Wednesday, 5 November 2025

The foundation for courage, healing, and transformative justice


Dr Sarah Lewis, Director of Penal Reform Solutions and Grow Transform Belong CIC, on growing psychological safety.

29 October 2025

Our justice system is shaped by the cultural habits that are socially constructed within it. These everyday messages guide people to operate in a certain way – contributing to harm and disengagement, or to safety, purpose and trust.

Recent reports in England and Wales have highlighted a 13 per cent increase in assaults between people in prison and a 24 per cent rise in assaults against staff (HMPPS, 2024a). We're seeing more self-inflicted deaths and self-harm, particularly in the female population, where self-harm increased by 37 per cent (HMPPS, 2023). The leaving rate for a 'shop floor' officer is 12.5 per cent (HMPPS, 2024b). Culturally, such harms communicate a sense of unease and lack of safety for those living, visiting, and working in prisons.

As staff focus on self-preservation and leaders become consumed with fire-fighting, trust erodes, making it difficult to create a positive working environment. In extreme cases, moral blindness can take hold. Bauman and Donkskis (2015) define this as a loss of sensitivity to human suffering, allowing inhumane conditions to persist unchecked.

So, the need for psychological safety is critical. It may be the very mechanism that allows us to move forward and step out of toxic cultures, into a trusting culture, where all can flourish. It is the starting place for honesty, reconciliation and healing, and, if achieved on a large scale, could allow us the space to redefine the future of correctional work as we know it. Psychological safety is the antidote to the current problem.

Over 20 years of working, researching and learning the art of correctional work, I have come to appreciate the importance of psychological safety in several ways: forming a team, repairing ruptures, delivering and designing interventions, building professional relationships, coaching leaders and delivering training, to name a few.

Here, I pull together theory, reflections and practice to illuminate the power of psychological safety, which can create cultures of courage, healing and transformative justice. All of these require discomfort, thrusting people into uncomfortable psychological spaces that are unknown. But it is in these spaces where innovation, change and flourishing can emerge.

This article explores the role of psychological safety as a catalyst for cultural change, drawing upon real-world examples to demonstrate its impact. It will outline the relevant elements of psychological safety, breaking down the conditions required to create environments where individuals feel valued, heard, and empowered to contribute.

This is followed by a practical guide to building psychological safety in correctional settings, highlighting strategies such as inclusive leadership, open communication, and co-production. Finally, the article situates psychological safety within the broader movement for penal reform, positioning it as a fundamental pillar of Justice 2.0, a global campaign that strives to upgrade the justice system into a humane, inclusive, and growth-oriented system that we can be proud of (see Lewis, in press, for details).
Psychological safety

Psychological safety, as defined by Edmondson (1999), is the belief that one will not face humiliation or punishment for speaking up, making mistakes, or expressing new ideas. McCauley (2022) expands on Edmondson's work, suggesting that psychological safety is not merely about comfort; it is about the ability to take interpersonal risks, to engage in open dialogue, and to trust that the system will not retaliate.

For this to be possible, prison culture needs to communicate to individuals that they are, in fact, psychologically safe, providing consistent sensory, cognitive and physical signals. Without this, the conditions by which psychological safety can flourish are stunted and the chances of meaningful change diminished. As I've written before (with Emma Hands, 2022, p.2), creating rehabilitative cultures provides significant benefits to both staff and people in prison.

Cultural interventions can transform prison identities, from criminogenic environments to safe, relational-focused spaces, reimagining organisational and individual identity. There is an increased need to design growth-centred environments to ignite transformative change and ultimately reduce recidivism.

But psychological safety is incredibly difficult to achieve when an organisational culture is toxic. People hide, put up a mask, and conceal their true vulnerabilities and struggles. If mistakes are made, people are more likely to stay quiet. If people are discriminated against or bullied, they might even struggle in silence, leaving their work rather than voicing their feelings and experiences. This means we no longer truly know each other, the true intentions of each other, or the environment more broadly. This only exacerbates shame, disconnection and harm.

