The mental health system fails the most vulnerable women in our society

Despite the rhetoric, this government continues to fail the most vulnerable women in our society.

by Sonia Adesara

The first patient I met whilst working in an psychiatric hospital was a young mother of 2. She was over 50 miles away from her family home, a 2 hour journey for her husband to come and visit her. She was admitted there because other hospitals closer to her home were full. She was with us for 3 weeks. I thought to myself, would this have been acceptable if she had required admission to hospital with a physical health problem?

The looming bed crisis is no overstatement. The managers are under immense pressure to free up beds and ‘get patients out’. I remember witnessing an 18 year old girl being told that she was ‘now better’ so had to be discharged to the local hostel that day. She broke down in tears, terrified of being sent back to the place full of ‘druggies and nasty people’. Understaffed, under-resourced, easy targets for dealers and abusers.

Mental health services receive just 13% of NHS funding, despite accounting for more than 23% of disease burden. Access to psychological services remains unacceptable. A report commissioned by mind.org.uk stated 50% of patients had waited over 3 months to receive psychological therapy, with 10% waiting over a year 1. Last year a government commissioned report stated that in eight CCG areas, less than 25% of those referred for therapy were assessed within 28 days. In 22 CCGs, over 10% of referrals waited more than 90 days. These findings come 7 years post the introduction of IAPT – the ‘4 year programme’ introduced by the government to improve access to psychological therapy.

So why is this a women’s issue?

Depression, anxiety, eating disorders, self-harming, all affect higher numbers of women. Various social factors put women at greater risk. Women are over represented in low income, low status jobs and more likely to live in poverty, proven risk factors for mental illness.

hospitalWomen with severe mental illness are up to five times more likely than the general population to be victims of sexual assault. Records obtained under the Freedom of Information Act show a 50% rise in reports of sexual violence in hospitals since 2011. The Metropolitan Police have said the issue was a particular problem in mental health units, with a significant proportion of alleged victims identified as vulnerable due to mental health problems. One patient described psychiatric hospitals as a ‘playground for predators’, after she was raped numerous times by a member of staff.

Women with mental illness are also two to three times more likely to be domestic violence victims. Yet domestic violence services are increasingly under threat from a lack of secure funding and spending squeezes, with some shelters having to close their doors. One in three victims is now turned away from a refuge for lack of space.

Recent cuts in funding of sexual health services are leading to closure of specialist services for sex workers, experts warning they are now at greater risk of violence and ill health. Many are suffering from drug addiction and have complex psychiatric issues, yet we are shutting down often the only support available to them, pushing them further out of sight.

These issues are particularly acute amongst the BAME community. African-Caribbeans are more likely to be sectioned, more likely to enter mental health serves through the court and police and are more likely to receive mediation then be offered talking therapy. Asian women have high rates of suicide compared to other ethnic groups. Yet despite these statistics, women from BAME communities still do not have adequate access to specialist support services.

It is the most vulnerable women in our society that we continue to fail. They remain bottom of the priority list of this government. It is time for policies that give mental and physical health equal standing, or psychiatric hospitals to be subjected to the same standards as the rest. It’s time we properly funded our psychiatric services so they are able to manage their increasing patient load and get behind the services that are supporting the most vulnerable. It’s time for change.

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Sonia Adesara is a junior doctor working in a sexual health clinic in London. UK born, daughter of a Asian-Ugandan refugee. Writes and campaigns against hostile and discriminatory immigration policies. Volunteers for doctors of the world, helping migrants in London get access to healthcare services. Unashamed feminist, co-chair of young Medical Women International Association, an NGO campaigning against women’s rights violations internationally. Twitter: @SoniaAdesara

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2 replies

  1. Attribution errors- do mental ‘illnesses’ cuse people to be victims of violence or does victimisation lead to mental distress? What if one leads to another? this artical assumes hospital is the only route for supprot. What if we had a vision of other formsof more meaningful support such as available support, meaningful relationships community connections, crisis houses, peer support. Lazy, circular thinking. We need a radical rethink.

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  2. Thank you for this insightful experience that has insight of a doctors on the floor experience – thoughts: (1.) yes, but the male suicide rate is about 400% higher with Men – the biggest killer of men under 45 – it is Afro-Carribean MEN Black men are 1700% more likely to be diagnosed with a psychotic illness when compared to their white counterparts, 44 % more likely to be detained under the Mental Health Act, and 29% more likely to be subjected to control and restraint measures to coerce them into mental health services. Black men are also twice more likely to be referred to mental health services through Police or Court services than their white counterparts. There is insight in this article but it is spoilt by what seems like feminist NGO liberalism.(2.) Ivan Illich Limits to Medicine: Medical Nemesis – The Expropriation of Health has a great critique of bureaucracy and health generally which I see as the systemic problem even reading this article even with welfare statist-bureaucracy. the psychologist Guilliane Kinouni in M/D has a more structural critique of psychiatry than what is presented here – the biomedical / DSM IS the foundational problem. Icarus Project, Dr. Lucy Johnstone, Gary Greenberg, David Healey and others look at this more depth – I think the technocrat approach to materialist healing is the problem before lack of funds because it doesn’t actually deal with the problem, hence readmissions and overcrowding, waste of resources. But good to learn about your experiences

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