Trauma Informed Behavioral Healthcare

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“Trauma-informed approaches suggests clinicians, organizations and whole systems of care are in an active and reflective process of engaging consumers with histories of trauma. Trauma-informed transcends the isolated, “in session,” application of specific clinical interventions that are designed to “treat” the symptoms and sequelae of trauma.

Rather, trauma–informed care implies individual and collective systems recognize that trauma can have broad and penetrating effects on a client’s personhood. These effects can range from sensory sensitivities, (to harsh noise, light for example) stemming from a sensitized nervous system, to more existential challenges, like distrust of others, despair, a damaged sense self or powerlessness.

In the active acknowledgment of these broad and varied effects, clinicians, organizations and systems of care actively work to cultivate physical environments that are healing and soothing. Also, we are working to create a “behavioral environment,” where staff (clinical and non-clinical) convey dignity, respect, hopefulness, the opportunity for choices and empowerment among consumers. This seems to be a never ending, ongoing process, involving exchange and dialogue with those we serve.”

-Bharati Acharya, MA, LPCC, Diplomat Narrative Therapy, Trauma Informed Therapist/Mental Health Professional

Trauma-Informed Care in a Nutshell



Cheryl Sharp
Senior Advisor for Trauma Informed Services
Cheryl Sharp holds the unique perspective of a person who has recovered from significant mental health challenges, a trauma survivor, a family member of a [...] Read More



Linda Ligenza, MSW
Clinical Services Director
Linda Ligenza supports national behavioral health quality improvement initiatives, with focus on helping organizations become trauma-informed. She was formerly with SAMHSA as the disaster trauma [...] Read More



Johnson Karen
Director, Trauma-Informed Services
Karen Johnson, MSW, LCSW, director of Trauma-Informed Services, brings to the National Council over 19 years of clinical and administrative experience in child welfare and [...] Read More


Request consulting services in trauma-informed care.


Trauma is a near universal experience of individuals with behavioral health problems. According to the U.S. Department of Health and Human Services’ Office on Women’s Health, 55% – 99% of women in substance use treatment and 85% – 95% of women in the public mental health system report a history of trauma, with the abuse most commonly having occurred in childhood. The Adverse Childhood Experiences (ACE) study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. Almost two-thirds of the study participants reported at least one adverse childhood experience of physical or sexual abuse, neglect, or family dysfunction, and more than one of five reported three or more such experiences.

An individual’s experience of trauma impacts every area of human functioning — physical, mental, behavioral, social, spiritual. The ACE study revealed the economic costs of untreated trauma-related alcohol and drug abuse alone were estimated at $161 billion in 2000. The human costs are incalculable.

Trauma is shrouded in secrecy and denial and is often ignored. When we don’t ask about trauma in behavioral health care, harm is done or abuse is unintentionally recreated by the use of forced medication, seclusion, or restraints.

The good news is trauma is treatable — there are many evidence-based models and promising practices designed for specific populations, types of trauma, and behavioral health manifestations.


Addressing trauma is now the expectation, not the exception, in behavioral health systems. Every day, behavioral health organizations are asking the National Council how they can be better prepared to offer trauma-informed care.

The National Council’s trauma-informed care initiatives have helped hundreds of organizations across the country map out and operationalize a plan for delivering trauma-informed care. National Council trauma experts can help you devise and implement a complete A-Z trauma-informed care plan for your organization. They help you address board and leadership buy-in, workforce training, practice changes and guidelines, community awareness, and outcomes measurement. Our experts are available for short-term and long-term consulting and training engagements at your site and can work hands on with your core implementation team.

Addressing trauma helps your organization improve the quality and impact of your behavioral health services, increase safety for all, reduce no-shows, enhance client engagement, and avoid staff burnout and turnover.

Start today with one or more of the three key trauma-informed care consulting and training packages that the National Council offers:

Organizational Self-Assessment and Follow-up

The National Council’s Trauma-informed Care Organizational Self-Assessment is designed to increase your awareness and readiness to adopt the key components of a trauma-informed care organization and to identify what you need to keep doing and reinforcing, stop doing, or start doing the right thing. Our consulting package is designed to help you complete the assessment, review results, and develop strategies for improvement. We meet face to face with your leadership and core implementation teams, offer in-person site visits and phone consultations, schedule monthly calls to track and discuss progress, and give your team access to key resources.

Introduction to Trauma-informed Care

A day-long training at your site for all your staff provides an overview of trauma across the lifespan, discusses its impact, explains what it takes to be trauma-informed, offers helpful tools (i.e., trauma-focused therapy, alternative healing such as WRAP), and explores proven models of trauma-informed care.

Seven Domains of Trauma-informed Care

The seven domains of trauma-informed care are early screening and assessment, consumer-driven care and services, nurturing a trauma-informed and responsive workforce, evidence-based and emerging best practices, creating safe environments, community outreach and partnership building, and ongoing performance improvement and evaluation. In each of these areas, the National Council offers a half-day education workshop followed by 1-day onsite consulting on the implementation process. We help you set up performance indicators and provide essential tools and resources.

And More…

The National Council also provides consulting and technical assistance to help you

  • Address compassion fatigue
  • Use the Wellness Recovery Action Plan (WRAP) as a tool to heal trauma
  • Nurture trauma-informed peers
  • Rebuild organizational culture in the context of trauma
  • Examine issues related to gender and trauma
  • Practice trauma-informed supervision of staff
  • Build trauma-informed communities
  • Understand trauma-informed evidence-based practices

National Council Magazine
An entire issue of National Council Magazine is dedicated to Trauma-Informed Behavioral Healthcare. The magazine contains more than 20 cutting edge articles from leading researchers, policy specialists, administrators, clinicians, and peer representatives as well as interviews and case studies from organizations and communities seeking to make the transition to a trauma-informed culture of care.