To address this, Clark (2020) highlights four stages to psychological safety, which can help create a roadmap to arriving in a psychological space. Firstly, inclusion safety focuses on ensuring all individuals are valued and respected. Secondly, learner safety focuses on providing a safe environment for people to learn new things without fear of judgment. Contributor safety then encourages dialogue, sharing ideas and promoting active, fun and energising conversations. Finally, challenger safety provides a space to question systems and advocate for reform.

The aim of these processes is to create enough relational connection to put down the mask, step out of the current culture and engage in meaningful conversations, which leads to transformative change. To look at that in greater depth, we need to consider my dynamic model of professional relationships (see Figure 1).
The dynamic model of professional relationships

Feeling safe and understood is important within correctional work. The dynamic model of professional relationships (Lewis, 2016) explores the psychological proximity between people who operate in the justice space and characterises different relational spaces, where practitioners and service users navigate.

It illustrates that professional relationships exist along a continuum, which is based on the degree to which two people connect to each other. If we can achieve a positive sense of relatedness, sharing our goals, those tasks needed to achieve our goals and the needs of one another, we can enter the Green Zone, where change becomes a reality for both practitioners and service users.

This Zone is where psychological safety can flourish under conducive conditions of trust, respect and empathy. If we can consistently achieve this across the majority of relationships within the organisation, new cultures can emerge, as people within the system can achieve the psychological safety they need to learn, grow and ultimately flourish. This can happen in small spaces (e.g. therapy sessions), communal spaces (e.g. libraries or faith rooms), subcultures (e.g. across a cohort of staff or people in prison) or culturally, across the whole prison community.
Fig. 1: The dynamic model of professional relationships



The Green Zone is a space where trust, respect, and professional engagement flourish, fostering an environment conducive to rehabilitation. The practitioner presents as open, compassionate, curious and is available in this space. It symbolically demonstrates to the service user that it is safe to engage with the practitioner and to step into the Green Zone, too. In light of past experiences with authority, trauma and adversities, the step into the green zone is an act of courage in its own right. Because, invariably, people in prison have been let down, and they carry this with them until proven otherwise.

The Red Zone is where relationships either become too distant (disengagement, hostility) or too close (manipulation, favouritism, ethical compromise), leading to breakdowns in trust and increased risk of harm. Either the service user or practitioner steps into this space when they feel psychologically unsafe, wary or mistrustful. The physical environment can also convey messages that alter the motivation someone may have to enter into the Green Zone. If a place is dirty, broken or inhumane, this symbolically tells an individual they are not deserving of safety.

In the Green Zone, people (staff, leaders and service users) feel supported, staff maintain professional authority while being approachable, and interactions are guided by mutual understanding and shared goals. This state is essential for creating an environment where individuals can engage in rehabilitative efforts without fear of judgment or punitive consequences (Lewis, 2022)​.

In the Green Zone, people in prison and on probation are more likely to disclose challenges such as mental health struggles, conflict, or personal goals, because they feel heard and supported. Therefore, the knowledge is authentic and clear, and practitioners and service users see each other as humans and worthy of kindness.

Staff can communicate with integrity and challenge poor practice without fear of backlash, reducing corruption risks and enhancing professional standards (Lewis & Hands, 2022)​. And leaders can set the tone, ensuring that open communication is valued and embedded in daily practice (Clark, 2020).

Without clear boundaries, relationships in correctional settings can become dysfunctional, either through excessive detachment (leading to punitive cultures) or over-familiarity (leading to ethical compromise). Reflective practice is therefore essential, allowing staff to examine their own biases, responses, and relational patterns to ensure they remain within the Green Zone (Lewis, 2016)​.

Professional boundaries must be actively maintained, with staff trained in ethical decision-making, emotional awareness and management, pro-social modelling and trauma-informed practice, to navigate complex relational dynamics, without disengaging or over-identifying with people in prison (Mann & Fitzalan-Howard, 2018). Psychological safety, therefore, brings accountability, ensuring that people in prison and staff understand the expectations of their roles and interactions.
The Growth Project

Correctional systems that prioritise psychological safety see measurable improvements in behaviour, engagement, and rehabilitation outcomes. By shifting correctional cultures towards psychological safety, prisons move away from punitive, fear-driven models and towards environments where growth, trust, and transformation can thrive.

