Women and mental health services

[BBCNewsRave]

Been thinking about a lot of things recently. Hope I can put this coherently...

Basically I'm concerned about the effect of mental health services on women, regarding therapeutic approaches and general approaches of professionals, including misogyny and attitudes to abuse and expected gender roles. (Am in the UK so specifically thinking about NHS services).

For example, everything seems very focussed on positive thinking, thinking about what you can change in your life rather than what you can't. This is I suspect very influenced by severe funding shortages meaning a service that tries to get people vaguely functioning in their expected roles ASAP rather than bringing about lasting insight or change. But sometimes, people need to get angry. On a personal note, despite feeling terrified and helpless at some of my life experiences, simply understanding the context is a help.

I suppose I sort of feel that services gaslight women. (Potentially men too, but I think there's particular issues for women.) A service that aims to get a woman out the door as soon as possible isn't going to be very good at spotting the signs of abuse, for example - or at least, of realising abuse is happening rather than the woman just being mentally ill. And in fact services try to push as much care as possible onto family/friends of the unwell person, so a woman could be doubly trapped.

Also men working within mental health services can come with shedloads of misogynistic attitutes (as can women actually). I won't repeat some of the advice I've been given here but it's hair raising.

Plus the whole idea of trauma as a mental illness, naming the problem as being within the person rather than the experiences they've suffered. Are women viewed as unstable because on average we kind of are, as so many have been traumatised (by men) over the years?

I don't know... I mean, psychiatry is set up to preserve the status quo, I guess. So it shouldn't come as a surprise... (And saying something like "psychiatry is set up to preserve the status quo" sounds like tinfoil hat territory... amazing how th system does that to you )
I suppose I'm still reeling at the shock of a system one expects to be there to help, not being. In fact potentially being harmful. And a sort of realisiation I'm not that crazy, but the world sure is

I hope this post makes some kind of sense... er...

BBCNewsRave
I don't know if it's your thing, but this was recommended on another thread, it's free on line courses, and they're lovely, I did two short ones, and one has inspired me to follow up another idea.

Learning always seems like an empowering way out of stasis to me, just for its own sake.
www.futurelearn.com/courses

God this is my experience, OP.

I was just wondering if I should try to seek more help or say fuck it to therapy, finally.

No one I have talked to has really understood trauma. It's meds, or you're being too complex to treat, or "too well" (can do your everydays tasks) to treat.

As someone wrote earlier we are injured, not metally ill.

That's interesting, Woman, thanks.

There’s a simple recognition that family is going to happen. You can’t just drop the baby in the fields.
And when we are expected to be robot-like economic units rather than humans, it's women who have to do all the family stuff, the care, AND somehow fulfil their expected role in paid employment.

So much essential work is done by women... I do wonder if the lower suicide rate in women might actually be due to the sense of responsibility we have for others, expected to look out for their emotional welfare if nothing else. I stress that this is just my ponderings, I'm not making such a strong claim without evidence.

It's all so complicated... more women present with "mental health problems" yet proprtionally more men get taken seriously/get the higher levels of care... yet they are more likely to be diagnosed with more extreme "othering" labels, be viowed as violent monsters etc... yet they are also much more likely to be violent... arghh!!

I will chip in with one anecdote: Male ex (contolling, mansplainy, eventually violent) saw GP regarding depression. GP couldn't do enough - very sympathetic, offered a two month sick note off work, antidepressants, referral to therapy (that ex refused to follow up). Same GP completely dismissive of me, would only speak civilly to my (male) friend. Said failing my benefits assessment obviosuly meant I was putting it on and should just go get a job (won by a landslide on appeal, I had a CPN at the time, wtf was he thinking?). Not interested in trying to help me get therapy.

Yes there is evidence that women's caring responsibilities prevent them committing suicide. Because there are some "holding" factors that prevent a successful suicide attempt and caring responsibilities are one of them. Also religion. Don't know where to find the evidence though.

It seems like we have all had some similar experiences though we are all very different women, thats why you are onto something here OP.

