World Suicide Prevention Day is an opportunity to consider not only how we respond when someone is suicidal, but whether we understand the circumstances that can bring someone to that point. For women experiencing domestic abuse, that question is particularly important. Domestic abuse can be a significant contributor to poor mental health and suicidal distress. Yet it is not always recognised as part of the picture when women present to mental health, primary care or other services.
At Woman’s Trust, we support women affected by domestic abuse who are experiencing significant mental health difficulties, including suicidal ideation. Their experiences have taught us that suicide prevention needs to look beyond the immediate crisis and understand what is happening in a woman’s life.
Ask what is happening in her life, not only what is happening to her mental health
A woman presenting with suicidal thoughts may be experiencing depression, anxiety or trauma. But those symptoms may be rooted in, or intensified by, domestic abuse.
Domestic abuse is not simply another risk factor to add to a clinical checklist. For some women, it is the context in which their mental health has deteriorated. Coercive control can progressively restrict a woman’s autonomy and access to support. An abusive partner may control money, communications, movements and relationships. Threats and humiliation can undermine a woman’s confidence in her own judgement. A woman can reach a point where suicide can feel like the only way to regain control or escape.
Sarah*, described it starkly: “You always consider taking your life to get away.”
For professionals, this should prompt a different question: what is happening around this woman that may be contributing to her suicidal distress? That question needs to be asked sensitively and safely, without an abusive partner present.
Leaving does not necessarily mean the risk has gone
Another assumption we need to challenge is that once a woman has left an abusive relationship, the mental health risk will reduce. Sometimes it does. But separation can introduce new risks. Post-separation abuse can include stalking, harassment, financial abuse, threats and the continued use of children as a means of control. Women may also face housing insecurity, financial instability and prolonged contact with multiple agencies.
The psychological impact of previous abuse can persist alongside these pressures.
For councils and commissioners, this has an important implication: support should not automatically reduce because a woman is now physically separated from her abuser. Mental health recovery can take considerably longer than physical separation.
Coercive control needs to be understood in relation to mental health
Coercive control is often understood primarily through a criminal justice or safeguarding lens. It is both. But it is also highly relevant to mental health. Living under sustained control and threat can affect how a person understands themselves, their relationships and their options. Women may experience hypervigilance, anxiety, depression, trauma, intrusive thoughts and suicidal ideation. Professionals do not need to diagnose coercive control. But they do need to recognise its potential impact.
Mental health services should be able to ask whether a woman is currently experiencing abuse, whether there has been abuse in the past, and whether the person causing harm still has access to her. Domestic abuse services need to recognise that securing physical safety is only one part of recovery. And councils and commissioners need to commission services that understand both domestic abuse and mental health, rather than treating them as separate pathways.
Organisations need to stop working in silos
Women do not experience their lives in service categories. A woman may simultaneously be interacting with a GP, mental health service, domestic abuse service, housing department, children’s services and the police. Yet each organisation may see only one part of what is happening. That fragmentation can be particularly dangerous when a woman is having to explain her circumstances repeatedly while experiencing trauma.
Local systems therefore need stronger connections between domestic abuse, suicide prevention and mental health strategies. This should include shared understanding, clear referral pathways and effective multi-agency working, while ensuring that information sharing does not inadvertently increase risk to the survivor.
We need to learn from suicide attempts as well as deaths
When a woman dies by suicide, there should be an opportunity to examine whether domestic abuse was a factor. But we also need to learn from women who survive suicide attempts and episodes of serious suicidal distress. What services had she approached? Had she disclosed abuse? Was her suicidal distress understood in the context of that abuse? Had she recently separated? Was she experiencing coercive control or stalking? What happened when she asked for help? Without asking these questions, we risk repeatedly responding to the crisis without understanding what created it.
Learning from attempts and serious suicidal distress could help services identify opportunities for earlier intervention.
Recovery needs to be part of suicide prevention
Suicide prevention cannot stop at keeping someone alive through an immediate crisis. For women whose suicidal distress is connected to domestic abuse, recovery may require long-term specialist support. If we know that domestic abuse can contribute to suicidal distress, then women need access to support that understands the relationship between trauma, coercive control and mental health – before they reach crisis point.
For councils and commissioners, the question is therefore not simply whether domestic abuse services are available. It is whether the local system is providing enough specialist mental health support to meet the level of need.
What should change?
This World Suicide Prevention Day, we need to broaden our understanding of what suicide prevention means for women experiencing domestic abuse. It means asking about domestic abuse when women present with suicidal thoughts or self-harm. It means ensuring professionals understand coercive control and post-separation abuse and their potential impact on mental health. It means connecting domestic abuse, mental health and suicide prevention strategies locally, rather than expecting women to navigate fragmented systems themselves. It means learning from suicide attempts and serious suicidal distress as well as deaths. And it means investing in specialist, trauma-informed mental health support that continues beyond the immediate crisis.
If we want suicide prevention strategies to work for women, we need to understand the circumstances in which suicidal distress develops – and respond to those circumstances as well as the crisis itself. Keeping a woman alive through a crisis is essential. But it is only the beginning.
We should ask whether our systems are doing enough to help women see a future beyond abuse. Because when a woman says she cannot see a way out, our responsibility is not simply to assess her risk. It is to understand what is making her feel trapped – and help create a way out.
* Sarah is a pseudonym used to protect her identity.
Alice Piller-Roner is Chief Executive of Woman’s Trust
If you need support, please reach out for help and advice
National Domestic Violence Helpline
0808 2000 247 – nationaldahelpline.org.uk
information and advice
Samaritans
116 123 – samaritans.org
24/7 emotional support
Shout
text 85258 – giveusashout.org
24/7 emotional support
Find more mental health helplines and crisis contacts here.
