Women only

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.