Policing sexual relationships on mental health wards

Stories of sexual abuse on mental health wards have left trusts in a dilemma over how to police consensual relationships, reports Sally Gillen

By the time Louise* discovered her son was having a sexual relationship with Julia* the latter was six months pregnant.

Not an unfamiliar story. Except Louise was not the mother of an adolescent faced with the product of a doomed teenage romance. Her son, John,* was in his mid-thirties, a psychiatric patient at a south London hospital and, apparently at the time that fellow patient Julia became pregnant, he was on a locked ward.

“Everybody at the hospital knew what was going on but I didn’t,” says Louise. “They didn’t seem to care and they weren’t worried about what had happened.”

She had known Julia and John were friends, both with a diagnosis of schizophrenia, and she was happy that her son, who had spent most of his adult life in institutions, had some company.

She never imagined their relationship would develop as it did while he was in the hospital’s care. Just a couple of months after Julia gave birth she committed suicide, which set in motion a chain of events that led Louise to a breakdown.

“I thought ‘there is no way I can do this’,” she recalls when she was asked to break the news to John.

“In the end I told him she had died but I didn’t say she had killed herself. I’m not sure he took it in. He went pale, we had a whisky and it was never mentioned again.”

Her grandchild is now 12. She was adopted by a family friend and Louise sees her regularly. There is a 50 per cent chance that she will develop schizophrenia.

Louise insists her story is not unusual. A report released by the National Patient Safety Agency (NPSA) in July revealed that there had been 122 allegations involving issues of sexual safety recorded by trusts, including claims to The NHS Litigation Authority for three unwanted pregnancies. It is evidence that sexual safety issues need to be addressed.

A survey by Community Care in July showed that, in the past three years, mental health trusts in England had recorded 224 allegations of sexual assault by patients against other patients.

Mental health tsar Louis Appleby told Community Care: “We do not know how many incidents are occurring. But we are getting a message about a safety problem that we have to tackle.”

Addressing the issue will be complex. Cases of consensual sex, as Louise’s story illustrates, are a moral maze for mental health trusts. Expecting trusts to devise policies that police consensual relationships effectively is not achievable, says Claire Johnston, director of nursing at Camden and Islington Mental Health and Social Care Trust.

“It would be a human rights issue,” she argues. “It is difficult to control the welter of human emotions and we would be arguing for a ban on sex.”

Louise acknowledges that people with mental health problems are entitled to a sex life but she believes the people caring for her son could have done more to manage it. “Why couldn’t they have put Julia on the pill?” she asks. “It is ridiculous to give condoms to someone in the state she was in as a form of contraception.”

The issue of consensual relationships may be fraught with complex arguments but allegations of sexual assault present greater problems for trusts.

Johnston hopes that most assaults would be reported to the primary nurse. Serious attacks are rare and would be dealt with by the police but remarks or the passing of an amorous note could make someone feel more vulnerable so the trust operates a policy of zero tolerance, she says.

Sometimes it is a case of someone harassing another patient because they are unwell and are unaware of the impact of their behaviour, which may be resolved by talking to them. If they persist they, or their victim, can be moved elsewhere.

But how do staff decide whether an allegation is credible if delusions or hearing voices are a part of the complainant’s illness?

And how do they decide whether the allegation is malicious?

“We try to defuse the situation with minimisation strategies,” says Johnston. “Every person who makes an allegation is taken equally seriously. We are not deterred by their diagnosis.”

But Mind policy director Sophie Corlett says: “Lots of trusts are overcautious about believing people to an extent that is dangerous. It would be better to err on the side of believing people.

“Staff appear to be tolerant of generally inappropriate behaviour such as indecent exposure and nothing is done, partly because of understaffing and a lack of managers.”

Jenny’s complaint (see They told me nothing could be done) about a male who assaulted her is an example of the blase attitude Corlett describes. She was told to avoid the person who had assaulted her. Given that he was confined in the same building this was neither realistic nor reasonable advice.

Her experience resulted from a placement in what was essentially a mixed-sex environment with separate male and female areas for sleeping and bathing, which many trusts operate.

Appleby denies that such accommodation is falsely defined as single-sex. Undoubtedly though, the number of assaults would be reduced if patients were given the option of segregation.

As a result of the NPSA report, Appleby is reviewing the 19 most serious assaults to find out how the trusts dealt with them and will report to health minister Rosie Winterton by the autumn. “We may find that it’s time to question whether the guidance on accommodation needs to be strengthened,” he says.

* Not their real names

‘They told me nothing could be done’
A week after Jenny* was admitted to a hospital on a three-month section a male patient started to harass her. It began with him talking to her, even though she made it clear she did not want to talk to anyone, and then he started following her.

“I mentioned it to staff but they told me to stay in the women-only wing all day. But then they told me they did not want me to do that because I couldn’t take part in activities.

“One evening, late on, I went into the kitchen and he followed me. He trapped me against the wall and was saying sexual stuff, what he wanted to do to me, and touching me. Then he heard someone in the corridor and I was able to escape because he was distracted. I got back to my room, which was on the ground floor, and he had gone outside and was by my window. I didn’t leave my room to tell anyone because I was really scared.

“I told a health care assistant the next day. She hung around me to make sure I was ok and told someone higher up. But nobody spoke to him.

“He continued to follow me and I was too scared a lot of the time to leave the women’s wing so I couldn’t do group activities. A ward manager said there was nothing that could be done because he was ill. I wanted them to speak to him but he was high half the time. But I could have been moved.

“I am appalled about the way my complaint was dealt with. I thought about complaining when I left but then I decided against. If they weren’t prepared to do anything when I was in the hospital, why would they once I’d left?”
*Not her real name