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Survivors of sexual violence can experience a range of trauma-related mental health problems, and pre-existing mental illness can also increase women’s vulnerability to sexual violence. However, although mental health and sexual violence services often see the same women, there is often a lack of communication and cross-referrals between services.

The With Study—Women’s Input into a Trauma-informed systems model of care in Health settings—was commissioned by ANROWS to understand how to promote a trauma-informed organisational model of care, responsive to women and practitioners, and embed it into the complex system of mental health and sexual violence services.

Based in Victoria and New South Wales, the research drew on qualitative work with women, stakeholders, and practitioners, as well as digital storytelling, and engaged with evidence and current theory around systems change in health settings. The findings provide guidance for future improvements to the health care system when responding to women with mental health problems and sexual violence, and other co-existing conditions that lead to trauma.

Trauma-informed care seeks to create safety for patients by understanding the effects of trauma and its close links to health and behaviour. Ideally, women experiencing mental health problems and sexual violence would have a pathway to safety and care no matter which service they approach first. But there has been little evaluative evidence to inform organisational and systems change, and no current organisational model outlines how services can optimally undertake trauma-informed care when both mental health problems and a history of sexual violence are present.

The findings integrating the perspectives of victims/survivors regarding recovery from sexual violence and mental health problems included:

•  Supportive counselling was essential, including feeling as if experiences of sexual violence were being genuinely heard, believed, and validated by the practitioner.
•  Healing was enhanced by, or relied on holistic services that understood their individual experiences and responded accordingly to empower women.
•  The healing process was supported by being connected to services and services that were connected with each other.
•  There was a need to support both “surviving” and “thriving”, including practical help that facilitated a positive recovery process.
•  Digital storytelling was a process that could assist women in this transformation to thriving, although required attention to supporting women if they become distressed as they remembered their experiences.
•  Women needed to understand the concept of male power and how it is associated with violence, and realise that many other women do experience sexual violence.
•  There was a benefit if women moved away from a reliance on alcohol and drugs, proactively avoided people who were violent, and, at times, were able to use medication to alleviate depressive and anxiety symptoms and enabled engagement in therapeutic social activities.

A number of factors regarding barriers and facilitators to change in health systems across the service settings emerged from the deliberative dialogues with staff and consultations with stakeholders. These included:

• a need for relationship building between teams;
•  a shared understanding of roles and language;
•  integrated care and coordination of referrals;
•  training of staff;
•  more workforce support;
•  leadership and governance; and
•  information systems for monitoring and evaluation.

Applying the lens and context of mental health and sexual violence services, The WITH Study also identified four main building blocks that enact change or implement features of women and practitioner-centred approaches. This study’s Health Systems Implementation Model is proposed to be complementary to existing health systems models in the area of violence against women to assist workplaces to implement changes.

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