Manage Trauma Infographic
The National Council’s popular infographic “How to Manage Trauma” presents key facts and stats on trauma in behavioral health and outlines the symptoms and coping strategies. View and share this infographic.

Trauma Survivors Bill of Rights
Thomas Maguire’s Recovery Bill of Rights for Trauma Survivors is presented in a National Council infographic to help persons who’ve experienced trauma cope and manage their rights.

Trauma-Informed Care Learning Community
The National Council’s 2015 Trauma-informed Care Learning Community connects you with trauma experts and agencies like yours to make sure you are offering quality trauma-informed practices. The year-long learning community includes a series of coaching calls, webinars, two in-person summits, access to tools and resources, as well as lifetime membership to an exclusive listserv. Applications are not currently being accepted.

National Council Webinars

Helping Children Recover From Trauma
Bruce Perry

Does Your Organization Measure Up: Are You Really Trauma-informed?
Cheryl Sharp and Linda Ligenza, October 18, 2012

Mobilizing a Community to Address the Impact of Childhood Trauma
Teri Barila and Mark Brown, September 17, 2012

Trauma from Adverse Childhood Experiences: The Hidden Epidemic
Vincent Felitti, August 27, 2012

Engaging Women in Trauma-Informed Peer Support
Cheryl Sharp, Cathy Cave, July 9, 2012

Stories from Survivors: A Primer on Suicide Prevention
David Covington, Cheryl Sharp, Kevin Hines, and Major General Mark Graham, September 12, 2012

Addressing Trauma through Mental Health First Aid
Cheryl Sharp, February 22, 2012

Mitigating Disaster Trauma: Lessons from Sandy
Linda Ligenza, Christian Burgess, Vicky Mieseler, November 14, 2012


Helping a Person with Schizophrenia

Overcoming Challenges While Taking Care of Yourself

Emotional and Psychological Trauma In This Article

The love and support of family plays an important role in schizophrenia treatment and recovery. If someone close to you has schizophrenia, you can make a huge difference by helping that person find the right treatment, cope with symptoms, and navigate the long road to recovery. Dealing with a family member's schizophrenia can be tough, but you don't have to do it alone. You can draw on others, and take advantage of services in your community–but you will also need to take care of yourself.

Schizophrenia and the family: How to help your loved one

If a family member or someone close to you has schizophrenia, you may be struggling with any number of difficult emotions, including fear, guilt, anger, frustration, and hopelessness. The illness may be difficult for you to accept. You may feel helpless in the face of your loved one’s symptoms. Or you may be worried about the stigma of schizophrenia, or confused and embarrassed by strange behaviors you don’t understand. You may even be tempted to hide your loved one’s illness from others.

In order to deal successfully with schizophrenia and help your family member, it’s important to:

  • accept the illness and its difficulties
  • be realistic in what you expect of the person with schizophrenia and of yourself
  • maintain a sense of humor

Do your best to help your family member feel better and enjoy life, pay the same attention to your own needs, and remain hopeful.

Tips for helping a family member with schizophrenia

  • Educate yourself. Learning about schizophrenia and its treatment will allow you to make informed decisions about how best to manage the illness, work toward recovery, and handle setbacks.
  • Reduce stress. Stress can cause schizophrenia symptoms to flare up, so it’s important to create a structured and supportive environment for your family member. Avoid putting pressure on your loved one or criticizing perceived shortcomings.
  • Set realistic expectations. It’s important to be realistic about the challenges and limitations of schizophrenia. Help your loved one set and achieve manageable goals, and be patient with the pace of recovery.
  • Empower your loved one. Be careful that you’re not taking over and doing things for your family member that he or she is capable of doing. Try to support your loved one while still encouraging as much independence as possible.

Helping people with schizophrenia tip 1: Take care of yourself

In order to successfully deal with schizophrenia in a family member, you need to take care of your own needs and find healthy ways of coping with the challenges you and your loved one face.

Put on your own "oxygen mask" first

Keeping a positive outlook is much easier when you have others you can turn to for support. Like your loved one with schizophrenia, you too need help, encouragement, and understanding. When you feel supported and cared for, you, in turn, will be better able to support and care for your loved one.

  • Join a support group. One of the best ways to cope with schizophrenia is by joining a family support group. Meeting others who know first-hand what you’re going through can help reduce feelings of isolation and fear. Support groups provide an invaluable venue for the relatives of people with schizophrenia to share experiences, advice, and information.
  • Make time for yourself. Schedule time into your day for things you enjoy, whether it be spending time in nature, visiting with friends, or reading a good book. Taking breaks from caregiving will help you stay positive and avoid burnout.
  • Look after your health. Neglecting your health only adds to the stress in your life. Maintain your physical well-being by getting enough sleep, exercising regularly, eating a balanced diet, and staying on top of any medical conditions.
  • Cultivate other relationships. It’s important to maintain other supportive, fulfilling relationships. Don’t feel guilty for looking after your social needs. You need support, too. These relationships will help buoy you in difficult times.

The importance of managing stress

Schizophrenia places an incredible amount of stress on family members. If you’re not careful, it can take over your life and quickly burn you out. And if you’re stressed out and overwhelmed, you will make the person with schizophrenia stressed. That’s why keeping your own stress levels under control is one of the most important things you can do for a family member with schizophrenia.

  • Practice acceptance. The “why me?” mindset is destructive. Instead of dwelling on the unfairness or life, accept your feelings (even the negative ones). Your burdens don’t have to define your life unless you obsess about them.
  • Seek out joy. Making time for fun isn’t frivolous or indulgent—it’s necessary. It isn’t the people who have the least problems who are the happiest, it’s the people who learn to find joy in life despite adversity.
  • Recognize your own limits. Be realistic about the level of support and care you can provide. You can’t do it all, and you won’t be much help to a loved one if you’re run down and emotionally exhausted.
  • Avoid blame. In order to cope with schizophrenia in a family member, it’s important to understand that although you can make a positive difference, you aren’t to blame for the illness or responsible for your loved one’s recovery.