To achieve honest, authentic knowledge to support the reconciliation process, practitioners and leaders need to feel safe enough to step into the Green Zone, to achieve connection and the collective impact that is needed for systemic change. The Growth Project provides a practical example of how these stages can be achieved, presenting tips for practitioners to apply to their work.

Three Growth Projects have taken place so far in England, in a training prison, a local remand prison and a women's prison. It is a cultural change programme, which relies on psychological safety. It focuses on co-defining cultural problems, co-creating the solutions and co-owning these solutions, to drive positive change.

This project has demonstrated that psychological safety is integral to fostering rehabilitative cultures (Lewis & Hands, 2022)​, suggesting that environments that prioritise relational connections and trust see reductions in violence, self-harm, and conflict, while simultaneously improving engagement and wellbeing​. The Principles of Growth, which were created following extensive research in three 'exceptional' Norwegian prisons, are used consistently in all activities designed and implemented as part of the project.

They focus on a holistic approach to human development, removing stigma and criminogenic language, which can create greater division that does not serve us or the end goal of rehabilitation. These principles are not for service users alone, but for everyone, promoting the notion of co-evolution, equality and growth.
Fig 2: Principles of Growth

Staff are encouraged to challenge norms and question entrenched practices: to reflect, to feel, and, in essence, wake up from the blindness that has transpired. This is achieved through relationship-focused work, individual coaching, and campaigns, which consistently convey the message that trust is there, that people can make sense of their own worlds in a trauma-informed and shame-sensitive way, and that unconditional love is available.

'Love' is used intentionally here – the unconditional positive regard, introduced by Carl Rogers. It is closely aligned to agape love, which is a compassionate, unwavering commitment to human dignity and transformation, even in the face of adversity. Unlike romantic (eros) or familial (storge) love, agape is not based on personal benefit or emotional attachment. Instead, it is a love rooted in deep care, compassion, and a commitment to the well-being of others, regardless of circumstances.

The Growth Project, then, promises a lot, and must start small to follow through on that. Small groups are created, with a universal shared goal or vision. Tasks and needs are assessed, co-defined and created, locking in the key elements of a correctional relationship, but on an organisational level. Then groups converge, join up, collaborate and unite, through events and activities (e.g. like wellbeing days, days of celebration or campaigns). The pace needs to be set correctly, and changes and stages to the process need to take place when an organisation is ready, rather than being pushed. Culture work needs to be done with people, not to people.
Does it work?

These projects have not been without their challenges. The first project had its funding cut six months early as new leadership took over the prison, causing us to leave the prison unfinished and unable to embed the cultural gains that had emerged. Outcomes took up to two years to emerge. But in terms of averages across the three sites, cultural investment has contributed to:70 per cent reduction in violence between residents, and 80 per cent reduction in assaults on staff;
60 per cent reduction in use of force.
Fewer staff sick days: from the first project, there were 1,643 fewer sick days (2016-2019, Lewis & Hands, 2022) in operational staff; sickness data was hard to use in the other sites due to COVID-19.
Improved staff retention, through enhanced workplace morale, with recent data showing a prison moving up 40 places on the staff retention league table, after 18 months of engaging with the Growth Project.
Residents are more actively engaged in rehabilitative and educational programmes; for example, one Governing Governor stated: 'The Growth Project's ability to engage staff and prisoners and their families, provide a voice for all, and empower and generate real autonomy for the whole community, has been critical to the progression of the prison.'
A more hopeful and optimistic prison community as a whole; for example, one member of staff stated: 'It has given an insight into how positivity can spread and people can feel valued in their everyday role, which in turn has an overwhelming impact on the ethos of the prison environment and all those who live and work within it.'

