women for Black women. She said, “No.” It was then that I decided that I would write one.

I also worked directly with New York State on a population health transformation programme that focused on fostering community partnerships with large public hospitals. This experience highlighted the challenges of implementing system change with inadequate social, economic, and environmental resources. It also gave me a greater understanding of how ‘“snowy white peaks’”, (where white males fill senior positions in large institutions) are formed and maintained.

My visit to Chicago coincided with a spike in shootings -on my first evening in the city, there was a fatal shooting close to my apartment. I spoke with several community members about the violence, and the recurring themes in these conversations indicated poverty, entrenched racial inequalities, exclusion, and systemic neglect. This experience left me distressed and angry. 

In my work with women who have experienced traumatic events, I find that the mental health of Black women is often severely impacted as a result of systemic failings. Some of the issues described above are germinated from the seeds of oppression and we live within a system where trauma sprouts from social injustice.  

Discrimination pervades our mental health system and influences the way we are treated and diagnosed, this serves in the re-victimisation and further disempowerment of Black women. Treated with an inadequate mental health model, in a mental healthcare system that we did not construct, Black women need new perspectives and models for mental health, domestic violence, and addiction. 

The social enterprise that I founded, We Are Black Gold CIC, runs workshops and focus groups with women and men born and bred in Manchester. Our programmes empower women who are marginalised and misrepresented and call for more accountability from men in BAME communities. Covering fundamental topics such as adverse childhood experiences, trauma, compassion, power and control, gender inequality, and racism, we help women to look at some of the things that have happened to them over their life course. They get the opportunity to understand how they express their distress and some of the social factors contributing to it. We highlight the effects of power imbalance, giving participants the chance to gain self-awareness and become aware of their strengths and assets, helping people to connect with the power and importance of writing their own stories. The programme for men teaches participants how to practise behaviours that support healthy and respectful relationships and looks at how domestic violence is conceptualised cross-culturally.

Our work is underpinned by the Power Threat Meaning Framework (PTMF), a radical approach to understanding emotional distress and wellbeing, this has led to me being co-opted onto the British Psychological Society PTMF committee.

We want to help people to reframe their stories to create hope and brighter futures, we want to strengthen communities, and introduce people to alternative perspectives in mental health. We are currently training facilitators to deliver the programmes and are seeking funding to pilot them across Greater Manchester.


The views and opinions expressed by any Fellow are those of the Fellow and not of the Churchill Fellowship or its partners, which have no responsibility or liability for any part of them.


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