Require the NHS to provide single-sex psychiatric wards including intake wards

[NonnyMouse1337]

I created a new post in the Petitions board. It's not my petition - just giving it publicity.

www.mumsnet.com/Talk/petitions_noticeboard/4065880-Require-the-NHS-to-provide-single-sex-psychiatric-wards-including-intake-wards

Well I wasn't expecting any thanks but that seems a bit harsh.
I can only say that I and my colleagues try our best to protect patients in difficult circumstances. People are not queuing out the door to work on these wards btw and assaults on staff are taken way less seriously than those on patients. We largely expect to stand in the way and get hit and sexually assaulted first and don't complain.

In an ideal world of course there would be enough funding for the very best care for all but this is NHS mental health. We are bottom of the pile and we know it. The government has underfunded mental health vs physical health for decades and the general public don't give a shit. You try to fundraise for our ward vs the cancer ward and you find that out.

In the middle of a Covid pandemic with the economy down the drain it would be lovely to think we will get funded for a tonne of new single sex facilities but we won't and I genuinely think that if a ruling is brought in with no funding then there will be less beds that women can access.

Maybe it was wrong of me to say that on this thread and I should just nod and smile.

All patients have 1:1 time with their keyworker every day and could raise any issue in confidence then

Mainly we know by looking. Staff are there observing what goes on in communal areas all the time. There is always at lest one staff member 'on the floor' so we don't rely just on report

Also they are our patients so we know who has a history or propensity for such behaviour

There is resource to segregate the very worst cases but not resource enough to segregate every ward. We'd need larger numbers of smaller wards which costs more money.

Note I did say there is a female only personality disorder ward too so there is some female only care but it enough for all. It is not just males who have a single sex ward. There is one each bit all the other wards are mixed. It's not as simple as just redistribute to make them single sex either as then you'd have to sacrifice age or diagnosis segregation and eg have adolescents, working age and elderly all together or eating disorders with dementia.

If there were the political will then we could have enough mental health beds and separate sex wards.

This. Not a dig at you Doug. I recognise these are difficult wards to work on, and I'm grateful that you do. I don't blame you for the lack of funding and appreciate that you are doing your best under the circumstances.

But women are so much more disadvantaged by mixed sex wards then are men, and we should speak out to gain more funding.

Oh, really sorry I didn't make nice conciliatory noises. Fully aware of MH provision being bottom of the pile. Fully aware of the low status and stretched nature of staffing a MH unit.

Not sure why you think I should be doffing my cap to the wonderful staff when I've been one of those female patients in a shared lounge, persistently intimidated by a male patient, whom the staff were aware of and kept steering away from me. Must have been really tough for them. But hey, at least I had a bed, and should thank my lucky stars, eh?

We are bottom of the pile and we know it. The government has underfunded mental health vs physical health for decades

Indeed. A sibling works in the police and reckons most of their work these days is making up for the lack of former mental health care units. I can't imagine how difficult or stressful your job is.

I agree that it's a fantasy really to think that funding will increase - but then if we never even try to indicate a desire for it, it must make it even less likely?

Thanks for sharing that info from a professional perspective, DougRossIsTheBoss.

I agree that there is a wider conversation to be had around adequate funding for these kinds of services. You're right that psychiatric services don't get as much public attention as other ones.

It's important to remember that vital services are chronically underfunded, not because of a lack of money, but because of political will. Money is not a finite resource, so it's important that as citizens we don't let governments fob us off with excuses of there not being enough money to be able to implement good quality mental and physical health care for everyone.
There are real constraints of course - like you might build lots of new hospitals but not have enough healthcare staff to work in these places because of years of not training enough people and paying them well to stay in these jobs.

Let's demand our government to take responsibility and not resort to quick and easy fixes. You're right there's always the risk of the good intentions being implemented poorly. If we can get enough signatures to debate this in parliament, and maybe even trigger some sort of consultation, that would be a great start. We can email MPs to ensure provisions and standard of care are not diminished by government attempts to be seen as quickly addressing public concerns.

Thank you for posting, @DougRossIsTheBoss. It's definitely food for thought.