This was echoed by those in prison, with one resident stating: 'SL and her Growth Project helped me to see hope and positivity within the system – SL helped me to realise through effective and consistent action we can change even the most desolate and lonely places in the world. Through the Growth Project, there's hope for a decaying UK prison system.A three-point increase in HMIP inspection scores, which assess how healthy a prison is.
Growth leaders

Across all Growth Project sites, leaders reported as more cohesive, hopeful and confident. The Growth Team (staff and people in prison) co-produced strategies for cultural change, embedding an ethos of reflective learning and resilience (Lewis, 2022)​. Leaders are provided with coaching to shift their thinking towards seeing errors as an opportunity for growth. They are given a regular psychological space that is independent of the system they work in.

This Growth work aims to create growth-centred leaders who prioritise vulnerability, curiosity, and deep listening (Lewis, 2024)​. When leaders openly share challenges and invite collaboration, the broader culture shifts towards trust and collective problem-solving. The feedback from growth leadership supervision highlighted learning on a personal level as well as a professional level.

For example, one leader said, 'As senior leaders, we are always conscious of supporting and developing our staff, but I found the growth sessions enabled me to think and reflect on my own well-being, my own practices and my own challenges.' Another said, 'It is rare that we get to discuss what we are finding difficult to manage or challenge or change – this gave me the opportunity in an open and safe space to consider these.'

This work not only operated as a grassroots cultural project but also addressed growth at the top, focusing on providing a range of people with the resources to offer solutions, co-create plans, and co-own the results. One prison leader reflected on the journey, stating, 'The project's ability to engage staff and prisoners and their families, provide a voice for all, and empower and generate real autonomy for the whole community, has been critical to the progression of the prison.'
What does this mean for your place of work?

Based on my experience with the Growth Project, here are some key takeaways to support practitioners irrespective of their role: my 'Five steps to psychological safety'.Be intentional

This focuses on demonstrating actively and consistently your commitment to psychological safety. State the space is safe and free from judgment (and make sure it is).
State your belief and alliance to those who are taking part in the activity (and speak honestly about any limitations of this).
Outline the bigger vision of the work and the impact it might have if people chose to open up
Design 'play' into interactions, encouraging laughter, stories, active exercises and opportunities for freedom to relax the atmosphere.
Encourage challenges, fears, and concerns to be voiced and state this as an opportunity to learn.Be curious

This communicates your willingness to learn and see others in their entirety. Use formal and informal spaces to be curious, attending to the here and now. This might be in group meetings, but also informally, whilst making a cup of coffee/tea.
Show genuine interest and care, through actions and words (e.g. make coffees/teas, provide homemade cakes, etc). The act of service communicates your motivation to connect.
Use appropriate self-disclosure and storytelling to encourage curiosity in others and normalise vulnerability, stating this as a measure of courage, rather than a weakness.Be open and humble

This communicates the intention of the practitioner. They are not self-serving, but service-serving and want to benefit something that is bigger than themselves. Focus attention on the value of others' knowledge, rather than your own
Encourage diverse perspectives
Make sense with people, rather than assuming the position of expertBe boundaried



Clarity is kind, and being self-aware is vital, so that practitioners can show up.

Define expectations at the start to encourage clarity and safety
Address behaviours that undermine psychological safety in a kind, but firm way
Operate in the Green Zone to achieve honest conversations that magnify the potential of change

Be growth-oriented



Gratitude and seeing strengths in those around you can expand imaginations and light up new possibilities in how someone is seen and viewed.

Recognise small successes and celebrate to reinforce a positive culture
Model a growth mindset, not taking feedback personally and creating opportunities for feedback, so responses can be explored
Reflect regularly in fun, informal and formal ways
Use motivational interviewing to reflect, affirm and provide feedback that inspires


Justice 2.0: Extending Courage

The Growth Project uses these steps and strategies to construct a positive climate. This can be infectious and can challenge the punitive foundations of correctional institutions, advocating instead for cultures that prioritise trust, belonging, and relational connection (Lewis & Hands, 2022)​. Staff have been seen to step up, challenge and push reform like never before. Here lies a key benefit of psychological safety: courage.

Justice 2.0 is a global campaign that aligns with the Growth philosophy by positioning psychological safety as a foundation for systemic change. Justice 2.0 promotes courage, providing champions of change with the resources, training and information they need to talk, share and act in ways that are compassionate and trusting.

