NHS confuse sex and gender on advice about The Mental Health Act

[HotRocker]

Apologies, I was going to post a screenshot but for some reason my phone won’t save them. The text isn’t far down the page though and I will quote. Please forgive me if I don’t use the correct formatting as I’m using speech software on my phone.

www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/TheMentalHealthAct.aspx

Quote
Hospital accommodation should be age and gender appropriate. Not all hospitals will be able to offer a ward dedicated to each gender, but all should at least offer same sex toilets and wash facilities.

I’m confused, a person should be put in a ward appropriate to their gender when possible, but should have same sex toilets and wash facilities. Does that mean a transwoman on a womens’ ward should use a toilet and shower for males? Also what does should mean? Does it mean probably but not necessarily in all cases, or does it mean you have the legal right to demand it? Also on a mixed ward does it mean that you should use it, or that you have to use it?

I was not looking at this with the transgender issue in mind. I’ve been sectioned before and in all likelihood will be again at some point, and after spending so much time discussing legal rights on here, I thought I needed to make sure I knew my rights under the mental health act. The NHS, I assumed, would offer me some clear and easily understandable advice… i’m in the middle of a pretty crappy bipolar episode at the moment, which has already landed me in hospital once, so clarity and reassurance was what I was after, not annoyance, frustration and utter bafflement.

Also, if they haven’t got enough single sex wards at the moment, they better get building if they want an appropriate ward for every gender under the trans umbrella.

Staff shouldn't be expected to deal with telling patients on a single sex ward that one bathroom is off limits because its mixed sex. Its not fair on the women or the transgender patient.
There are that many bathrooms on a ward because that's the number of bathrooms needed for the patient capacity.

There's no way I want to go back on a mixed ward. The women's dormitory on the mixed ward felt unsafe, there were no staff in there and violent patients, and everyone knew the code for the door because new patients were told to write it down.

I've seen teenagers (14 years upwards) on adult wards. They were treated differently, instead of going to the assessment/intake ward which was mixed sex, they were taken straight to the women's ward.
They were girls, and a couple of us did wonder how staff would have dealt with them if they were boys. We asked, and staff said they would probably have been kept on the assessment ward and kept a close eye on them.

On the ward that I’ve been on they’ve had individual bedrooms and single person toilets and shower rooms, but they have always been terribly short staffed. I don’t know whether to anticipate that if I go in again there might be a male bodied patient. Under normal circumstances, hostels and more general hospital wards with single sex accommodation and single occupancy toilet and shower facilities I wouldn’t be bothered, but psychiatric wards are threatening, and often violent places. I’ve seen fights, and I’ve seen women kick off, myself included, unfortunately, and it’s dangerous and scary. Even just going into the communal areas I find deeply unnerving, so the thought that a male bodied person, with males strength and a male propensity towards violence might be around is a serious worry.

Obvs namalt and all that, but serious mental illness can make people do things that are completely out of character. I’m 5 feet two and quite slim, but not in any way fit, but I’ve fought off four male police officers before during one episode.
I need all this stuff clarified. This isn’t good enough.

January 2018
'Lancaster mum with “fear of men” locked on hospital ward with transgender patient'

(extract)
"A Lancaster mum whose bi-polar disorder left her believing men were conspiring to kill her said she was left terrified when she was locked on a women’s psychiatric ward with an “extremely male-bodied” transgender patient.

Philippa Molloy, 42, said she was “genuinely, absolutely terrified” because she had suffered a relapse in her condition that made her irrationally terrified of men – including her own husband.

When she raised her concerns with hospital staff, however, she said she was not taken seriously and her medical notes implied that she was a “transphobic bigot”. She said the NHS had failed to think through the implications of allowing patients to self-identify their gender." (continues)

www.lancasterguardian.co.uk/news/lancaster-mum-with-fear-of-men-locked-on-hospital-ward-with-transgender-patient-1-8963648

Well, that’s reassuring, not.
I definitely think there needs to be clarification on this. At the very least the NHS need to get their story straight. It’s just confusing.
I have no idea who to contact about this. If anyone has any ideas they would be much appreciated.

I have a lot of sympathy for Philippa, but actually, surely a number of mental health patients are irrationally terrified of things that would still be on a single sex ward? What if you developed an irrational fear of people of your own sex? Or people will a certain colour hair?

And surely a lot of women have a rational fear of men?

But trying to force a mental health patient to ‘believe’ an untruth is just.... I have no words.