I know staff on these wards are treated badly, unpaid, overworked and burnt out.
This is sadly also why they are often not able to provide the care needed to vulnerable inpatients (including being able to sensitively protect females from males). Again drawing on my sister's experience, many of the staff were clearly so tired they were only able to do the bare minimum, and only deal with the most overt problems (and certainly not low level discomfort of women due to, e.g., low key sexual behaviour from men).
Sadly, there was also a man on the staff of the ward (a senior mental health nurse) who was incredibly dismissive of the women, and at times quite abusive himself (e.g., he mocked the women on the basis of their appearances). The whole system is deeply, deeply problematic.

On a psychiatric ward 30 years ago. One bloke kept on until I told him to fuck off. And he did luckily (it must have been the angry, out of control gleam in my eye that did it). So mark me up as being another woman on a ward, which in spite of really great members of staff who were wonderful, got harassed without intervention. Doug - no one is criticising the job you and your team are doing under the worst circumstances. We are just debating what would be better.

Ok. I am persuaded. I will sign. We should hope for better and ask for better. We should not give up.

I guess after many years I have just stopped hoping that mental health patients will ever get equal care and I am afraid of making things even worse.

That can certainly happen if there is lip service paid to a good idea eg 'care in the community' actually a really good idea if it had been funded but in fact it became just an excuse to cut beds and save money with no funding to replace the beds with adequate community services.

There are systemic injustices like that mental health is largely block funded. You get a budget and you have to provide services within that no matter what the demand. Physical health are paid 'by results' or in fact by activity. The more work they do the more they get paid. Thus our local acute hospital sucks all the money from mental health and community services. If they stop doing hip ops because the CCG run out of money they are guaranteed sad face daily mail stories by if they shave a bit more off the MH budget no-one cares.

If you are medically fit for discharge and 'bed blocking' in a physical hospital social care have to pick up the bill after a certain point so they pull their finger out. For many years MH hospitals were exempt and you could not block a MH bed. You can imagine how keen social care were to help us to discharge? Allegedly it's been rectified now but in fact we have to go to a committee to get it agreed that anyone be put on delayed discharge and they will refuse for all kinds of bizarre reasons lately not having had a Covid test =
not ready for discharge but we can't order a Covid test unless there is a discharge destination and care package set up so no-one who needs care can now ever be delayed discharge.

We were also excluded from access to reablement services for years until we complained (no one needs rehab or help at home after a MH illness of course). Now we are not formally excluded but informally our referrals are always 'unsuitable'.

And on and on

I can only hope that society eventually changes its attitude to mental illness and sees it as worth the investment.

Fair enough, Doug. Sorry for being short. I'm rather on edge right now, but there's no need to be ripping into you while you're doing your best.

Thanks for that Floral. Appreciated.
I understand that this is a very shit time for anyone with MH issues with support networks, coping strategies and services shot to pieces.
I hate the way we are working at the moment. It's a tightwalk between risk of giving someone (or a whole ward in my worst nightmares) COVID and the reality that COVID restrictions are definitely harming care despite our best efforts.

It's a good thread. I didn't mind even the blunt responses. It did change my mind and show me that we still need to keep striving for the best and not just try to do the best with what we have although that is my day to day.

It should be single sex units not wards. Otherwise you end up with a setting where all the women are on one corridor, the men on another but all the shared spaces (including where they take meals) are mixed sex. Plus the fact that a) men can easily access the female corridor and b) it feels unsafe for women knowing that men can access them and they have no power to leave the situation.

What about male staff on female units?

A woman traumatised by male violence is deprived of her liberty; held on a mixed unit; with male staff enforcing her confinement incl for restraining her (quite probably on her bed by multiple men holding her down if the unit decides to use restraint and forced injections because it's more convenient); on one-to-one observations with a man watching her sleep, shower, go to the toilet. Staff with almost unfettered power over her and who will be protected by the NHS even if they abuse her too.

Sounds incredibly therapeutic for trauma. And indeed, no wonder so many patients who weren't admitted for trauma leave deeply traumatised.

