Improving safety for women in psychiatric wards

When considering safety of women in psychiatric wards, it is essential to look beyond just the issue of separation of men and women in psychiatric wards. It is necessary to take social and cultural factors into consideration and think beyond safety from physical (including sexual) harm. As highlighted in the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (Galletly et al., 2016), taking lifecycle considerations such as pregnancy into account is also important.

Kulkarni and Galletly have drawn attention to the common practice in Australia of housing male and female patients together and argue that this policy of unisex wards places women with psychiatric illnesses at risk. This is well supported by evidence and should be addressed as a matter of urgency. However, the risks faced by women when inpatients in a psychiatric unit are not all due to being housed in same-sex accommodation.

Women with a psychiatric illness admitted to an inpatient unit face many challenges and risks. These include violence from, and sexual assault by, male co-patients which can be overcome by wards offering same-sex accommodation. However, risks such as violence from women towards women, exposure to unfamiliar lifestyle behaviours such as illicit drug use and psychiatric practices such as physical restraint are not affected by ‘women-only areas’ or single-sex wards. Nor will same-sex wards overcome sexual assault of women by male staff members (National Patient Safety Agency, 1996).

Gender and cultural sensitivity by staff are key to improving safety for women in Psychiatric wards. This needs to start with an understanding of how gender and culture must be considered when assessing women in psychiatric wards. Various factors such as disparity in power and status between men and women and the pressures of women’s multiple roles may contribute not only to the development of mental health problems and the need for psychiatric admission but also to how safe a woman feels in a psychiatric ward.

Gender sensitivity includes overcoming the ways in which women are patronised by male staff and ensuring that women who disclose sexual abuse and other traumatic experiences are not met with silence, trivialisation or other disempowering responses. It also includes staff taking care when prescribing medications to ensure these will not place the woman at risk from problems such as possible teratogenic effects should she be or later become pregnant. If women are pregnant, or considering becoming pregnant, they should be provided with adequate information about the benefits and risks of continuing versus ceasing medication and time to discuss this with their partner and treating staff.

Cultural sensitivity and culturally appropriate practice have been emphasised for both Aboriginal and Torres Strait Islander Peoples (National Aboriginal and Torres Strait Islander Health Council, 2004) and for Maori (New Zealand Ministry of Health, 2008). These practices also need to be developed for the range of culturally and linguistically diverse people now making up a significant proportion of the population in Australia. And, within different cultural groups, different gender appropriate behaviours need to be respected if women are to be and to feel safe while in psychiatric wards.

If women are to feel and to be safe in psychiatric wards, a broad agenda needs to be implemented. This must include a zero tolerance for violence against women in psychiatry wards as proposed by Kulkarni and Galletly (2017), but must also include education and training for staff which includes developing a gender-sensitive approach and developing cultural competencies when caring for culturally diverse groups.

See Commentary by Kulkarni and Galletly 51: 192–193.