Tips for keeping stress in check—no matter the challenges in your life

Dealing with schizophrenia in a family member can be stressful, but you can keep your stress levels in check by learning and practicing a variety of stress management techniques.

Helping people with schizophrenia tip 2: Encourage and support treatment

The best way to assist the recovery of a family member with schizophrenia is to get them into treatment and help them stick with it. Often, the first challenge of treatment is convincing the ill relative to see a doctor. To people experiencing delusions, hallucinations, and paranoia, there is no need for medical intervention because the voices and conspiracy theories are real.

If a family member with schizophrenia is reluctant to see a doctor, the following strategies might help:

  • Provide options – Your loved one may be more willing to see a doctor if he or she can control the situation somewhat. If your relative appears suspicious of you, suggest another person to accompany him or her to the appointment. You can also give your family member a choice of doctors.
  • Focus on a particular symptom – A person with schizophrenia may resist seeing a doctor out of fear of being judged or labeled “crazy.” You can make the doctor less threatening by suggesting a visit in order to deal with a specific symptom such as insomnia or a lack of energy.

Tips for supporting a family member’s schizophrenia treatment

  • Seek help right away. Early intervention makes a difference in the course of schizophrenia, so don’t wait to get professional help. You family member will need assistance finding a good doctor and other effective treatments.
  • Encourage independence. Rather than doing everything for your family member, encourage self-care and self-confidence. Help your loved one develop or relearn skills that will allow for greater independence of functioning.
  • Be collaborative. It’s important that your loved one have a voice in his or her treatment. When your family member feels respected and acknowledged, he or she will be more motivated to follow through with treatment and work toward recovery.

Helping people with schizophrenia tip 3: Monitor medication

Once your family member is in treatment, careful monitoring can ensure that he or she is staying on track and getting the most out of medication. You can help out in the following ways.

  • Take side effects seriously. Many people stop taking their schizophrenia medication because of side effects, so pay attention to your loved one’s drug complaints. Bring any distressing side effects to the attention of the doctor. The doctor may be able to reduce adverse effects by reducing the dose, switching to another antipsychotic, or adding another medication that targets the troublesome side effect.
  • Encourage your loved one to take medication regularly. Even with side effects under control, some people with schizophrenia refuse medication or take it irregularly. This may be due to a lack of insight into their illness and the importance of medication, or they may simply have trouble remembering their daily dose. Medication calendars, weekly pillboxes, and timers can help people who are forgetful. Two typical antipsychotics, Haldol and Prolixin, are also available in a long-acting injectable form, given as shots every 2 to 4 weeks, eliminating the need for a daily pill.
  • Be careful to avoid drug interactions. Antipsychotic medications can cause unpleasant and dangerous side effects when combined with other substances, including certain prescription drugs, over-the-counter medications, vitamins, and herbs. Help your family member avoid any problems by giving the doctor a complete list of the drugs and supplements he or she is taking. Mixing alcohol or illegal drugs with schizophrenia medication is also harmful, so talk to the doctor if your relative has a substance abuse problem.
  • Track your family member’s progress. You can help the doctor track treatment progress by documenting changes in your family member’s behavior, mood, and other symptoms in response to medication. A journal or diary is a good way to record medication history, side effects, and everyday details that might otherwise be forgotten.

Helping people with schizophrenia tip 4: Watch for signs of relapse

Stopping medication is the most frequent cause of relapse in schizophrenia, so it’s extremely important that your family member continues to take all medication as directed. Many people whose schizophrenia is stabilized or in remission still require medication to maintain their treatment gains and keep symptoms at bay.

Unfortunately, even if a person is taking medication as prescribed, relapse into an acute psychotic episode of schizophrenia can occur. But if you learn to recognize the early warning signs of relapse and take immediate steps to deal with them, you may be able to prevent a full-blown crisis. The warning signs of relapse are often similar to the symptoms and behaviors that led up to the person’s first psychotic episode.

Common warning signs of schizophrenia relapse:

  • Insomnia
  • Social withdrawal
  • Deterioration of personal hygiene
  • Increasing paranoia
  • Hostility
  • Confusing or nonsensical speech
  • Strange disappearances
  • Hallucinations

If you notice any warning signs of relapse or other indications that your family member’s symptoms of schizophrenia are getting worse, call the doctor right away.

Helping people with schizophrenia tip 5: Prepare for crisis situations

Despite your best efforts to prevent relapse, there may be times when your family member’s condition deteriorates rapidly and drastically. During a schizophrenia crisis, you must get help for your family member as soon as possible. Hospitalization may be required to keep your loved one safe.

Emergency planning

It’s important for the family members of people with schizophrenia to prepare for such crisis situations. Having an emergency plan ready for an acute psychotic episode will help you handle the crisis safely and quickly. A good emergency plan for a family member with schizophrenia includes:

  • A list of emergency contact information for your loved one’s doctor, therapists, and the police.
  • The address and phone number of the hospital you will go to in case of emergency for psychiatric admission.
  • Friends or relatives who will take care of other children or dependents while you deal with the crisis.

It’s also wise to go over the emergency plan with your family member. The crisis situation may be less frightening and upsetting to your loved one If he or she knows what to expect during an emergency.