Woman I'm actually studying now. :) Yeh it's good, but it's so hard to do when you feel physically ill due to the emotional pain and anxiety, and struggle to concentrate etc. That's something that's really hard - the things one is expected to do to get better often boil down to "do more stuff". People - including mental health professionals - confuse cause and effect. Yes, I was happier when I had a job, but not because I had a job! The whole effort seems focussed on getting you appearing well... again, it's back to your role, don't ask questions.

Just had a quick google looking for info. on female:male ratios in secure units (which is apparently where most of the mental health funding goes) and got distracted by a thing about violence... did you know the NHS zero-tolerance policy includes shouting as violence? Which made me wonder if patient violence might be being misrepresented in these stats... what's someone being ill or very distressed, and what's actualy violence? What's the female:male ratio of physical violence? Not sure how relevant that is, mind.

Ooh, just found this: Women in acute psychiatric units, their characteristics and needs: a review.

Studies have shown that single-gender wards are not necessarily safer or more gender-sensitive. The provision of a gender-sensitive approach requires staff attitudes to change and treatment programmes to be tailored to the needs of the women they are treating. However, research into what this should look like has been scarce, and there remains no clear, single approach to issues of gender, despite the government guidance. This is especially the case in secure and acute settings where the difficulties faced by female patients may be more subtle, and the hierarchical environment may feed into their feelings of powerlessness, exacerbating their illness. There is evidence that the needs of women in these services may have been particularly overlooked. This is worrying, given that women with a serious mental illness are considered to be more vulnerable to abuse and exploitation.

They closed the amazing women only ward near me, despite campaigns and articles in the press. Money as usual was the reason. The unit had won awards and all sorts.

Re. violence, from the link:
It is generally found that female in-patients are aggressive at similar rates and severity levels as male in-patients, although they may be less likely to cause injury to others. Krakowski & Czobor found that women had a much higher level of verbal assaults and early physical assaults. Difficulties with ward routine and social interactions were found to be more highly associated with aggression in these women. A more recent survey of incidents on medium and low secure units found that women were more likely to be involved in other-directed and self-harm incidents, but that men were involved in the most severe incidents.

"on getting you appearing well... again, it's back to your role, don't ask questions"
Absolutely! Agree with you there. I'm not sure when the tipping point in the last 30 years was when women became socially required to talk like insecure little girls and dress and make up like pastiches of femaleness
( in the 1970s and 1980s girls could be fat, make up less, human, without fear of opprobrium), but it hasn't helped that the 'rule' is to dress up and act up a certain way. Absolutely.

Enjoy your studies, good to hear! Hope it's going OK; let me know when you publish this great research into mh, I'd love to read it.

Only mainstream writer I know of who's writing or has written honestly about some of this business is Rachel Cusk. "A Life's Work" "Marriage an aftermath". She was roundly vilified. Wonderful writer.

'they closed the amazing women only ward near me' Tragic, this. On closing good quality female wards; part of this insidious system is to shut down female environments, online and especially state provided. And at what cost to women's health, it's a travesty.

And what is being done to young women's mh in schools, Camhs etc is like bringing up a generation who only know suffering. If fact their suffering has become an identity for many teenage girls and young women, they've been infantilised and oppressed into a victim mode. Very strange, it was not always like this!

Marking my place so I can come back and join in.
Fantastic thread and currently close to my heart.

I think a lot of mental health provision is focused on giving people the tools to function in a society approved way, rather than actually helping people.

I read a fascinating interview with a doctor in Afghanistan who said that nobody gets diagnosed with PTSD there because it's just the normal way of living, but as a society they can't afford for two thirds of people to fall apart so they focus on getting people back to functioning. I guess it's a way of limiting collateral damage when you can't change the world.

The difference is we don't live in a war zone, we just don't want to put the effort into e.g. examining what's wrong with the current system and fixing it when women complain of depression because it's just quicker and cheaper to medicate them.

I'm marking my place too. Thank you for starting this thread OP.

I've always had extensive mental health diagnosis (plural, but don't know what the word is). I now suspect I have autism. Apparently it is common for this to happen.

I do wonder if the much touted success rates of CBT are because it's effective at helping someone with undiagnosed autism function in the mainstream. Another tinfoil hat theory there.

