‘Across the sector you’ve always got this dynamic that we’re in competition for tenders, but you really don’t feel that in our group at all,’ says Via CEO Anna Whitton of the Collective Voice Women’s Treatment Working Group. ‘People are happy to share policies and the detail of what they’re doing. We just want to make a difference.’

Launched just over two years ago, the group includes service leads and representatives from specialist women’s services who work collectively to help improve women’s treatment provision. The impetus originally came from an APPG on women and alcohol use, says Hannah Shead, who chaired the group from its inception until Kirsty Day of the Nelson Trust took over at the end of last year. ‘Karen Tyrell from Humankind asked whether – with the Dame Carol Black review – there’d been enough focus on women in recovery. She made contact afterwards and we thought, let’s try to get together with other female leaders in the sector, just to get their thoughts on things they’re worried about, who’s doing what, and pushing forward the agenda for women’s needs in services. That’s how it began.’

‘We felt there wasn’t enough happening – we recognised that both in our own organisations and across the sector,’ says Whitton. ‘In a way we were just talking it through initially, and then over time we’ve found ways of making things happen. That sense that as women we could come together to make a difference – it felt like a really empowering thing to do.’

STRONG RELATIONSHIPS
The group aims to both bring about change in its member organisations and influence the wider sector, while the ability to share expertise has been invaluable, Whitton states. ‘You get the group coming together to talk about particular focus areas, but we’ve also built stronger relationships. If there are things we’re struggling with, or we want to find out if another organisation is doing something we’re about to do, we can just get in touch – there’s this really active sharing of what people are doing and how they’re doing it.’
The group meets virtually – as members are spread across the country – every six months, and there are sub-groups and webinars on top of that. ‘We get pretty consistent attendance – people really prioritise the meeting – which I think says a lot,’ says Whitton. ‘And we’ve had quite a few new members join as well, so you get a sense that it’s really something people want to be part of and are committed to.’ The group did get together in person at the Ophelia House open day last September, however. ‘That was great – it felt really fitting to be in a new women’s service and we all said how much we valued the chance to meet in that setting,’ says Shead.

At last year’s DDN conference she pointed out that while women were 52 per cent of the population, their treatment needs still weren’t being properly taken into account. ‘We can sit and talk about this forever but what we need to see is real change,’ she told delegates (DDN, September 2023, page 6). Does she get a sense that things are genuinely starting to improve, or is that still a way off? ‘Being in a women-only service, my sense is that people are really wanting to engage and understand our work,’ she says. ‘My experience used to be that some of the women’s stuff felt like an afterthought, but I’ve seen that change. People do seem much more interested, and there’s a willingness to understand women’s needs as different – not better or worse – to men’s, and wanting to understand that what we do to get treatment right for them might be different as well.’

There’s also ‘a real drive’ to do things differently in mixed services, adds Whitton. ‘Several organisations have used the grants that were available to have women-only outreach workers, for example, or women-only provision. And we’re definitely seeing a lot more women-only groups developing.’ Via recently took on the contract to provide Gloucestershire’s community drug and alcohol services (DDN, February, page 5), which includes an end-to-end women’s pathway in partnership with the Nelson Trust. ‘Interestingly that tender process had specific questions around women – we’re starting to see more of that now,’ she says. ‘We know it’s important, but it also helps if our commissioners are asking for it.’

WOMEN-ONLY DETOX
The organisation is also launching the UK’s only women only detox centre in Gloucestershire later in the year. ‘It’s interesting – when you think about the vulnerability of women going into those environments – that it hasn’t existed before, so that’s significant as well,’ she says. And the idea originally came from discussions at the Women’s Treatment Working Group, she points out. ‘So there are some things where we need to be influencing commissioners and system change, and others that we can make happen ourselves.’

While drug-related deaths among women have risen significantly over the last decade, the most recent OHID figures show that the gender split in drug treatment is still around two thirds men to one third women – and approximately 60/40 in alcohol treatment – indicative of the barriers and disincentives to accessing treatment.