10 Tips for Handling a Schizophrenia Crisis

  • Remember that you cannot reason with acute psychosis
  • Remember that the person may be terrified by his/her own feelings of loss of control
  • Do not express irritation or anger
  • Do not shout
  • Do not use sarcasm as a weapon
  • Decrease distractions (turn off the TV, radio, fluorescent lights that hum, etc.)
  • Ask any casual visitors to leave—the fewer people the better
  • Avoid direct continuous eye contact
  • Avoid touching the person
  • Sit down and ask the person to sit down also

Source: World Fellowship for Schizophrenia and Allied Disorders


Helping people with schizophrenia tip 6: Explore housing options

Treatment for schizophrenia cannot succeed if your family member doesn’t have a stable, supportive place to live. But finding the right living situation for a person with schizophrenia can be challenging. When considering housing options, think about the individual needs of the person with schizophrenia:

  • Can your family member care for him or herself?
  • How much support does he or she need with daily activities?
  • Does your family member have a drug or alcohol problem?
  • How much treatment supervision does he or she require?

Living with family

For many families, the most difficult choice involves whether or not the relative with schizophrenia should live at home. Living with family can be a good option for people with schizophrenia if their family members understand the illness well, have a strong support system of their own, and are willing and able to provide whatever assistance is needed.

At-home arrangements are less likely to be successful if the person with schizophrenia uses drugs or alcohol, resists taking medication, or is aggressive or uncooperative.

Choosing the Right Housing Option for a Person with Schizophrenia

Adapted from : Schizophrenia: A Handbook For Families, Health Canada

Living with family works best if:
  • The person with schizophrenia functions at a fairly high level, has friendships, and is involved in activities outside the home.
  • The interaction among family members is relaxed.
  • The person with schizophrenia intends to take advantage of available support services.
  • The living situation does not negatively impact the lives of any young children in the home.
Living with family is not advised if:
  • The main support person is single, ill, or elderly.
  • The person with schizophrenia is so ill that there is little or no chance to lead a normal family life.
  • The situation causes stress in the marriage or leaves children in the home feeling frightened and resentful.
  • Most family events and concerns revolve around the person with schizophrenia.
  • Support services are not used or are unavailable.

Try not to feel guilty if you are unequipped to house a family member with schizophrenia. If you can’t look after your own needs or those of others in the family while caring for your ill relative, he or she will be better off somewhere else.

Residential options outside the family home

If an at-home living arrangement isn’t the right fit, make contact with local mental health facilities, social service agencies, support groups, and public housing authorities. These organizations can help you explore the residential facilities in your community and put your family member’s name on the appropriate waiting lists.

Options in your area may include:

  • Residential treatment facilities or 24-hour care homes – A more structured living environment for those who require greater assistance with medications and daily living tasks or for those going through an acute psychotic episode.
  • Transitional group home – An intensive program that helps individuals transition back into society and avoid relapse after a crisis or hospitalization. Includes skills training and rehabilitation services.
  • Foster or boarding homes – A group living situation for people with schizophrenia who are able to function relatively well on their own. Foster and boarding homes offer a certain degree of independence, while providing meals and other basic necessities.
  • Supervised apartments – An option for those whose condition is less severe or well-managed with medication. Residents live alone or share an apartment, with staff members available on-site to provide assistance and support.

More help for schizophrenia

Resources and references

Schizophrenia help for families

Information for Families: Schizophrenia (PDF) – Tips on how communicate and interact with a schizophrenic person and how to look after your own well-being. (World Fellowship for Schizophrenia and Allied Disorders)

Schizophrenia: The Journey to Recovery (PDF) – A consumer and family guide to schizophrenia assessment and treatment. (Schizophrenia Society of Canada)

Dealing with Unusual Thoughts and Behaviors (PDF) – Fact sheet from the U.K.-based National Schizophrenia Fellowship on coping with the symptoms and behaviors of schizophrenia in a loved one. (Rethink)

Finding schizophrenia services and support in the U.S.

Find Your State and Local NAMI – Locate the nearest branch of the National Alliance on Mental Illness, an organization that offers support, education, and referrals for people coping with mental illness. You can also call the toll free HelpLine at 1-800-950-NAMI (6264).

State and Local Programs for Families, Young Families, and Providers – Directory of education, training, and support programs for the caregivers of people with mental illness. (National Alliance on Mental Illness)

Finding schizophrenia services and support in other countries

Rethink: Schizophrenia offers a helpline (0300 5000 927) and information on support and services in the UK.

Sane Australia offers a helpline (1800 18 7263) and online advice and referrals to support agencies in Australia.

Schizophrenia Society of Canada offers links to regional societies in Canada that offer helplines and local programs and services.

Medical coverage for schizophrenia

Social Security Benefits – Describes the process of applying for social security benefits and what can be done if benefits are turned down initially. (National Alliance on Mental Illness)

Health Insurance and Mental Health Services – Learn about mental health coverage under the Affordable Care Act. (

Medicare and Your Mental Health Benefits (PDF) – A guide to the mental health services that are covered under Medicare. (

Housing options for people with schizophrenia

Finding a Good Residential Option for Someone with Severe Mental Illness – Provides suggestions for choosing the right living arrangement for a family member with schizophrenia. (

Moving On: Federal Programs to Assist Transition-Age Youth with Serious Mental Health Conditions (PDF) – A collection of fact sheets on U.S. government programs available to help young people with mental illness. (Bazelon Center for Mental Health Law)

Authors: Melinda Smith, M.A., and Jeanne Segal, Ph.D.  Last updated: February 2015.


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Protecting Yourself and Escaping from Domestic Violence

Help for Abused and Battered Women In This Article

Getting out of an abusive or violent relationship isn’t easy. Maybe you’re still hoping that things will change or you’re afraid of what your partner will do if he discovers you’re trying to leave. Whatever your reasons, you probably feel trapped and helpless. But help is available. There are many resources available for abused and battered women, including crisis hotlines, shelters—even job training, legal services, and childcare. You deserve to live free of fear. Start by reaching out.

