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For a woman who has experienced domestic violence or sexual abuse, sitting down to breakfast with a group of disturbed men she doesn't know is hardly conducive to feeling relaxed and secure. Yet this is precisely what female in-patients on psychiatric wards are expected to do, at a time when they are feeling most vulnerable.

Cath Collins, spokesperson for the Campaign for Women Only Wards, says that being on a mixed psychiatric ward was one of the most terrifying experiences she has endured. "I ended up in an acute ward for four months. I've never been so frightened in all my life. When I told staff I was scared that someone was going to hit me or get me, which took a lot of courage to do, they said 'well, just go to your room'. So I spent an awful lot of time in my room, not going to any groups or anything. I think that was why I spent so long in hospital."

Penny Stafford, who has been an in-patient several times, says: "Women are put into units for treatment alongside men who might have histories of sexual assault or violence against women."

Both women are speaking on a video produced by Mental Health Media in response to a government consultation on improving mental health services for women.¹ The video is part of a training pack for mental health professionals and ought to be compulsory viewing for anyone working in the sector.

The lack of women-only wards is one of the most striking ways in which mental health services in the UK fail women. Another is the failure of many professionals to acknowledge the role violence and abuse play in the development of mental illness in at least half their female service users. Astonishingly, most mental health workers receive little if any training on the impact of violence and sexual abuse or on other issues underlying women's depression and mental breakdown. Women may not even be asked about abuse during assessments.

Rachel Perkins, clinical director of adult mental health services at South West London and St George's Mental Health Trust has herself been a psychiatric in-patient. She believes there is a long way to go in improving basic training. "It would not be standard practice for professionals to receive training on the impact of sexual abuse and the ways in which you can help women who have been sexually abused," she says. "We need to be looking much more at schools of nursing, psychology courses and so on and say that there is a set of skills we expect every mental health professional to have. These should be addressed as part of the core training rather than as peripheral add-ons."

A consultation document published last year by the Department of Health,² as part of the government's strategy for women's mental health, indicates that ministers are at last taking on board the need for radical change in the way mental health services are delivered for women. The document outlines a proposed strategy for improving services and recognises that women's experiences and concerns need to be addressed.

Andrew McCulloch, chief executive of the Mental Health Foundation and member of the government's task force on the Women's Mental Health Strategy, welcomes the principles behind the proposed strategy and believes there has been considerable progress within government in acknowledging that at the moment services are not meeting women's needs. However, he questions whether ministers are serious about implementing change and points out that there is no new money attached to the strategy. "They want to do this but they aren't showing any evidence of it being a high priority," he says.

"Implementation isn't just about money. The sorts of things that civil servants put in place when they want things to happen are missing, like targets and time frames." As a former head of mental health policy at the DoH, he should know.

McCulloch also believes the strategy should go much further in looking at women's needs across their lifespan. "The needs of older women with depression or dementia are given very low priority. And there should be more attention to adolescents."

Although mental disorders are often first manifest between the ages of 16 and 18, this is the age group that tends to fall between children's and adults' services.

McCulloch also wants the government to pay much greater attention to promoting the mental health of mothers. Not only are most women with mental health problems mothers, but also being a mother in itself entails risk factors that do not apply to the rest of the population. The most obvious is the risk of post-natal depression (PND), which affects about one in 10 new mothers. Yet despite strong research evidence that even a single bout of depression in the first year after a child's birth can have lasting consequences for the child, there is still a lack of universal screening for PND and most cases go untreated.


New mothers are often unprepared for the isolation they might experience, and women encountering problems in their role as parents often have nowhere to turn. Behavioural problems in a child and mental health problems in a mother may be so closely entwined that it is impossible to separate cause from effect. The mother feels depressed about her child's difficult behaviour, which renders her less able to handle the behaviour effectively, exacerbating the child's difficulties.

McCulloch would like to see more family-focused services that support mothers long before problems get out of hand. He says: "We need a completely different model for services that is more proactive and intervenes early. Apart from a few examples in the independent sector, like Newpin [a charity that works with families to break the cycle of destructive behaviour], there is almost nothing joined-up that works with the whole family." He underlines the importance of preventive services such as parenting education which can play a valuable role in promoting mothers' mental health, but are rarely seen as part of the mental health agenda.

Despite the potential risk to children of having a mother who is mentally unwell, not to mention the strain on a mentally distressed parent of trying to care for children, services rarely take into account the fact that service users may have young children. Aside from possible abuse, children with a mentally ill parent may be at risk from the difficulties that so often accompany mental illness, such as poverty, isolation and the breakdown in relationships between parents. Yet women may be unable to access services such as counselling because of a lack of child care.

"If we want to create sensitive services, it means designing services around individual needs rather than a bureaucratic one-size-fits-all model," McCulloch says. "If we can get it right for women we can get it right for everyone. At the moment services are rigid and don't meet anyone's needs."

¹ Mental Health Media, What Women Want: Mainstreaming Women's Mental Health, Mental Health Media, 2003 www.mhmedia.com
² DoH, Women's Mental Health: Into the Mainstream, Strategic Development of Mental Health Care for Women, DoH, 2002 www.doh.gov.uk/mentalhealth

Women's mental health: key facts

• 50 per cent of women using mental health services have experienced violence or abuse, often as young girls. 
• Women are more likely than men to suffer from anxiety, eating disorders and phobias or to be diagnosed as suffering from a borderline personality disorder, the diagnosis often given to women who self-harm. 
• Women suffering from a mental disorder are more likely to be single, unemployed or lone parents than women without a disorder. 
• At any one time more than one in 10 women is suffering from a depressive disorder or from mixed anxiety and depression. 
• One in 10 new mothers suffers an episode of post-natal depression.