Justice 2.0 prioritises liberation, connection and co-creation (see Lewis, 2025). It calls for an upgrade to Justice, acknowledging the moral injury a toxic culture has achieved. Justice 2.0 centres on democratising knowledge, involving the public, people impacted by the system and those living in it, to reimagine Justice, embracing diversity and difference. Justice 2.0 also focuses on mobilising communities to celebrate the good, to create a counter-narrative that will push against the current punitive tide within mainstream news.

Finally, Justice 2.0 is a campaign that is co-defined, co-created and co-owned, similar to other movements such as #MeToo and #BlackLivesMatter. It provides spaces to discuss critical issues and arrive at meaningful solutions, which are communicated openly and respectfully.

This campaign was ignited following the lessons from the Growth Projects, which highlighted the reality that prison reform might not only be situated in prison, but also in the community. This campaign is therefore educational, sharing stories and highlighting the issues with the current populist view, which focuses on punishing harder and longer, without fully appreciating the collateral damage of this approach.

In practical terms, people who want to reform culture are provided with the resources they might need to; spark new conversations, talk to their communities, fundraise or participate in the consistent online debates. These are not just discussions on the upgrades we need but deal with the entrenched issues that plague our cultural system (e.g. toxic masculinity, discrimination, and othering).

One method for this is a 'hackathon' – an intensive, time-bound event where individuals or teams collaborate to solve problems, innovate, and create solutions, typically in technology, business, or social impact fields. Originally rooted in software development, hackathons have expanded to include social justice, policy-making, education, and organisational change.

People can give as much as they can to this movement, celebrating each other's achievements through the hashtag #justice2point0, or calling out harmful practices through the hashtag #justice1point0. It is hoped that action will become normalised within this movement, as people join and understand the vision; to ignite a global movement of compassion, courage and transformation. To achieve this, psychological safety is the essence of this campaign.
Conclusion

Psychological safety is a prerequisite for cultural change. Within correctional settings, where harm and fear have historically dominated, creating an environment of trust and relational integrity is not just an ideal but a necessity. By embedding psychological safety within leadership, practice, and organisational ethos, we can cultivate cultures of courage, healing, and transformative justice. The Growth Project has demonstrated that such change is not only possible but essential in reimagining correctional spaces as environments of hope, dignity, and humanity​.

Justice 2.0 represents a fundamental shift in how correctional environments operate, moving beyond punitive frameworks towards growth-oriented, rehabilitative cultures. By embedding psychological safety into the foundation of prison culture, Justice 2.0 offers a pathway to breaking cycles of harm and fostering environments where both staff and prisoners can thrive. Rather than relying on control-based strategies that instil fear and disengagement, this approach encourages trust, connection, co-production, open dialogue, and meaningful rehabilitation.



Justice 2.0 is not just about reforming prisons; it is about redefining justice itself, in a way that is humane, inclusive, and fundamentally designed to enable healing and growth rather than perpetuate harm. By embracing this vision, we move closer to a system where psychological safety is the norm, ensuring that individuals leave prison better equipped to reintegrate into society, reducing reoffending, and ultimately, creating safer communities for all.


References



Bauman, Z. & Donkskis, L. (2015). Moral blindness: The loss of sensitivity in liquid modernity. Polity Press.

Byeon, Y.V., Lau, A.S., Lind, T., Hamilton, A. B., & Brookman-Frazee, L. (2022). Organizational factors associated with community therapists' self-efficacy in EBP delivery. Implementation Research and Practice, 3, 1–13.

Clark, T.R. (2020). The 4 stages of psychological safety: Defining the path to inclusion and innovation. Berrett-Koehler Publishers.

Edmondson, A.C. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383.

HMPPS (2024a). Safety in custody statistics.



HMPPS (2024b). Workforce Quarterly.



HMPPS (2023). Safety in Custody Statistics- Deaths in Custody



Inniss-Thompson, M.N., Leath, S. & Harris, J.N. (2024). Seeing Black girls in their glory: Cultivating spaces that facilitate Black girls' psychological safety. Journal of Black Psychology, 50(3), 259–292. =5}.

