The gender agenda

Disabled women tell Disability Now about sexual threats and abuse while in mixed-sex wards in mental health facilities. Cathy Reay asks, is the Government’s thinking and policy muddled on questions of patient safety

"I was once put in a room opposite a man who had strangled his wife. Given that I had a long history of being physically abused, the fact that this man could access my private space at any time made me feel more vulnerable than I did before I was admitted.”

More than a decade later, mental health service user Glynis Stirling, from London, like hundreds of other patients, still feels unsafe in an environment that is supposed to protect her and help her recovery.

A recent Conservative Party report revealed the startling figure that around 36 per cent of today’s mental health service users are still being treated in mixed-sex conditions, 13 years after the then Labour Opposition first criticised the Government for not enforcing nationwide same-sex mental health wards.

“I once found a male patient wandering around the female bedroom area. Staff removed him but it scared us and made me feel very uncomfortable with the security on our ward,” added Sue Toms (pictured left), from Berkshire.

In the same month, health minister Lord Darzi of Denham told the House of Lords that a manifesto pledge by Labour to abolish these wards when they came into government in 1997 simply was “an aspiration that cannot be met”.

“The message from politicians and Government has been and still is very confusing and needs addressing,” said Dr Trevor Turner, member of the Royal College of Psychiatrists. “They made this promise to abolish mixed-sex ‘wards’ but their take on what a ward actually is has always been very careful to refer to it instead as a ‘facility.’”

Lord Darzi instead said that the solution is single-sex bays within mixed-sex wards, where male and female beds and washing facilities are separated by partitions or walls. These wards have a recreational area for both sexes and some also have a women only area. Many units were already following this design and others are in the process of changing but the safety of this set-up is still disputed; according to a Government report, the number of reported sexual incidents in wards between 2003 and 2005 was over 122, including 19 rapes.

“A male patient came up to me once and said ‘if I wear two condoms can I have sex with you?’ I’m strong enough to say bugger off but other women are more vulnerable; I’ve seen it happen,” said former mental health service user Janey Antoniou, from London, who has stayed in a mixed-sex ward that follows the new design.

“Nurses do police the wards [I stay on] and most people follow the rule, but I have had to tell men to get out of the girls’ bedrooms before.”Dolly Sen, also from London, added: “I was pushed up against a wall and felt up by a male patient, but again others received much worse treatment. You could just be sitting in the recreation room and men would come up to you and ask for a blowjob. When you say no, they get angry.”

Ian Hullat, a mental health adviser at the Royal College of Nursing, said that the Government has acknowledged that their progress in eradicating mixed-sex mental health wards hasn’t been “too fast.”

Further evidence suggesting that mixed-sex wards are dangerous is in the Conservatives’ report on mental health wards, released in January, in which one ward recalls a situation where “a female patient was found lying in bed with a male patient.

They appeared to be only lying on the bed fully clothed, yet the female patient is currently very uninhibited and vulnerable.”

Despite the findings of this report, Mr Hullat said the Royal College doesn’t particularly feel mixed-sex wards are dangerous. He added: “there have been instances where patients feel threatened and it is the responsibility of psychiatrists and nurses to make sure that they feel safe.”

Dr Michele Hampson, adult mental health consultant at Nottingham Healthcare Trust, said that it is women’s vulnerability and patients’ overall lack of choice that is the concern. But she doesn’t necessarily believe single-sex wards are the answer: “Shouldn’t wards be separated by level of disturbance? If that can’t happen then the ideal set-up is mixed wards with women and men only sections, and a mixed area too, all of which should be equally staffed.

Often women only areas are left unsupervised and patients are too scared to use them as a result. It is possible to be more creative with this but ultimately people should be admitted to a ward appropriate to their care, which is not segregated by gender.”

“I’m in a minority, I think, because I actually prefer mixed-gender wards,” said former mental health service user Fi Woods, from Bristol. “I can’t imagine being stuck in a ward with just women. My ward was recently renovated and there is now a ‘women’s only’ lounge. Why should women get preferential treatment?

“I don’t feel any need for separation; we’re all human and should be able to be around each other.”

Dr Hampson’s suggestion of separating wards by level of disturbance rather than sex might also be a more ideal approach for minority groups, such as transgendered patients like Alice from Northern Ireland, who has been ill-treated on a single-sex ward.

“The staff wouldn’t allow me to dress as a woman on a men only ward. They didn’t let me shave, forcing me to grow a beard, and would call me only by my male name. They verbally punished me and treated me like I was brain-dead.

“I felt very threatened by the other men on the ward. If I am on a solely male ward I’m not happy but if I was on a female ward the women wouldn’t be happy either, so I think I am better placed in a mixed-sex ward.”

Dolly Sen said that, while she said she prefers staying on single-sex wards, her “most violent” experience was actually in a same-sex unit, though she added: “With women you can get up and walk away and you don’t have to worry about people attacking you in your sleep.”

Perhaps what we should be asking the Government to address, then, is the requirement for, firstly, more patient-sensitive and secure methods of ensuring patients’ safety (Josie Fletcher, London, recalls: “A scary-looking male security guard would come in during the middle of the night and shine a torch on our faces to check on us”) and to consider giving patients a choice of facility, whether mixed-sex or single-sex.

Disability Now asked the Department of Health (DoH) whether this would be a viable option and their reply was that there are currently “no plans to offer this level of choice”. A spokeswoman added: “Good progress on mixed-sex accommodation in mental health has been made and 70 per cent of available beds across the mental health estate are in single rooms. We recognise that appropriate gender separation on mental health units is essential for privacy, dignity and safety.”

However, Claudia Hammond, presenter of BBC Radio 4 programme on mental health All In The Mind and lecturer in Psychology at Boston University’s London base, agreed that dividing patients by gender “doesn’t suit everyone”.

“It is of course the case that not all aggression will be aimed at a member of the opposite sex, which does make this a very difficult area.

“Perhaps one day there could be a system where every patient has a place in a hospital that takes into account his or her personal preferences for ward companion and feels like a genuine place of sanctuary. This would be expensive so I fear this could be a long way off, but in the meantime the option of a single-sex ward could at least provide some more people with the feeling that they’re in a place of safety.“

Though many of the mental health service users that spoke to Disability Now admit that security on wards has gradually improved, they have a long way to go before patients will stop feeling vulnerable and in danger of being put at risk.

It has been suggested that the NHS are resistant to change but it seems Government are insistent on leading them in the wrong direction. From the number of reported assaults alone that occur on a yearly basis on mixed-sex wards with single-sex bays, it is important that the Government reconsider their plan and prioritise patient safety to ensure that their experience in hospital is regenerative, not degenerative.