Getting out of an abusive relationship

If you need immediate assistance, call 911 or your local emergency service.

For domestic violence helplines and shelters, click here.

If you're a man in an abusive relationship, read Help for Abused Men.

Why doesn’t she just leave? It’s the question many people ask when they learn that a woman is being battered and abused. But if you are in an abusive relationship, you know that it’s not that simple. Ending an important relationship is never easy. It’s even harder when you’ve been isolated from your family and friends, psychologically beaten down, financially controlled, and physically threatened.

If you’re trying to decide whether to stay or leave, you may be feeling confused, uncertain, frightened, and torn. One moment, you may desperately want to get away, and the next, you may want to hang on to the relationship. Maybe you even blame yourself for the abuse or feel weak and embarrassed because you’ve stuck around in spite of it. Don’t be trapped by confusion, guilt, or self-blame. The only thing that matters is your safety.

If you are being abused, remember:

  • You are not to blame for being battered or mistreated.
  • You are not the cause of your partner’s abusive behavior.
  • You deserve to be treated with respect.
  • You deserve a safe and happy life.
  • Your children deserve a safe and happy life.
  • You are not alone. There are people waiting to help.

Help for abused and battered women: Making the decision to leave

As you face the decision to either end the abusive relationship or try to save it, keep the following things in mind:

  • If you’re hoping your abusive partner will change... The abuse will probably happen again. Abusers have deep emotional and psychological problems. While change is not impossible, it isn’t quick or easy. And change can only happen once your abuser takes full responsibility for his behavior, seeks professional treatment, and stops blaming you, his unhappy childhood, stress, work, his drinking, or his temper.
  • If you believe you can help your abuser... It’s only natural that you want to help your partner. You may think you’re the only one who understands him or that it’s your responsibility to fix his problems. But the truth is that by staying and accepting repeated abuse, you’re reinforcing and enabling the abusive behavior. Instead of helping your abuser, you’re perpetuating the problem.
  • If your partner has promised to stop the abuse... When facing consequences, abusers often plead for another chance, beg for forgiveness, and promise to change. They may even mean what they say in the moment, but their true goal is to stay in control and keep you from leaving. But most of the time, they quickly return to their abusive behavior once they’ve been forgiven and they’re no longer worried that you’ll leave.
  • If your partner is in counseling or a program for batterers... Even if your partner is in counseling, there is no guarantee that he’ll change. Many abusers who go through counseling continue to be violent, abusive, and controlling. If your partner has stopped minimizing the problem or making excuses, that’s a good sign. But you still need to make your decision based on who he is now, not the man you hope he will become.
  • If you’re worried about what will happen if you leave... You may be afraid of what your abusive partner will do, where you’ll go, or how you’ll support yourself or your children. But don’t let fear of the unknown keep you in a dangerous, unhealthy situation.

Signs that your abuser is NOT changing:

  • He minimizes the abuse or denies how serious it really was.
  • He continues to blame others for his behavior.
  • He claims that you’re the one who is abusive.
  • He pressures you to go to couple’s counseling.
  • He tells you that you owe him another chance.
  • You have to push him to stay in treatment.
  • He says that he can’t change unless you stay with him and support him.
  • He tries to get sympathy from you, your children, or your family and friends.
  • He expects something from you in exchange for getting help.
  • He pressures you to make decisions about the relationship.

Help for abused and battered women: Safety planning

Whether or not you’re ready to leave your abuser, there are things you can do to protect yourself. These safety tips can make the difference between being severely injured or killed and escaping with your life.

Prepare for emergencies

  • Know your abuser’s red flags. Be on alert for signs and clues that your abuser is getting upset and may explode in anger or violence. Come up with several believable reasons you can use to leave the house (both during the day and at night) if you sense trouble brewing.
  • Identify safe areas of the house. Know where to go if your abuser attacks or an argument starts. Avoid small, enclosed spaces without exits (such as closets or bathrooms) or rooms with weapons (such as the kitchen). If possible, head for a room with a phone and an outside door or window.
  • Come up with a code word. Establish a word, phrase, or signal you can use to let your children, friends, neighbors, or co-workers know that you’re in danger and the police should be called.

Make an escape plan

  • Be ready to leave at a moment’s notice. Keep the car fueled up and facing the driveway exit, with the driver’s door unlocked. Hide a spare car key where you can get it quickly. Have emergency cash, clothing, and important phone numbers and documents stashed in a safe place (at a friend’s house, for example).
  • Practice escaping quickly and safely. Rehearse your escape plan so you know exactly what to do if under attack from your abuser. If you have children, have them practice the escape plan also.
  • Make and memorize a list of emergency contacts. Ask several trusted individuals if you can contact them if you need a ride, a place to stay, or help contacting the police. Memorize the numbers of your emergency contacts, local shelter, and domestic violence hotline.

If You Stay

If you decide at this time to stay with your abusive partner, there are some things you can try to make your situation better and to protect yourself and your children.

  • Contact the domestic violence/sexual assault program in your area. They can provide emotional support, peer counseling, safe emergency housing, information, and other services while you are in the relationship, as well as if you decide to leave.
  • Build as strong a support system as your partner will allow. Whenever possible, get involved with people and activities outside your home and encourage your children to do so.
  • Be kind to yourself! Develop a positive way of looking at yourself and talking to yourself. Use affirmations to counter the negative comments you get from the abuser. Allow yourself time for doing things you enjoy.

Source: Breaking the Silence Handbook

Help for abused and battered women: Protecting your privacy

You may be afraid to leave or ask for help out of fear that your partner will retaliate if he finds out. This is a legitimate concern. However, there are precautions you can take to stay safe and keep your abuser from finding out what you’re doing. When seeking help for domestic violence and abuse, it’s important to cover your tracks, especially when you’re using the phone or the computer.