You can't leave, you can't decide to discharge yourself, you can't go outside in many cases, you can't exercise, you have no access to activities to fill your days, you are treated like a zoo animal to be watched without interaction, you can't make any meaningful decisions about your life, you won't be believed if you speak out about poor or abusive treatment because nobody listens or believes or cares about what happens to people with mental illness inside hospital.

We are barbaric and despicable in how we treat people with mental illness.

Sorry, but it really upsets me the horrors we visit on vulnerable and suffering people. This petition is not enough.

Wow. I can't really just let that stand.

That's not a picture of any mental health ward I've worked on. It's not one flew over the cuckoos nest these days. If you have experienced such care I would encourage you to inform CQC.

You are free to come and go and to discharge yourself unless you are detained under MHA which is a legal process with safeguards.
If you are detained under MHA you and your nearest relative have a right to appeal and you have free legal representation and advocacy
Most wards have gardens that can be freely accessed at least in the daytime.
Enforced IM medication would be a very last resort and not a common occurrence and would be for serious violence not convenience
1:1 obs similarly are a costly and extreme intervention only done for short periods where there is no other way of containing risk and even then patients can go to the toilet and shower alone unless the risk of self harm is very high when an effort would be made to have same sex staff.
There is a full OT programme of activities daily usually including exercise groups and walking and at our hospital there is a gym.
Staff want to talk and interact with patients not just observe silently (bizarre idea). You have 1:1 time scheduled daily but if you want to be alone you can go to your private room where no one will watch you apart from an hourly check on your welfare.
Even if you are detained under MHA this does not give control over all aspects of patients lives. Usually before Covid visiting was unrestricted. You can wear what you like (aside of ligature risk items of that is assessed as a risk for you). If you hate the food you can buy your own or order in takeaway. On our wards patients can have their mobiles, laptops etc and we have free WiFi. The only restrictions are they have to be charged in the office (ligature risk) and you must abide by sensible rules ie no porn sites, don't take photos of others with your camera or post about others to social media.
Pretty much the only things you are not allowed are drugs, alcohol and weapons.
We have community meetings and if there are suggestions of how things could be better we try to accommodate.
If a patient makes a complaint or allegation about staff they are always believed and the matter investigated. Sometimes our patients are psychotic and they believe/ see or hear things that did not happen but every incident is investigated and if it's a serious allegation the staff member is suspended until it's resolved. Action is taken up to and including dismissal if required.

I do know that our care can fail sometimes, there are some bad pennies, I am not naive to think it's all roses but it is not unrelentingly bleak and untherapeutic either.

DougRossIsTheBoss

That is not how all mental health units are set up. My local ward is in a general hospital, there are separate sleeping areas and toilets but no separate corridors or locks on the doors. All common areas are mixed sex.

Our local unit has an outside area, I have never seen anyone in there as the staff are too busy to supervise.

I know many of the staff are doing the best they can and I know the people running mental health services are doing the best they can to juggle their small compared to need budget. But most people don't give a shit unless it's affected them or someone they care about.

Bumping up for those who might not have seen this yet.

Some units are awful for patients. I want to be able to discuss the problems without having staff react defensively.

Staff who are defensive about comments from patients online demonstrate what happens when we complain when we are on the ward.

This is a public forum and anyone can post from their own experience.
Whether patient or staff without it being dismissed.

If you want to start a thread about experiences you've had and not have any staff posting then there is a mental health board here that I would never post on because I am aware staff opinions are not welcome as it's for peer support.
Why not start a thread about the topic there?

This isn't a support thread. It wasn't posted in mental health and there was civilised debate about the original topic of single sex wards and I have signed the petition as a consequence as maybe others have too.

Then it degenerated into just slagging off all mental heath wards in general about issues other than single sex as though they are all the same. Maybe the ward you were on was crap. Maybe mine isn't. Those things could both be true you know?

My 'defensive' post was just to correct some actual factual inaccuracies eg that all wards have no activities or that you are not allowed to leave which is clearly untrue if you are informal
Saying untrue things like that is harmful to anyone who might need those services and be scared of accessing them. That's why I posted and for that reason only.

If you want a thread about bad experiences on mental health wards generally then start one and I promise not to go anywhere near it but you cannot hijack someone else's thread and then police who can post on it and what they can say.