I'm so sorry HotRocker, I should have added a comment rather than just splatting the article down (was doing 3 things at once) I do realise how concerning this is.

It may be worth writing to your MP specifically on this issue. I believe you can ask them to ask a specific question to the relevent minister.

Jackie Doyle-Price MP is the
The Parliamentary Under Secretary of State (Mental Health and Inequalities)

www.gov.uk/government/ministers/parliamentary-under-secretary-of-state--84

THere have been a number of MPs who have also been active in improving MH services and awareness.

The APPG (all party parliamentary group) has a list of MPs & peers:
publications.parliament.uk/pa/cm/cmallparty/register/mental-health.htm

Charities, patient groups etc may be an alternative, especially if you have a connection.

The case that I linked to did have some media attention & hopefully has already highlighted an important issue,

Also, with the government saying they will maintain the single sex exemptions under the Equalities act. This should likely be an area where it would be most relevant,

Thank you very much for that. I’ll get on it as soon as I can hold a thought for long enough.

I remember being stuck on a mixed sex ward when I had my wisdom teeth out. Grim. I gave up on the day room because it had a chap it who looked like a tramp and I didn't want to sit on my own with him.

Some smug old git hogged the shower room first thing in the morning whilst people were waiting for the pre-op shower and came out grinning 'the early bird gets the worm' and left the sink full of his shavings. Not sure what his last slave died of. He reminded me of a documentary showing an expat from India who did not know how to use a tin opener at the age of 60something.

Then post op I got to the toilet only to find some dirty bugger had emptied his shaver in it, and on it, and since I was recovering from the GA and had no energy to walk to the other toilet, I had to clean it before I could sit on it.

I talked about NHS guidance on this subject earlier on another thread without having seen this one. I am on a waiting list to go into a psychiatric hospital (obviously not in crisis, but still) and I looked into the relevant Trust's policy on transgender patients.

The document says that trans patients should be admitted into the ward that corresponds with their "preferred gender" as a matter of course. It makes it clear that access to toilets and showers facilities will be considered in the same way: Trans people have equal rights to access single sex toilets or showers as any other man or woman. Consequently trans people should be able to use the facility appropriate to their preferred gender.

It mentions the EA exemptions, but suggests these will not often apply. There is a paragraph stating that the discomfort other patients may have over being housed in supposedly same-sex wards with people of the opposite sex will likely be thought of as transphobia, and not pandered to in the same way racism wouldn't be: But a trans service user should not be moved to an inappropriate setting and the decision should not solely be made on the basis they are trans. Just as an Asian patient would not be automatically moved to an inappropriate ward due to potential racism by other patients, so too, a trans person should not be moved from a ward appropriate to their preferred gender due to potential prejudice of other service users.

I wonder if genuine concern about sex-based rights being ignored altogether, and/or a visceral fear or extreme discomfort or just embarrassment at being around male bodies in a supposedly female space counts as "prejudice"?

The policy also makes it very clear that patients will not need a GRC or to have made any moves to physically transition to be able to access same-sex facilities of their "preferred gender".

HotRocker

Fairplay for Women have some good resources on their website and will be producing more in coming weeks.

fairplayforwomen.com/uk-equality-law-womens-rights-factsheet-2/

It all feels very intense this week but the consultation is running for a couple of months.

It was good news & an important step forward when the government committed to upholding the single sex protections in the Equalities Act.

Yesterday's article by James Kirkup also worth reading and gives me hope, it is being discussed:

(extract)
"For all that some people suggest it’s somehow prurient or distasteful to talk about penises in this debate, there is, as Nick Robinson put it in some excellent interviews on the Today Programme yesterday, no way to avoid this. The simple fact is that people with penises, whatever word we use to describe those people, are biologically different to people without penises, and that difference matters to many women in a way that cannot be dismissed as bigotry. It is, again, a simple fact that people with penises have the potential to commit certain acts of violence and abuse against others. That fact is the reason Parliament and society accept the concept of single-sex spaces: women have a right to keep someone with a penis out of those spaces.