Phone safety for abused and battered women

When seeking help for domestic violence, call from a public pay phone or another phone outside the house if possible. In the U.S., you can call 911 for free on most public phones, so know where the closest one is in case of emergency.

  • Avoid cordless telephones. If you’re calling from your home, use a corded phone if you have one, rather than a cordless phone or cell phone. A corded phone is more private, and less easy to tap.
  • Call collect or use a prepaid phone card. Remember that if you use your own home phone or telephone charge card, the phone numbers that you call will be listed on the monthly bill that is sent to your home. Even if you’ve already left by the time the bill arrives, your abuser may be able to track you down by the phone numbers you’ve called for help.
  • Check your cell phone settings. There are cell phone technologies your abuser can use to listen in on your calls or track your location. Your abuser can use your cell phone as a tracking device if it has GPS, is in “silent mode,” or is set to “auto answer.” So consider turning it off when not in use or leaving it behind when fleeing your abuser.
  • Get your own cell phone. Consider purchasing a prepaid cell phone or another cell phone that your abuser doesn’t know about. Some domestic violence shelters offer free cell phones to battered women. Call your local hotline to find out more.

Computer and Internet safety for abused and battered women

Abusers often monitor their partner’s activities, including their computer use. While there are ways to delete your Internet history, this can be a red flag to your partner that you’re trying to hide something, so be very careful. Furthermore, it is almost impossible to clear a computer of all evidence of the websites that you have visited, unless you know a lot about computers.

  • Use a safe computer. If you seek help online, you are safest if you use a computer outside of your home. You can use a computer at work, a friend’s house, the library, your local community center, or a domestic violence shelter or agency.
  • Be cautious with email and instant messaging. Email and instant messaging are not the safest way to get help for domestic violence. Be especially careful when sending email, as your abuser may know how to access your account. You may want to consider creating a new email account that your abuser doesn’t know about.
  • Change your user names and passwords. Create new usernames and passwords for your email, online banking, and other sensitive accounts. Even if you don’t think your abuser has your passwords, he may have guessed or used a spyware or keylogging program to get them. Choose passwords that your abuser can’t guess (avoid birthdays, nicknames, and other personal information).

Protecting yourself from GPS surveillance and recording devices

Your abuser doesn’t need to be tech savvy in order to use surveillance technology to monitor your movements and listen in on your conversations. Be aware that your abuser may be using hidden cameras, such as a “Nanny Cam,” or even a baby monitor to check in on you. Global Positioning System (GPS) devices are also cheap and easy to use. GPS devices can be hidden in your car, your purse, or other objects you carry with you. Your abuser can also use your car’s GPS system to see where you’ve been.

If you discover any tracking or recording devices, leave them be until you’re ready to leave. While it may be tempting to remove them or shut them off, this will alert your abuser that you’re on to him.

Help for abused and battered women: Domestic violence shelters

A domestic violence shelter or women’s shelter is a building or set of apartments where abused and battered women can go to seek refuge from their abusers. The location of the shelter is kept confidential in order to keep your abuser from finding you.

Domestic violence shelters generally have room for both mothers and their children. The shelter will provide for all your basic living needs, including food and childcare. The length of time you can stay at the shelter is limited, but most shelters will also help you find a permanent home, job, and other things you need to start a new life. The shelter should also be able to refer you to other services for abused and battered women in your community, including:

  • Legal help
  • Counseling
  • Support groups
  • Services for your children
  • Employment programs
  • Health-related services
  • Educational opportunities
  • Financial assistance

Protecting your privacy at a domestic violence shelter

If you go to a domestic violence shelter or women’s refuge, you do not have to give identifying information about yourself, even if asked. While shelters take many measures to protect the women they house, giving a false name may help keep your abuser from finding you, particularly if you live in a small town.

Help for abused and battered women: Protecting yourself after you’ve left

Keeping yourself safe from your abuser is just as important after you’ve left as before. To protect yourself, you may need to relocate so your former partner can’t find you. If you have children, they may need to switch schools.

To keep your new location a secret:

  • Get an unlisted phone number.
  • Use a post office box rather than your home address.
  • Apply to your state’s address confidentiality program, a service that confidentially forwards your mail to your home.
  • Cancel your old bank accounts and credit cards, especially if you shared them with your abuser. When you open new accounts, be sure to use a different bank.

If you’re remaining in the same area, change up your routine. Take a new route to work, avoid places where your abuser might think to locate you, change any appointments he knows about, and find new places to shop and run errands. You should also keep a cell phone on you at all times and be ready to call 911 if you spot your former abuser.

Restraining orders

You may want to consider getting a restraining order or protective order against your abusive partner. However, remember that the police can enforce a restraining order only if someone violates it, and then only if someone reports the violation. This means that you must be endangered in some way for the police to step in.

If you are the victim of stalking or abuse, you need to carefully research how restraining orders are enforced in your neighborhood. Find out if the abuser will just be given a citation or if he will actually be taken to jail. If the police simply talk to the violator or give a citation, your abuser may reason that the police will do nothing and feel empowered to pursue you further. Or your abuser may become angry and retaliate.

Do not feel falsely secure with a restraining order!

You are not necessarily safe if you have a restraining order or protection order. The stalker or abuser may ignore it, and the police may do nothing to enforce it. To learn about restraining orders in your area of the U.S., call 1-800-799-7233 (SAFE) or contact your state's Domestic Violence Coalition.

Help for abused and battered women: Taking steps to heal and move on

The scars of domestic violence and abuse run deep. The trauma of what you’ve been through can stay with you long after you’ve escaped the abusive situation. Counseling, therapy, and support groups for domestic abuse survivors can help you process what you’ve been through and learn how to build new and healthy relationships.