I do not recognise this experience. Mental health services saved my life, and when I was vulnerable and in an abusive relationship, they told me to stay away from him.

MH services are often shit, but in my experience they are as shit for men as for women, due to lack of funding.

I don't believe psychiatry is a big conspiracy to keep women in their roles. It is a legitimate medical specialty that changes peoples' lives.

You could just as easily claim that cancer treatment is designed to aggressively remove the cancer so women can return to their roles. It would carry about as much weight as this argument.

My experience is that upon seeing your GP he will quickly put you on ADs and sleeping tablets. You fiddle about with those for a while before you get to primary and secondary therapy. Strangely enough, you get more talking therapy at primary level.
Secondary seems more psychiatrist led with the offer of courses. There isn't any free form talking therapy.
It seems that they make no effort to try and make an early diagnosis or atleast assess you, so they can steer you in the right direction regarding therapy. They seem to blindly treat you without knowing what they are treating.

Kane you seem to contradict yourself there. Courses are designed to help certain conditions, so an assessment must have taken place in order for appropriate courses to be offered.

"Free form talking therapy" is not proven useful for most psychiatric conditions.

No assessment. It was completely patient led. The courses were for depression, anxiety and also CBT.
As you know depression and anxiety can manifest from many things. It can be a biproduct of many conditions or experiences.

Free form talking, is also crucial in the assessment of mental health, imo.

Depression and anxiety are so hugely common that to provide every patient with free form talking therapy (which often takes place over years, sometimes even decades) would be hideously impractical. That's why the focus is on relieving symptoms, not digging into why things have happened.

Care is prioritised for those who are psychotic or at risk of harm. Talking therapy can be pursued on a private basis by those who want it.

True but it makes the system inefficient. Generalised treatment doesn't really tackle the problem.

Wow...this has got me thinking.

I have a diagnosis of Generalised Anxiety Disorder. I saw a great female counsellor for 8 months last year but we had to stop as she was a student and her placement was ending. I really wasn't convinced at first - she was a CBT therapist mainly and I've had CBT on the NHS numerous times and found it useless. But she also had training in person centred counselling and we just talked, talked and talked.

It made me realise that my anxiety comes from trying so hard to be the perfect daughter and wife. I felt like I didn't know who I was anymore and hadn't for a long time when I walked into that office. I still have a long way to go but I keep reminding myself that I have a better understanding of who I am and all the pressure I've internalised. And this is the case for so many women - stamp your anger down, lose sight of yourself, feel like it's you that's broken when expectations are what broke you.

That's ridiculous, namey. For a start, there are different severities of depressiona and anxiety. I've been unabe to work for years due to my mental health - it would be much more economical to provide therapy. More to the point, I AM at risk of harm, and have in fact been harmed. My suicide risk is increasingly higher, and I've been repeatedly abused by opportunistic men because of being vulnerable.

And talking therapy cannot be pursued privately by many, especially the most unwell, precisely because their mental health means they have a very low income. It's not a luxury, fgs, its to correct years of harm done to me by others! And i'd need significantly less therapy if they'd done it in my teens when I asked instead of treating me horrifically and compounding the issues, as well as encouraging me to walk right into further abuse.

Do you think patients who want expensive treatments for physical health should pay for it themselves, or are you just cold and callous to those struggling mentally?

Plus how on earth do you think they "relieve symptoms" without sorting out the underlying problem? They don't/can't. That's why lots of us get no therapy at all.

Oh also namey private therapy is no good if you're really struggling - they expect you to have background support from the NHS for safety reasons. My therapist stopped seeing me because of this - too risky for her for me to have no support.

Oh i've jusy realisw you written loads of bollox namey just becaus they helped you. Well lucky you, i'm alright Jack. FFS. How exactly did they treat abuse without recognisisng it? I was told to stay in two different abusive relationships. Even when this guy had revealed he was living a double life and had stolen hundreds of pounds from me, they said i should stay with him. So have a little think and realise that just cos you're alright doesn;t mean the system is generally up to scratch. If you got helpf for abuse ypu are a very rare case indeed

I think the difference in private mental health service and NHS mental health service is vast. Much greater than any other area of private service and the NHS.