Upholding that legal right is possibly the founding principle of several women’s groups that have sprung up since the Government first announced its intent to make it easier for people to change their legal gender. Unlike the charities that lobby for transgender rights, the women’s groups — Woman’s Place UK, Fair Play for Women and ManFriday — have no corporate or public sector funding, and not much money at all. They are genuine grassroots political organisations that have sprung up from a concerned public. Those groups have made a difference. Back in the autumn, that point about female-only spaces was either often ignored or dismissed in political debate. Women talking about penises were ridiculed as bigoted cranks, accused of transphobic misinformation. Their meetings were subjected to violent protests (one person has been convicted of assault) and a bomb threat, threats that went shamefully unremarked on by most politicians. Nevertheless, the women persisted: the meetings continued; the campaigns went on; and it made a difference." (continues)

blogs.spectator.co.uk/2018/07/labour-and-tories-finally-see-the-truth-about-the-gender-debate/

The Equalities Act

There's literally no point in the PM and Penny Mordaunt making warm noises about retaining the sex-based exemptions in the Eq Act when no-one knows how to use them. Or even what the difference is between sex and gender. Or which transpeople are legally entitled to access (certain) single sex spaces because they have a GRC and which transpeople (most of them) are not.

Olenna, from what I can gather, trans people without a GRC are already entitled to access any same-sex services they want based on their gender identity. The wording in the EA makes it sound as though excluding trans people from such spaces is permitted, but not to be encouraged. I have no idea what has to be done to demonstrate this "proportionate means of achieving a legitimate aim" crap, or how commonly providers of same-sex services make use of it, or will in future. It makes a mockery of the idea of same-sex provision.

HotRocker I think Norman Lamb MP (LibDem) may be a really good person to write to.

Fair Play has been doing some work related to this. This post has inspired me to get onto twitter and give it a bigger push.

900 sexual incidents on mental health wards over 3 months recorded by the CQC. (Care Quality commission). They have refused FOI requests to tell us more.

Come onto twitter and put some pressure on the CQC press office to tell us how many of the 900 sexual incidents in mental health wards happened in women-only wards and committed by male-born people.

twitter.com/fairplaywomen/status/1015541122028974081

Dr Paul Lelliott of @CareQualityComm says "900 sexual incidents, including assault and harassment, recorded on mental health wards in just three months. Some of the incidents have taken place on same sex wards".

www.cqc.org.uk/news/stories/sexual-safety-mental-health-wards

Anyone would think they had something to cover up, DoctorW.

Will leaning on the CQC on Twitter make a difference? What other avenues are open when this exemption is used to avoid giving out information?

Oh its always worth adding pressure in public. They know the answers alright, they are just using the FOI rules to dismiss us hoping we will go away. We will not!

DoctorW

I have copied your comments above to the important thread which collates many Mumsnet members' concerns:

www.mumsnet.com/Talk/site_stuff/3297067-Mumsnet-moderation-response-to-yesterdays-feedback

Honestly, I'd imagine that the incidents were broad - and likely reflecting the much greater propensity to commit sex offences among dicky people. So between patients and patients, and patients and staff (both ways) and even between staff, with majority of them dicky person with either a dicky or cunty person as a victim, would be my guess.

900 sex incidents (crimes presumably not consensual (which is possible with people living together on a ward although complicated to say the least when it's a psychiatric ward) contact between patients) in 3 months is an awful lot.

To me like with the prison stats, the question needs FIRST to be, why is there so much violence / sex crime in these insititutions that are supposed to be safe? That's a massive concern.

Agree that finding out if any of these incidents could have been avoided by sex segregation is a good idea, but, the main issue here really is that we KNOW that people (adults and children) are at extreme risk of sexual abuse and explitation, not least because they are deemed extremely low credibility "witnesses" (ie they are routinely disbelieved) and to see 900 in 3 months is horrifying.

Let's push for these stats and they will be useful for MANY advocacy groups around improving / addressing issues in these types of settings.

It might be worth asking for the answers to those FOI questions one at a time -- in separate requests. Sometimes they will do it then, because they can't claim that it would be too onerous and time-consuming.

It is also worth remembering that the last two governments have sanctioned hospitals for failing to provide single sex hospital wards because people HATE them. No matter how it is dressed up, individuals instinctively recoil from being treated in mixed sex wards. It's amazing how the medical profession can suddenly forget / ignore this and yet again, shows the power of certain exceptionally powerful lobby groups.

A few weeks ago there was a poster who was a nurse. She said on her ward in the couple of weeks before she posted there had been four incidents of sexually deviant behaviour from men identifying as women. The incidents ranged from them stripping off and masturbating, to actually sexually molesting a female patient while she slept. That was just one hospital ward in a period of a couple of weeks. Scary stuff when people are at their most vulnerable.