After the trauma you’ve been through, you may be struggling with upsetting emotions, frightening memories, or a sense of constant danger that you just can’t kick. Or you may feel numb, disconnected, and unable to trust other people. When bad things happen, it can take a while to get over the pain and feel safe again. But treatment and support from family and friends can speed your recovery from emotional and psychological trauma. Whether the traumatic event happened years ago or yesterday, you can heal and move on.

Building healthy new relationships

After getting out of an abusive situation, you may be eager to jump into a new relationship and finally get the intimacy and support you’ve been missing. But it’s wise to go slow. Take the time to get to know yourself and to understand how you got into your previous abusive relationship. Without taking the time to heal and learn from the experience, you’re at risk of falling back into abuse.

Where to turn for help for domestic violence or abuse

In an emergency:

Call 911 or your country’s emergency service number if you need immediate assistance or have already been hurt.

Helplines for advice and support:

In the US: call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE).

UK: call Women’s Aid at 0808 2000 247.

Australia: call 1800RESPECT at 1800 737 732.

Worldwide: visit International Directory of Domestic Violence Agencies for a global list of helplines, shelters, and crisis centers.

For a safe place to stay:

In the US: visit for a state-by-state directory of domestic violence shelters in the U.S.

More help for abused & battered women

Resources and references

Help for abused and battered women

Domestic Violence: Finding Safety & Support – Guide for abused and battered women offers advice on getting safe, using the police or the courts, and finding support. (New York State Office for the Prevention of Domestic Violence)

Breaking the Silence Handbook (PDF) – Help and advice for abused and battered women, including legal options. (Nebraska Health and Human Services)

Domestic violence hotlines

National Domestic Violence Hotline 1-800-799-SAFE (7233) or 1-800-787-3224 (TTY) – A crisis intervention and referral phone line for domestic violence. Hotline staff access to translators for other languages. (National Domestic Violence Hotline)

State Coalition List – Lists the phone numbers for the state offices of the NCADV. These offices can help you find local support or a shelter from domestic violence, as well as free or low-cost legal services. (National Coalition Against Domestic Violence)

Domestic violence shelters and support

Tour a Domestic Violence Shelter – Find out what you can expect at a typical women’s refuge or shelter and hear personal experiences of what life there is like. (Safe Horizon)

Tips for staying safe and protecting yourself

Safety Planning – Guidelines for how to safely leave an abusive relationship, what to do if you've filed a restraining order, and what to do once you've left the relationship. (Women’s Law Initiative)

Internet Security – Gives detailed instructions on how to clear your computer’s Internet browser and email account from showing evidence of your seeking help for domestic abuse. (Women’s Law Initiative)

Authors: Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: April 2015.

Suicide Prevention

1-800-273-TALK (8255)

Suicide Warning Signs

The following signs may mean someone is at risk for suicide. The risk of suicide is greater if a behavior is new or has increased and if it seems related to a painful event, loss, or change. If you or someone you know exhibits any of these signs, seek help as soon as possible by calling the Lifeline at 1-800-273-TALK (8255).

  • Talking about wanting to die or to kill themselves.
  • Looking for a way to kill themselves, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live.
  • Talking about feeling trapped or in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious or agitated; behaving recklessly.
  • Sleeping too little or too much.
  • Withdrawing or isolating themselves.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

Suicide Risk Factors

Risk factors are often confused with warning signs of suicide, and frequently suicide prevention materials mix the two into lists of “what to watch out for.” It is important to note, however, that factors identified as increasing risk are not factors that cause or predict a suicide attempt. Risk factors are characteristics that make it more likely that an individual will consider, attempt, or die by suicide. Protective factors are characteristics that make it less likely that individuals will consider, attempt, or die by suicide.

Risk Factors for Suicide

  • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders
  • Alcohol and other substance use disorders
  • Hopelessness
  • Impulsive and/or aggressive tendencies
  • History of trauma or abuse
  • Major physical illnesses
  • Previous suicide attempt
  • Family history of suicide
  • Job or financial loss
  • Loss of relationship
  • Easy access to lethal means
  • Local clusters of suicide
  • Lack of social support and sense of isolation
  • Stigma associated with asking for help
  • Lack of health care, especially mental health and substance abuse treatment
  • Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
  • Exposure to others who have died by suicide (in real life or via the media and Internet)

Protective Factors for Suicide

  • Effective clinical care for mental, physical and substance use disorders
  • Easy access to a variety of clinical interventions
  • Restricted access to highly lethal means of suicide
  • Strong connections to family and community support
  • Support through ongoing medical and mental health care relationships
  • Skills in problem solving, conflict resolution and handling problems in a non-violent way
  • Cultural and religious beliefs that discourage suicide and support self-preservation

(This was adapted from "Understanding Risk and Protective Factors for Suicide” and “Risk and protective factors for suicide" by the Suicide Prevention Resource Center.)



This is a list of commonly used terms in information about mental health and suicide prevention.

Best practices – Activities or programs that are in keeping with the best available evidence regarding what is effective.


Chat service – Crisis counseling provided via instant messaging.


Comprehensive suicide prevention plans – Plans that use a multi-faceted approach to addressing the problem. For example, including interventions targeting biopsychosocial, social and environmental factors.


Confidentiality – The principle in medical ethics that the information a patient or client reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party.


Consumer – A person who is using or has used a health service.


Contagion – A phenomenon whereby susceptible persons are influenced towards suicidal behavior through knowledge of another person's suicidal acts.


Crisis center – A facility or call center where individuals going through personal crises can obtain help or advice, either in-person or by crisis hotline.


