Would single-sex treatment keep female patients safer?

Analyzing the latest research affecting women.
May 19 2010 9:42 AM

Sexual Assault in the Psychiatric Ward

Would single-sex treatment keep female patients safer?

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Research shows that more female patients than male patients would support a sex-segregated option, though there is no consensus about exactly how the numbers break down. The British study that explored rates of sexual harassment also noted that 52 percent of women preferred female-only wards; another, a 1994 paper from the British Journal of Clinical Psychology, surveyed long-term psychiatric patients and found "that the majority of patients preferred single-sex living." But a 2003 German study from Der Nervenarzt, which looked at the transition of a hospital from sex-segregated to mixed-sex, found that while 25 percent of patients preferred single-sex treatment initially, the number dropped to 9 percent after the change took place. Interestingly, the abstract notes, "Younger patients, voluntarily admitted patients, and those with substance addiction preferred mixed-sex wards."

Even if there were a stronger movement from patients and psychiatrists to develop more single-sex treatment options, the change would not be easy—or cheap. The United Kingdom's National Health Service Executive called in 1999 for an end to mixed-sex wards, vowing to stop their use by 2002. It didn't go so well at first: In January 2009, after a decade of dawdling and seven years after the practice was meant to cease, Health Secretary Alan Johnson set a new goal of finally eliminating mixed-sex units in 2010, threatening to fine hospitals that didn't shape up. The 100 million pound "Privacy and Dignity Fund," part of the Delivering Same-Sex Accommodation program, provided hospitals with funds to rework their layouts, and the Department of Health now declares that most facilities "meet single-sex accommodation standards."

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Along with assault, women in mixed-sex wards go through harassment and discomfort that surely don't help their recovery. A relative of mine suffers from bipolar disorder and has been hospitalized several times, in a variety of conditions—units both in wealthy suburban and poorer urban hospitals; entire facilities dedicated to treating the mentally ill. She has never stayed on a women-only ward and has had some truly frightening experiences; one man, she says, "kept telling me we were meant to be together. He crept into my room one night (you were supposed to keep the bedroom doors open and my roommate was catatonic so she was useless) and put his arms around me. I woke up and told him to get out." She wasn't raped—but afterward, she felt more scared and vulnerable when she should have been able to focus on healing. Had she not been able to assert herself, the night could have ended quite differently.

Giving women who are more vulnerable to assault or who are terrified of being in a psychiatric facility the option of same-sex treatment would make their inpatient visits safer, even more productive. This could be particularly important for women who have been the victims of violence, as is the case with so many psychiatric inpatients: The severely mentally ill are far more likely than the mentally healthy to be victims of crime, including sexual violence. One of the few women-only mental health wards is at Toronto's Centre for Addiction and Mental Health, which serves women who, in addition to mental illness, have suffered from traumas like physical or sexual abuse, or addiction. But that unit has just 18 beds.

If female patients don't have the option of single-sex care, then at the very least they deserve to be in the hands of well-trained, caring, and observant staff members. Other safety measures would also be helpful, like an electronic monitoring system, which Florida's St. Joseph Hospital installed after a rape was reported, or giving patients the ability to lock doors if they feel threatened, so long as staff members can override the lock if necessary. A woman who just attempted suicide should be free to get a good night's sleep without worrying about a man crawling into her bed uninvited.

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