Lewis, S. (2016). Therapeutic correctional relationships: Theory, research and practice. Routledge.

Lewis, S. & Hands, E. (2022). Growth: An emerging new philosophy to transform correctional culture, Advancing Corrections Journal, 14(7)

Lewis, S. (2025). Justice 2.0: The Strategy. Grow Transform Belong CIC. Publication can be accessed at www.growtransformbelong.com.

Mann, R.E. & Fitzalan-Howard, F. (2018). The role of dynamic risk factors in risk assessment and treatment planning. Advances in Psychology Research, 132, 87–106.

McCauley, C.D. (2022). The evolution of psychological safety in leadership development. Leadership & Organization Development Journal, 43(1), 45–60.

Oppen, M. (2024). Exploring innovation in the public sector: Study of direct and indirect effects of psychological safety, learning behaviour, transformational leadership and learning attitudes on innovation climate. Innovation Journal, 29(3), 2–17​.

Sumanth, J.J., Hannah, S.T., Herbst, KC. & Thompson, R.L. (2024). Generating the moral agency to report peers' counterproductive work behavior in normal and extreme contexts: The generative roles of ethical leadership, moral potency, and psychological safety. Journal of Business Ethics, 195(3), 653–680.


SOURCE:


Thursday, 30 October 2025

Gender-based violence in migration

Gender-based violence (GBV) and different crisis situations are inextricably linked. The information shared on this page draws on EIGE’s research findings and gender statistics to highlight how crisis situations exacerbate the risks of GBV.

Recent years of increased migration demonstrated the need to address gender-based violence (GBV) in migration settings. The risks of GBV increase during times of crises and subsequent migration due to a variety of reasons, such as the breakdown of rule of law, changes in gender norms or scarcity of resources.

During migration, girls and women are vulnerable to sexual exploitation and violence, risks stemming from the disruption of social support networks or the language barriers. Women’s and girls’ vulnerabilities are heightened due to their insecure legal and asylum status, which impacts their access to justice and ability to report GBV.
Addressing gender-based violence in migration
How to strengthen national actions plans on Women, Peace and Security across the EU


EIGE’s recent project explores the opportunities for strengthening the protection of women and girls who are migrants, asylum seekers or refugees from GBV. One of possible instruments to increase the protection and empowerment of women and girls in migration and asylum settings are national action plans (NAPs) on Women, Peace and Security (WPS).Includes recommendations and best practices for EU institutions and Member States on how to develop coordinated, gender-responsive NAPs with the goal of eradicating GBV.
Underscores the crucial role of civil-society organisations, need for robust data collection, sufficient financial and human resources for creation and implementation of NAPs, and monitoring and evaluation of progress and challenges when it comes to implementation.
Analyses the potential of NAPs on Women, Peace and Security (WPS) as instruments to prevent gender-based violence and empower and protect women and girls in migration settings.



Women, Peace and Security


Women, Peace and Security agenda is an umbrella term encompassing a series of UN Security Council resolutions, which reshaped the role and narrative around women in conflict and security, highlighting their active role as peacebuilders and change makers, not passive victims.

The strengthening of the WPS agenda within national action plans focuses on:Addressing GBV in migration contexts
Improving support mechanisms for migrant and displaced women
Promoting inclusive and gender-responsive migration and security policies
Aligning international normative commitments with realities on the ground
Challenges

The major challenge identified in connection with NAPs was Member State’ focus on external conflict settings and lack of concrete actions to be implemented internally. The policy brief includes recommendations and best practices from NAPs of 7 analysed Member States that address these challenges.

These recommendations and best practices centre on: Engaging with civil-society organisations during the design, implementation, evaluation and monitoring phases of NAPs
Effective coordination of NAPs between different ministries and entities, strengthened role of gender equality bodies
Robust monitoring and evaluation practices, using gender-responsive indicators and sex-disaggregated data
Sufficient and sustainable financial and resource allocation

SOURCE:

Gender-based violence in armed conflicts


Armed conflicts expose all civilians to the risk of experiencing conflict-related sexual violence. Women, men, girls and boys – all can become victims of conflict-related sexual violence (CRSV). They all need safety and protection.

