A distinct approach

The Womanifesto opens by setting out why women’s treatment needs a distinct approach, arguing that women’s experiences with substance use differ significantly from men’s, necessitating a tailored response:

Women comprise 52% of the population but only 33% of treatment service users.

• They face higher rates of childhood trauma and interpersonal violence.
• Drug-related deaths among women continue to rise.
• Women are six times more likely than men to have children removed due to substance use.
• They are overrepresented in maternal deaths, often linked to domestic abuse.

Recommendations

The report makes three key recommendations to Government; providing a rationale, key components of implementation and next steps for each.

Recommendation One – Women only spaces and services

Ask: Make women-only spaces and services a mandatory requirement for all drug and alcohol treatment providers.

Rationale: Women often have histories of trauma and male violence. Single-sex environments provide physical and psychological safety, enabling more effective engagement and recovery.

Implementation:

• Women-only groups and drop-ins
• Female key workers by default
• Staff trained in women’s issues
• Women-centric health assessments and care plans
• Timely access to women-only residential services
• Policies addressing domestic abuse, menopause, and pregnancy.

Next Steps:

• Develop strategic approaches and minimum standards for women’s services
• Make compliance with these standards a commissioning requirement

Recommendation Two – Motherhood and maternity

Ask: Improve responses for mothers, including those without children in their care.

Rationale: Fear of child removal deters mothers from seeking help. One in five women has another child after removal, often facing accelerated proceedings. Stigma and lack of child-friendly environments further hinder access.

• Implementation:
  
  Strength-based approaches to keep families together
• Timely, appropriate interventions
• Specialist support for women at risk of child removal
• Trauma-informed, collaborative safeguarding practices

Next Steps:

• Share findings from the June 2025 sector-wide safeguarding engagement
• Explore opportunities for system-wide improvement in collaboration with children’s social care

Recommendation Three – Co-designed women’s pathway and partnerships

Ask: Redesign the treatment system from a woman’s perspective, with strong partnerships across services.

Rationale: Women face unique barriers and require tailored responses. Generic tweaks are insufficient; a full redesign is needed.

Implementation:

• Flexible, trauma-informed access (e.g., outreach, relational approaches)
• Proactive barrier reduction (e.g., childcare provision)
• Co-designed services with women
• Strong partnerships with women’s centres, domestic abuse and sexual violence (DASV) services, and sexual health providers

Next Steps:

• Commissioning areas to map women’s treatment journeys
• Identify missed opportunities and key local partners
• Ensure women with lived experience are central to the mapping process

Conclusion

In conclusion, the Women’s Treatment Working Group calls on OHID to co-produce a gender-responsive treatment system that reflects the realities of women’s lives. Through dedicated spaces, support for mothers, and co-designed pathways, we can build a system that is safe, inclusive, and effective for all women.