It’s impossible to discuss this without mentioning stigma, along with women’s very real fear of having their children removed. Almost a third of women reported either living with a child or being a parent when they started treatment, while according to a 2022 report by the University of Glasgow, mothers are six times more likely to have children removed than substance-using fathers. ‘Stigma is something we have to continue to work on, and I think the lived experience input into this is really, really important,’ says Whitton. ‘And we of course have responsibilities as providers – we want more women to come into services when they need them.’

It’s also, crucially, about services feeling safe for women, adds Shead. ‘That’s one of the things I hear time and time again. There’s that fear of judgement, but also that practical stuff about the many women who are survivors of male violence finding themselves in treatment settings with people who’ve harmed them. I think we need to get to a place where we’re really thinking about what it looks like for women to come into our treatment settings, and how we create safe spaces. Those conversations are happening, but that’s still a reason why many women won’t stay engaged. We need to be looking through that lens of women’s experiences – and stigma’s a massive part of that.’

DOMESTIC VIOLENCE
The Adult psychiatric morbidity survey found that women with experience of violence or abuse were more than twice as likely to have an alcohol problem and eight times more likely to be drug dependent than other women. A report last year from the Centre for Justice Innovation, however, that said not only was it clearly very difficult for women to talk about issues like abuse in groups with men present, but that some women were also being put at risk by predatory males in treatment settings (DDN, December/January, page 6).

‘I think there’s a real challenge to our sector about how we work ethically with women,’ Shead states. ‘I can only talk about what women have shared with me, where they’ve said that to disclose their experiences of sexual violence or domestic abuse with men in the room – even the loveliest men in the world – is deeply triggering and re-traumatising. So as we start to really get under the skin of what it means to do women’s work well, we need to challenge ourselves in a way that maybe we haven’t always done up to now.’

One thing the drug and alcohol field could do is take more learning from the women’s sector, she stresses. ‘Look at all the good work there – they know about this stuff. There’s a lot of learning that we really should be translating into our sector to get it right. So it’s not like we have to start from scratch – there’s years and years of best practice and evidence-based ways of working with women that we can learn from to make our services work.’

‘That’s totally right,’ states Whitton. ‘And working with the women’s sector around operating environments that feel safer for women – when women come into a women-only space they’ll tell you that it feels so different and so safe.’ One of the first things the group did, in fact, was to write to OHID setting out the minimum provision for women that should exist in every service, including proper women-only spaces. While there has been some improvement here, there’s still ‘quite a lot of inconsistency’, Whitton says. ‘We have a responsibility to make that happen, and I definitely think there’s a growing momentum. You can see it in the conversations in our group – “we’re thinking of doing this in this location, has anyone got an example we can use?”’

ENGAGEMENT LEVELS
The level of engagement in the group’s webinars is also evidence of how much people want to get all of this right, Shead stresses. ‘We have really quick sign-ups, and people stay on the webinars. You get a real sense that people are interested and want to understand more.’

It’s vital to remember that people’s experiences are different, adds Whitton. ‘We have to think about things like intersectionality, the experience for women with children or women whose children have been removed, issues around menopause and perimenopause – there are so many things we need to be considering, and thinking together about how we change and develop.’

It’s also important to focus on the entire pathway for women, she says, including things like mutual aid. ‘We might have implemented lots of great women-only provision in core services, but we also need to think about next steps and aftercare, and what the options look like there’ – with some user engagement work historically having been dominated by male voices.

‘There’s always more to do in this space and we have to work really hard at it and challenge ourselves and listen, and we’re really committed to that,’ she says. ‘But it takes time and resources – you have to put the time into doing it well.’

Reps of the Collective Voice Women’s Treatment Working Group at Ophelia House open day, Sept 2023. L–R: Kendra Grey – BAC O’Connor, Karen Biggs – Phoenix Futures, Karen Marsh – MPFT, Kirsty Day – Nelson Trust, Hannah Shead – Trevi, Beth Hughes – Nelson, Rebecca Beatie – Via, Anna Whitton – Via, Nic Adamson – Change Grow Live, and Laura McIntyre – Changing Lives.