Women and girls are primarily targeted by conflict-related sexual violence for multiple intersecting reasons. These include pre-exisiting gender inequality and power imbalances, in addition to the conditions driven by armed conflict.

Moreover, CRSV is exacerbated by war strategies such as using rape as a tactical weapon of war.

Women and girls face an additional layer of negative outcomes concerning their reproductive health, namely forced pregnancy, pregnancy complications, induced abortions, gynaecological problems, and miscarriages.

They are in urgent need of sexual and reproductive health services that treat their rights, needs and wishes as an absolute priority.

Organisations such as WHO regularly issue publications, which define guiding principles for the provision of victim-centered care and list the essential elements and optimal timelines for the clinical management of rape.
Women fleeing war in Ukraine
The provision of sexual and reproductive healthcare services in the EU under the Temporary Protection Directive

Since the onset of Russia’s war of aggression against Ukraine on the 22nd of February 2022, human rights violations and violence have become the new harrowing reality of Ukraine, with growing evidence of mass atrocities and crimes of sexual violence and torture committed against civilians in the territories occupied by Russia’s armed forces.

Millions of people fled Ukraine and sought refuge and protection across Europe, these are mostly women and children since martial law prevents men from leaving the country.

EIGEs report ”Women fleeing the war: Access to sexual and reproductive healthcare in the EU” assesses the availability of specialised services for victims of conflict-related sexual violence available in the European Union.

Specifically, the report focuses on women and girls fleeing Ukraine and who have been protected under the Temporary Protection Directive (TPD), which was activated on the 4th of March 2022, shortly after the Russian invasion on Ukraine.



The report aims to identify gaps in the provision of six sexual and reproductive health (SRH) services which are essential elements of the clinical management of (conflict-related) sexual violence. These six services reviewed include:emergency contraception
sexually transmitted infection (STl) prevention and treatment
obstetric and gynaecological care
short- and long-term psychological counselling
and safe abortion and post-abortion care

The conclusions are drawn from an EU-wide questionnaire completed by 26 experts representing EU Member States and 12 follow-up interviews with representatives of relevant NGOs and public bodies, conducted in four of the Member States: Czechia, Germany, Poland and Slovakia.
Key recommendations

Below you will find key recommendations for EU institutions and Member States to improve the provision of specialised SRH services for victims of CRSV. These recommendations are based on gaps and challenges identified in “Women fleeing war in Ukraine: The provision of sexual and reproductive healthcare services in the EU under the Temporary Protection Directive” report.

Key recommendations for EU institutionsImplement the Istanbul Convention to ensure coherence across EU Member States in preventing and combating violence against women, and support Member States in ensuring specialised services for victims of all acts of violence covered by the convention.

Adopt the proposed directive on combating violence against women and domestic violence to enshrine minimum standards in EU law and Member States for ensuring, among other things, protection and support for victims and coordination between relevant services.
Adopt the revision of the Victims’ Rights Directive and ensure that victims of (conflict-related) sexual violence have easy access to targeted and integrated specialist support services, and a possibility to rely on free of charge psychological support for as long as necessary.
Clarify the scope of necessary healthcare for victims of (conflict-related) sexual violence in the Temporary Protection Directive, to guide Member States in ensuring service provision so that victims can exercise their sexual and reproductive rights in each Member State on an equal basis.
Provide guidelines on the correct implementation of EU rules on temporary protection and victims’ rights, and support Member States in developing or improving existing needs assessments and referral mechanisms for victims of (conflict-related) sexual violence.
Disseminate existing international guidelines on how healthcare providers should respond to sexual violence, for example, through the development of an online training course reinforcing the need for ethical standards, and trauma-informed and gender-sensitive responses

Key recommendations for Member StatesEnsure that women and girls under temporary protection are fully eligible to access specialised sexual and reproductive health (SRH) services.