I didn't read that ALL wards have activities and such.

This seems rather uncomfortable now tbh.

My mother works in mental health, mainly she works with people with alzheimers, but also often on the mixed issues ward (moreso when shes covering, most planned shifts are on the alzheimers ward), which tends to deal with people who have atempted suicide, theres a proper name for it that I cannot remember, she certainly does not call it that

She obviously does all she can with limited time and resources. And also accepts that people who have suffered will be agry. They will complain. Them complaining does not mean they are disparaging ALL people like her, who do try their best. Half tempted to send her a link to this and ask if she would be so defesive rather tha..well understanding.

Of course this is an open forum as stated though. But I find the above response really harsh tbh. I appreciate the work you do, I cxertainly couldn't do it. If not for my disability meaning a lot of the physical side is problematic at best for me, I do not have the patience or dedication that people must have to have to do your job, genuinely, I am really thanful there are people willing to do it. My mother says its often thankless, and I get that.

Not sure what I hoped to achieve with this post really. Have just take my nighttime morphine so might ask for deletion in the morning. But yeah, while I am grateful for both the work you do, and the professional perspective gained from your posts on here, the massively defensive (and honestly, a little 'not ALL mental health units are like that' type answer) post really feels off, given the topic and sensitivity for some people who have been patients, or family mmbers of patients.

If it offends people I'll stop posting
Some wards are shit, some are fine, most are in the middle
I have never, ever said they are all perfect. In my 'defensive' post the last paragraph literally said that I know we get it wrong sometimes.

The post I originally replied (by user 12455 which in itself is a red flag) was alarmist and practically implied that you will definitely be IM'd, never let out and watched naked by a man if you are admitted to a MH ward. These things are possible but not a majority experience in any way.
It was also written in the 3rd person therefore not implying any personal
experience
I felt it was untrue and inflammatory and could put someone off seeking care.
The things I described are factual and are the absolute truth in regard to my ward and whilst I cannot be sure it's the same everywhere I just hoped that it would counter the previous very extreme post.
If it was clearly personal and/ or less extreme I would have ignored it

As I said if it was a support thread in MH I also wouldn't go near it
But this is a debate thread in feminism chat a topic where largely people are happy to debate, often robustly.
FloralBunting and I had a bit of debate upthread and I have admitted I was wrong not to sign the petition and I did

My original reason for posting was to say that possibly a campaign for all wards to be single sex may result just in less beds women can access. I still think that's true but was persuaded to sign the petition anyway by people pointing out that it is wrong not to hope and campaign for better.
So you can see I am willing to change my mind and see other viewpoints

I did not post for people to be nice about my job or anything. If I needed people to clap or pat me on the back I'd go work on a cancer ward. People who are seriously mentally ill don't have to be nice to others and no-one expects deference, thanks or even politeness. Nor do I deny people's traumatic experiences. If you are mentally unwell enough to be in hospital then that is traumatising in itself. Some people are medicated against their will but as a last resort within a legal framework with safeguards.

You can believe it or not but I did not post to defend myself but to give a balance in case someone was harmed not seeking care because of the alarmist post.

Think it's likely time for another name change or a bit of a Mumsnet break as usually I do try never to mention my job but lately with Covid etc am getting drawn in and it's never a good idea

I want to make it clear that the petition is not to make all wards single sex, in case that puts anyone off signing it. Single sex accommodation is a requirement, not an innovation.

''In mental health inpatient units, women-only day rooms must be provided.''
''Patients should not have to share toilet or bathroom facilities with members of the opposite sex.''
improvement.nhs.uk/documents/6005/Delivering_same_sex_accommodation_sep2019.pdf

@DougRossIsTheBoss, I've found it interesting to hear your perspective.

As well as having close family experience, I also work in a similar field. I have to say that I've never encountered an inpatient mental health unit in this country which I didn't think was deeply problematic. Yes, some are far better than others, but the assumptions and systems they're based around are - in my opinion - profoundly abusive. I also think women face particular challenges in these units, and their treatment by males (inpatients and some staff) would be unacceptable in most other fields.

Bumping this up for more signatures, discussions, different perspectives etc.