Royal college of psychiatrists inclusive Q&A session does not go to plan.

[userlotsanumbers]

Twitter ratio, replying to a tweet with shades of Nottingham Council about it.

Questions were not welcome at a Q&A session.

45 Transphobic questions

Institutional capture?

The problem is that space wise, lots of places can't accommodate third spaces.

The problem is that space wise, lots of places can't accommodate third spaces.

Thats not women's problem to solve.

Absolutely

True but if we suggest that TW need other spaces and third spaces cannot be made, we inadvertently strengthen the arguments for TW being in women's spaces. I think they belong in men's spaces and if there are safety issues there, this needs addressing directly.

That doesn't work. It was whined a lot when places were told they had to create accessible entrances and toilets for disabled people. That was done and dusted in about five years, through government and local authority programmes, funding available, inspections, regulation that all new builds must evidence this. The blueprint exists, it would be easy. Disabled people incidentally didn't whine and pout that this took time: they'd spent decades fighting and knew that change in progress was a good thing. Which is rather different to 'if I can't have it right now I'm snatching your space off you and I don't care about anyone but me'.

There are many, many females who express their ability to share intimate space with male people, who have been lucky enough not to feel they want or need single sex spaces. The obvious answer is to remove some sexed space from both existing provisions, create a gender neutral one AND two smaller sex based spaces. That's inclusion: no one excluded because of their needs.

Then you come to the actual crunch which would be trying to get some male people to respect female need for a single sex space and their equality of inclusion, and not to target that space and the non consenting females in there in order to meet their own emotional needs.

That's the bit that would truly be the difficult one.

I work in MH inpatient. Since 2000, the vast majority of acute psychiatric wards are single bedroom plus en-suite spaces instead of traditional “wards” iyswim. Sure, most of these bedrooms are on single-gender corridors, but in practice, most of the safety comes from having your own lockable (these locks can be overridden by staff) space to retreat to. In most hospitals, day rooms/ recreation spaces are mixed to avoid institutionalisation. To what extent this is a good idea is debatable. As for third spaces, many newer hospitals (ie built in the last 20 years or so) have “swing zones” imbedded in their design which can be used for men/women or to keep certain patient groups separate. In theory these could be used for TW. See more here www.england.nhs.uk/wp-content/uploads/2021/05/HBN_03-01_Final.pdf

The obvious answer is to remove some sexed space from both existing provisions, create a gender neutral one AND two smaller sex based spaces. That's inclusion: no one excluded because of their needs.

Why? Single-sex spaces are fully inclusive of every sex-based need, except the need to have the support of a carer who may not be the same sex as the user. That need is provided for by providing accessible unisex spaces.

Single-sex spaces are gender-neutral. Gender feelings are not sex-based needs. If feminine men are not happy using men's spaces, that's men's proven to solve. It should not be pandered to by reducing the provision for women.

@JellySaurus The sticky issue there though is that someone’s “gender feelings” may be a core part of their illness or key to them becoming recovered enough for them to be able to be discharged. Acute MH settings are not really the place to address deep seated issues and not addressing someone’s gender based needs may lead to them becoming more difficult to manage. You could argue that this is a male problem but, in practice, this just causes more problems for mental health nurses, 80% of which are female.

But gender feeling is not supposed to be mental illness.

Does pandering to an anorexic patient's body feelings support them in their recovery?

No, but say someone with another mental illness admitted in crisis also has eating problems. Not addressing the eating isn’t a good idea because it might be key to supporting the other illness but it also isn’t a good idea to start unpicking deep issues on a short term admission. The same is generally true with gender based needs (and, tbh, gender based needs and anorexia do often go together in something of a toxic mess).
Imagine you have a large, potentially aggressive, schizophrenic TW. The gender issues may be part of a delusion or may not be, it’s hard to tell. What is key though is that if you don’t respect their perceived gender based needs they are going to become very agitated and potentially violent. So what do you do? Many MH units would place them in a bedroom on the women’s corridor nearest the nurses’ station so that it’s possible to keep an eye on them.

Just look at what you've written JennieTheZebra:
Imagine you have a large, potentially aggressive, schizophrenic TW. The gender issues may be part of a delusion or may not be, it’s hard to tell. What is key though is that if you don’t respect their perceived gender based needs they are going to become very agitated and potentially violent. So what do you do? Many MH units would place them in a bedroom on the women’s corridor nearest the nurses’ station so that it’s possible to keep an eye on them.

Now imagine a risk assessment / safeguarding approach that centred their potential victims (women) rather than their demands?

I have great admiration for those who work in mental health. But repeatedly using women as support humans to pacify violent men and dispensing with women's rights to be safe is unacceptable.