Establish mechanisms addressing the vulnerability of unaccompanied minors to ensure that their age or lack of parental consent do not limit their access to SRH services.
Ensure that the provision of SRH services is affordable, provided in a timely manner and geographically accessible. Interpreters and female healthcare professionals should be available to assist women and girls, if requested.
Introduce national guidelines outlining the responsibilities of the police, healthcare and social care sectors in responding to victims of (conflict-related) sexual violence and improve referral mechanisms and needs assessments among these sectors.
Establish accessible rape crisis centres that provide specialised and immediate support to ensure the holistic, victim-centred, and gender and culturally sensitive provision of SRH services.

Explore the different dimensions of sexual and reproductive health services:

Monday, 27 October 2025

Painful periods and loneliness often go hand in hand


A recent study finds that physical functioning links menstrual pain and loneliness, offering an opportunity anticipate the impact of periods on social lives.

23 October 2025

By Emily Reynolds

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Menstrual pain affects many of those who have periods. And, while we're all familiar with the image of someone lying in bed clutching a hot water bottle to try ease their menstrual pain, how painful periods shape social wellbeing in the long term has received comparatively little attention. This is particularly the case when it comes to loneliness, which we already know is strongly associated with other pain conditions.

Writing in the British Journal of Health Psychology, a team led by Julia McCurry of Deakin University looks at this issue, exploring the links between menstrual pain, physical functioning, and loneliness. Their findings suggest that it is not the presence of pain alone, but rather the way in which pain impairs daily functioning, that contributes to loneliness. They believe that physical functionality may therefore serve as an important early warning sign, helping clinicians identify those at greater risk of becoming socially isolated, and intervene before loneliness becomes more entrenched.

The study formed part of a larger longitudinal project looking at menstrual health among Australian women aged 18 to 50 years old. Baseline data was collected from 289 women in May 2019, with follow-up surveys in 2020 and 2021.

Measures included self-reports of menstrual pain severity, responses to loneliness items such as "I lack companionship" and "I feel left out," and assessments of physical functioning. The latter captured perceptions of health and ability to carry out daily activities, including ratings of statements such as "to what extent does pain prevent you from doing what you need to do?" and "how well are you able to get around?"

Participants' fluctuating pain levels across the course of the study gave the team a window to observe the ways in which pain and physical functioning influenced each other. Higher menstrual pain at one stage predicted lower general physical functioning later, and lower physical functioning also predicted higher pain: the relationship was reciprocal.

Yet pain alone did not predict loneliness. Instead, overall physical functioning was the key mediating factor: women who were better able to manage day-to-day activities at the end of the study also reported lower levels of loneliness. This suggests that it's not the experience of pain itself that drives feelings of loneliness, but the way it disrupts daily activities and mobility. In short, physical impairment appears to be the main pathway through which menstrual pain contributes to loneliness, making low levels of physical functioning a valuable early warning sign for future social difficulties.

This distinction has important clinical implications. Efforts to preserve or improve physical functioning during menstruation could help reduce loneliness, even in cases where pain can't be fully eliminated. Addressing the impact of pain on daily life, rather than focusing solely on symptom intensity, may represent a more fruitful avenue for interventions designed to protect wellbeing.

The authors note several limitations. Recruitment through peer support groups may have meant that those who participated don't necessarily have the same experiences or insights as those who are more isolated, for example. Additionally, loneliness was measured only at the final time point, preventing analyses of its interaction with pain and functioning over time. Future research could also explore exactly what kind of social connections or strategies those with more severe pain need to mitigate feelings of loneliness.

Overall, the findings highlight the ability to maintain daily activities as a central link between menstrual pain and loneliness, underscoring the need for clinicians to attend not only to pain severity, but also to its impacts on everyday life and social functioning. Supporting individuals to stay active — through strategies from medical treatment to practical guidance for managing daily activities — may help reduce the social burden of menstrual pain and address its significant impact on quality of life.

Read the paper in full:
McCurry, J., Skvarc, D., Evans, S., Mikocka‐Walus, A., Druitt, M. L., Payne, L., & Marshall, E. M. (2025). In pain and lonely? A longitudinal study examining the associations between menstrual pain, physical functioning and loneliness. British Journal of Health Psychology, 30(3). https://doi.org/10.1111/bjhp.12805


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