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?

On Christmas Eve in 2003, an 18-year-old woman with schizophrenia was walking through the ward at Philadelphia's Albert Einstein Medical Center. As she clutched a teddy bear, a male schizophrenic patient grabbed her, brought her into his room, and pushed her on his bed. Then, he and his roommate sexually assaulted her. The three were all patients in the medical center's psychiatric ward, yet no staffer noticed that a patient had been snatched from the hallway in the middle of the day.

If your knowledge of psychiatric wards comes from Girl, Interrupted and One Flew Over the Cuckoo's Nest, it may seem that men and women would be far apart. But very few inpatient units separate men and women, leaving women in the throes of depression, mania, psychosis, or mental breakdown vulnerable to sexual assault from the male patients they share space with.

Torie Bosch Torie Bosch

Torie Bosch is the editor of Future Tense, a project of Slate, the New America Foundation, and Arizona State that looks at the implications of new technologies. 

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In addition to the case in Philadelphia, accusations of psychiatric patient-on-patient sexual assault have cropped up over the past few years in California, Oregon, Boston, Florida, Missouri, and elsewhere. In 2007, an estimated 435 inpatients were sexually assaulted in Britain alone, including 15 alleged rapes. A 1997 British study surveyed 50 female in-patients and found that 56 percent had been "pestered by men in any way," 8 percent had "done anything sexually against their will," and 12 percent had "been asked to have sex for favours."

If the chances for sexual assault and harassment are so great, why are mentally ill men and women housed together in the first place? Historically, they weren't. The practice of housing them side-by-side in psychiatric units began sometime around the 1950s and 1960s. The shift was made primarily for therapeutic reasons: The psychiatric community wanted to normalize the hospital environment for patients—if the goal of a psychiatric stay is to prepare a patient to re-enter the "regular" world, he or she should interact with members of both sexes.

As part of the deinstitutionalization movement toward community-based treatment, the purpose of psychiatric units transformed as well. No longer did the severely mentally ill remain in the hospital for decades; instead, people began to check in for brief stays, perhaps a week or two, during an acute episode—a suicide threat or attempt, a severe episode of depression or mania, or a psychotic break. Accordingly, the number of beds available for the mentally ill has fallen drastically. In 1970, there were 524,878 24-hour hospital and residential treatment beds in the United States; in 2002, there were 211,199. So there's less physical space available to devote to sex-segregated spaces.

Recently, an administrator at a Wisconsin mental health facility that has been under investigation for on-site sexual assault defended co-ed housing by saying that the presence of women calms male patients. According to the Milwaukee Journal Sentinel, John Chianelli, administrator of the county's Behavioral Health Division said, "It's a trade-off. … Putting 24 aggressive male patients into a male-only unit would increase the level of violence in the unit." A "trade-off" is a remarkably blasé way to frame what has gone on at Milwaukee County's Mental Health Complex: According to reports, a 22-year-old male patient, whom one medical supervisor called "a very devious sexual predator," assaulted several women; allegedly, he impregnated one and then raped her when she was six weeks pregnant. But there's little research to support Chianelli's claim, beyond a 1996 German study, which noted that staff members of a ward that went from mixed-sex to single-sex observed "a significant increase in annoyance and aggression."

If housing men and women together poses clear dangers for some female patients, especially those who experienced sexual violence prior to hospitalization, why does it continue? The idea that it's therapeutic lingers. And it's also not clear that the patients want to go back to sex-segregation.

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