As someone said the other day, what is the difference between this and sitting an aggressive, disruptive male child next to a quiet, well behaved female one in the hope that she manages his behaviour?

Which will happen by the female child sucking up the low level abuse until she breaks, and by those actually responsible managing to dump the hassle and problem onto someone else and off their own back.

All this says really is that violent, aggressive behaviour in male people not getting their own way works really well in coercing female staff to let them do their thing at the expense of female patients.

It's partly about very poor systems to manage male behaviour problems, and an even poorer attitude to females based on a hell of a lot of sexist ingrained thinking.

Thank you for clarifying that women are human shields.

Yes, but everyone here is in separate lockable bedrooms. The woman in the room next to the TW is likely going to have to socialise with them anyway as socialising spaces are mixed. I mean, I appreciate what everyone is saying but surely the actual “human shields” here are the staff?

Maybe what people are arguing for is single sex hospitals with zero mixing? Isn’t that a bit institutional/asylum-esque?

I agree @JellySaurus It's great to be flexible and consider alternatives but ultimately spaces are not segregated by sex. I'm really happy to share spaces with any other (actual) woman despite having nothing in common with them identity wise. The risk to some men in male settings has everything to do with male aggression and nothing to do with anyone's identity.

What concerns me most is how revealing this is about how they think of themselves as separate to service users and above them.

If a service user self harms quite severely, they are labelled emotionally unstable or manipulative, and get ignored or told to manage their emotions. But here it’s “one of them” and digging nails into a hand is reframed as self-harming and is a catastrophe. Because doctors are gods who should never come to any harm and the rest of us are the worthless others that keep them off the golf course.

Meanwhile in teaching, we are told digging nails into your hand is a standard strategy for stress management.

@JennieTheZebra Staff can't be everywhere at once, they aren't there at all during handover. Locked rooms are not safe, shared mixed spaces are not safe - and more importantly they don't feel safe. How do you expect women to recover from trauma in that environment?

TW Karen White had no difficulty in multiply raping a female patient on the women's ward through one horrendous night of attacks. White left the woman so badly injured she may never have children. Locked rooms or even staff capacity for regular check on patients does not seem to have saved the day there.

We're not a hive mind, that's a good thing and MMV

I'm happy to respect that some people do not want to use sex based provision and want an alternative.

In that, I expect equal respect and consideration for other people's inclusion and access needs, and feelings. Hence I'd support third spaces WITH some male people having to realise they cannot have all the spaces all the time and push females out of having anything at all.

Just re-write that:

Everyone is in separate lockable bedrooms. The man in the room next to the TW is likely going to have to socialise with them anyway as socialising spaces are mixed.

No need to put the TW on a female ward, put them on the male ward after all as you say the rooms are separate and lockable.

Maybe what people are arguing for is single sex hospitals with zero mixing? Isn’t that a bit institutional/asylum-esque?

If that's the only way to keep vulnerable traumatised women suffering with poor mental health safe and give them the privacy and dignity they deserve away from violent, aggressive males whatever said male decides their gender identity is then yes that's what we will have to do.

It is time to stop using women and their spaces and services as pacifiers, validators, collateral damage and human shields for males whatever their identity.

No need to put the TW on a female ward, put them on the male ward after all as you say the rooms are separate and lockable.

Exactly. What difference would it make?

There is no right for males to be provided with non consenting females in their space. It's not a known form of therapy, female humans are not service animals.

That a male person may kick off and become challenging is something to be managed by staff, therapy and if necessary medication. Not by reinforcing that female humans are emotional regulation resources for their use.

Interesting to say that single sex wards with no mixing are 'asylumesque' in that the original push for mixed sex NHS wards in the 80s came from the old mental health asylums, as part of a belief in deinstitutionalising patients who had been there for decades. It was also dobe imo without much understanding of the true vulnerability of women in that situation- the idea of vulnerability to abuse was thought to be a sexist hangover from the past, which it wasnt. Transferred into acute wards with multiple beds, it was so hated that it was banned from around the late 80s/early 90s. But I still think it's needed most of all in high vulnerability wards such as hematology (substance abuse) and mental health.

Specialist new build wards such as ICU, haematology, cardiothoracic tend now to be single ensuite rooms and are effectively mixed, though I haven't seen one that has a separate social space on the ward, hospitals have more cafes etc these days for any patients who have reached the point of moving around.

Just had a look on the main RCPsych website and still no report but does say the webinars will be on YouTube so I’ll keep checking.
A college webinar is interesting as the college is not our employer so attendees may feel more able to ask questions than at an employer organised event. I just wish I knew what those questions were!