Crisis counseling – Brief counseling that is focused on minimizing stress, providing emotional support and improving an individual’s coping strategies in the here and now. Like psychotherapy, crisis counseling involves assessment, planning and treatment, but the scope of service is generally much more specific.


Crisis hotline – A phone number individuals can call to get immediate emergency crisis counseling by telephone.


Crisis intervention – See Crisis counseling


Gatekeepers – Those individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine; they may be trained to identify persons at risk of suicide and refer them to treatment or supporting services as appropriate.


Health – The complete state of physical, mental, and social well-being, not merely the absence of disease or infirmity.


Health and safety officials – Law enforcement officers, fire fighters, emergency medical technicians (EMTs), and outreach workers in community health programs.


Imminent risk – A situation in which there is believed to be a close temporal connection between an individual’s current risk status and actions that could lead to his or her suicide.


Intentional – Injuries resulting from purposeful human action whether directed at oneself (self-directed) or others (assaultive), sometimes referred to as violent injuries.


Intervention – A strategy or approach that is intended to prevent an outcome or to alter the course of an existing condition (such as providing lithium for bipolar disorder or strengthening social support in a community).


Means – The instrument or object whereby a self-destructive act is carried out (i.e., firearm, poison, medication).


Means restriction – Techniques, policies, and procedures designed to reduce access or availability to means and methods of deliberate self-harm.


Methods – Actions or techniques which result in an individual inflicting self-harm (i.e., asphyxiation, overdose, jumping).


Mental disorder – A diagnosable illness characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress that significantly interferes with an individual's cognitive, emotional or social abilities; often used interchangeably with mental illness.


Mental health – The capacity of individuals to interact with one another and the environment in ways that promote subjective well-being, optimal development and use of mental abilities (cognitive, affective and relational).


Mental health problem – Diminished cognitive, social or emotional abilities but not to the extent that the criteria for a mental disorder are met.


Mental health services – Health services that are specially designed for the care and treatment of people with mental health problems, including mental illness. Includes hospital and other 24-hour services, intensive community services, ambulatory or outpatient services, medical management, case management, intensive psychosocial rehabilitation services, and other intensive outreach approaches to the care of individuals with severe disorders.


Mental illness – See Mental disorder.


Postvention – A strategy or approach that is implemented after a crisis or traumatic event has occurred.


Prevention – A strategy or approach that reduces the likelihood of risk of onset, or delays the onset of adverse health problems or reduces the harm resulting from conditions or behaviors.


Prevention network – Coalitions of change-oriented organizations and individuals working together to promote suicide prevention. Prevention networks might include statewide coalitions, community task forces, regional alliances, or professional groups.


Protective factors – Factors that make it less likely that individuals will develop a disorder. Protective factors may encompass biological, psychological or social factors in the individual, family and environment.


Psychiatric disorder – See Mental disorder.


Psychiatry – The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders.


Psychology – The science concerned with the individual behavior of humans, including mental and physiological processes related to behavior.


Public health - The science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society.


Risk assessment – The process of quantifying the probability of an individual harming himself or others.


Risk factors – Those factors that make it more likely that individuals will develop a disorder; risk factors may encompass biological, psychological or social factors in the individual, family and environment.


Screening – Administration of an assessment tool to identify persons in need of more in-depth evaluation or treatment.


Screening tools – Instruments and techniques (questionnaires, check lists, self-assessment forms) used to evaluate individuals for increased risk of certain health problems.


Self-harm – The various methods by which individuals injure themselves, such as self-cutting, self-battering, taking overdoses or exhibiting deliberate recklessness.


Self-injury – See Self-harm.


Social services – Organized efforts to advance human welfare, such as home-delivered meal programs, support groups, and community recreation projects.


Social support – Assistance that may include companionship, emotional backing, cognitive guidance, material aid and special services.


Stakeholders – Entities, including organizations, groups and individuals, which are affected by and contribute to decisions, consultations and policies.


Stigma – An object, idea, or label associated with disgrace or reproach.


Substance abuse – A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use. This includes maladaptive use of legal substances and illicit drugs.


Suicidal act (also referred to as suicide attempt) – A potentially self-injurious behavior with a nonfatal outcome, for which there is evidence that the person intended to kill himself or herself. A suicide attempt may or may not result in injuries.


Suicidal behavior – A spectrum of activities related to thoughts and behaviors that include suicidal thinking, suicide attempts, and completed suicide.


Suicidal ideation – Self-reported thoughts of engaging in suicide-related behavior.


Suicidality – A term that encompasses suicidal thoughts, ideation, plans, suicide attempts, and completed suicide.


Suicide – Death from injury, poisoning, or suffocation where there is evidence that a self-inflicted act led to the person's death.


Suicide attempt – See Suicidal act 


Suicide attempt survivors – Individuals who have survived a prior suicide attempt.


Suicide survivors – Family members, significant others, or acquaintances who have experienced the loss of a loved one due to suicide. Sometimes this term is also used to mean suicide attempt survivors.


Suicide warning signs – Indications that an individual is at risk for suicide.


Adapted from the National Strategy for Suicide Prevention: Goals and Objectives for action. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2001

Helpful Fact Sheets

Learn more about suicide prevention with information from the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, and the Suicide Prevention Resource Center.

Suicide: Facts at a Glance (Centers for Disease Control and Prevention)

Understanding Suicide: Fact Sheet (Centers for Disease Control and Prevention)

Suicide Prevention Dialogue with Consumers and Survivors: From Pain to Promise (Substance Abuse and Mental Health Services Administration)

Suicide Prevention 101: Customized Information Series (Suicide Prevention Resource Center)


Please visit these suicide prevention and peer support organizations for more resources and information.

Suicide Prevention Organizations

Mental Health Support Organizations


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