Women need greater safety in psychiatric wards

To the Editor

Psychiatry inpatient units in Australia have housed male and female patients together since the 1960s. The Victorian Women and Mental Health Network (VWMHN) published a report stating that 61% of women inpatients reported experiencing harassment or abuse during hospital admissions to mixed sex psychiatric wards (Clarke, 2008). In London, a study found that 56% of women had been pestered by men and that 8% had taken part in a sexual act against their will (Barlow and Wolfson, 1997). In 2008, major reform of UK psychiatry wards took place, with gender segregation on psychiatric wards being a major focus.

The aim of this letter is to highlight some of the challenges and vulnerability that Australian women inpatients experience and create awareness of the need for reform.

Ms A is a 25-year-old female patient who was an inpatient in a psychiatric ward of a metropolitan hospital in Melbourne, Australia. She had a 10-year history of anorexia nervosa with comorbid borderline personality disorder, depression and anxiety. She was involved with mental health services for the past 2 years and had multiple admissions. Ms A was managed by a community mental health team and was recommended for involuntary admission after she became hypokalaemic and had a life-threateningly low BMI.

Ms A received many unwanted sexual comments from male patients such as, ‘showing a bit of leg today’, which disturbed her greatly, further compounding her anxiety symptoms.

One of the most traumatic incidents that Ms A described was when a male patient expressed his attraction to her and attempted to kiss her a few days later. Ms A said that the male patient told her that he was acting on behalf of ‘God’, and attempted to sexually touch her. This assault occurred in the main ward area and after pushing him away and calling for help, the staff transferred the male patient to the high dependency unit (HDU).

This case highlights the need for greater safety for women patients being treated in acute psychiatry units. The above-mentioned scenarios could be prevented if there were women-only wards, or at least specially designated women-only areas. Patients with hallucinations or other common psychiatric symptoms have an increased likelihood of disinhibited behaviour that can result in assaults or harassment. Because women are more likely to be the victims of assaults, there is a great need for increased monitoring and gender segregation in psychiatric inpatient units (Thomas et al., 1995). Although we have come a long way from the nightmarish history of overcrowded asylums, there is still much to be done to improve the quality of health care in psychiatric wards. A greater awareness of gender sensitivity in designing and building psychiatry wards plus more studies tackling gender-specific issues need to be done to improve the quality of psychiatric care overall.