“Genuinely” single sex wards are not the best standard of care for all and in particular, trans and non-binary service users - survey

[IwantToRetire]

Through desk-based research and a survey, led by a trans and non-binary researcher, we have asked the question: what are trans and non-binary people’s experiences of single sex spaces in mental health settings in England?

We have asked this question in order to centre the experience of trans and non-binary service users on single sex wards and to better understand what needs to change to make mental health settings safer places for trans and non-binary people experiencing mental distress.

This research found that there is significant variation in trust policies relating to trans and non-binary service users, with gaps between trust policies and peoples’ actual experiences that indicate the urgent need for a better standard of care for trans and non-binary service users. Trans and non-binary service users face serious discrimination and harm within care settings from staff and other service users.

Our key recommendations for services are are:
~ Recognise that single sex wards are not the best standard of care for all service users, in particular, trans and non-binary service users, and take steps to assess and mitigate possible negative impact.
~ Locate the problem in services, not in service users: ask how services and practice can change to support and include trans and non-binary service users.
~ Name the political nature of trans health in policy, education and practice, and the ways in which the needs of trans and non-binary service users may be being neglected or undermined in services.
~ Set out how gender-affirming care and physical health needs of trans patients in mental health inpatient settings will be met with emphasis on not being an obstacle to gender-affirming care.

Extract from www.nsun.org.uk/news/new-nsun-research-report-single-sex-spaces/

NSUN = National Survivor User Network

Exactly. Sometimes the needs of women and trans people will clash, and women and girls should not be asked to set aside their own fears so they can affirm trans people or make them happy.

And this is so bloody predictable! Realising they have been allowed or encouraged to seek irreversible damage to their previously healthy bodies. In pursuit of a delusion. Heartbreaking.

I think saying that these women do or don't have specific issues that could be healed by psychotherapy isn't necessarily right either. Hard to know given the fact that NHS mental health services are shredded to almost nothing. Sometimes inpatient admission is what it takes, and goodness knows there are some amazing people working in the services too. Alongside some abusers.

Mental heth presentations have a cultural element. What is going on in the culture will be represented in services too.

I note that the report's author received some replies apparently from people with DSDs, which questioned the premise of placing trans and DSDs together as the same issue. So obviously as a serious scientific researcher they left those responses out. I suppose at least they documented what they did.

@Davros - that sounds very difficult. Sending you my best wishes. 💐

I'd imagine the suicide rate of people who have medically transitioned, and who have realised they have made a monumental mistake from which there is no going back, is much higher than the suicide rate of young people who think they are trans.

THAT'S the kind of data we need to be keeping over the long term.

What do DSD and AFAB stand for here?

~ Recognise that single sex wards are not the best standard of care for all service users, in particular, trans and non-binary service users, and take steps to assess and mitigate possible negative impact.

nope.
Do you have any natal women conducting this survey?

Because all the questions are about "woe are the trans". They can have 3rd spaces. Women and men want their own single sex spaces. We have seen the side effects of transwomen being in women's wards. No. Thank. You.

i may have stopped reading and not taken in the rest of the survey. So I'll read again :)

"Open" ward for all with female only because of the biological need

Like sports

@Laladybird sorry.

AFAB 'assigned female at birth', also known as women and girls.

DSDs - disorders of sexual development, also known as variations in secual development or VSDs. A definite category but types of disorder that are included in it are disputed.

I don't think you can have a single policy because the needs of patients vary depending on why they are accessing in patient settings. For short stays, especially emergencies and surgical, then I think patients should simply placed where there's a bed. For longer stays eg geriatric/dementia wards then single sex becomes necessary due to their needs/potential issues. For long stay situations like mental health, rehab single rooms should be used wherever possible anyway.

As most hospital wards are built with a number of bays plus side rooms, mostly it's possible to segregate anyway - and by definition gynaecology, which has its own ward here, is single sex! (Actually breast surgery shares the ward so very much a female sex zone).

If I'm in an accident and smash my leg up for instance, I really couldn't care less if there's a man in the next bed, it's just not the same as a sensitive surgery

I wouldn't want it to be accepted that transmen would go to an open ward.

What this might do is start a greater discussion on abuse and risk in inpatient mental health services. I just hope* that it's a discussion accepting the particular physical vulnerabilities of women and to male abuse. Not a discussion only about the overpowering importance of staff not misgendering each other and having 'awareness' of nonbinary identities.

*I don't have very much hope of this

There is probably an element of that, but I suspect it is more that transitioning never solved the mental health crisis that drove them to transition in the first place. That whilst ‘gender affirming’ and the process of transitioning provides some temporary distraction, it doesn’t actually work.

If that's what transmen want then they should be allowed

Since they remain female that is also an option for them

@gogohmm I agree that as there are more single rooms, the problem gets less. Thing is though, if you smash up your leg, the most likely ward you will be on is a trauma ward, where a huge proportion of the patients will have dementia, a broken hip and delirium on top. You might need bedpans or a catheter if you're not mobile in the early days. People aren't made up of separate bits.

@midgemadgemodge mental health wards which are locked are there to stop the patients being exploited- if open, abusers cone in and steal stuff from the patients, and sell them drugs. These are incredibly vulnerable people. You can't just say 'whatever they want they should have', there would have to be some- gasp - gatekeeping about their needs.

DSD - difference in/disorder of sexual development - often referred to as ‘intersex’ but intersex suggests they are someone in between sexes when they are all either male or female.

AFAB - assigned female at birth - a woman

If that's what transmen want then they should be allowed

The female trans person in the screenshot Reddit post I posted below is extremely vulnerable and under DoLs as they self harm. I don't think this person should be placed with men.

@gogohmm I honestly can't agree that if you're needing an emergency or surgical admission that single sex accomodation is less important. As someone who has had several emergency admissions with respiratory problems, it bothers me a lot to be in close proximity to men when I can't get away, speak or shout, am not wearing a bra and have to sit hunched in an effort to breathe, constrained by drops and oxygen. It feels horrible to be so exposed. Sharing bathroom facilities with men, where the locks are insecure and the gaps around doors big, and they wee all over the floor, when you can barely stagger there yourself, let alone hold the door shut or hover to avoid their spills.... I've had elderly, incontinent men with dementia try to get into my bed. All I could do was press my buzzer...and we all know how quickly they're answered...

Being post surgery, catheterised, having drips and drains, wounds, only wearing a gown...I don't want to be in a bed next to a male, with only a curtain that doesn't quite fit between us while I am helped to wash or use a commode...

Ultimately a hospital has a duty of care to its patients.

A transman, especially one who is very vulnerable should not be on a male ward. This is for safety reasons.

I am not sure they should be on an open female ward (perhaps private room) especially if they are passing, as this may make the other female patients uncomfortable and this is not fair on them.

Likewise I am not sure a transwoman should be placed on a male ward if they, because it may make the other patients uncomfortable (again a private room would be an option).

Ultimately many trans people make significant changes to their appearance. That is their choice. With every choice we make there are consequences, limitations etc.

That is why third (and actually 4th spaces) are needed. These should also be single sex for those who have transitioned.

Well being in a mixed mental health ward once. Being 18 with a male 6ft psychotic patient adamant I was a spy and attacking me, I was a lamb to slaughter... never a mixed ward for me again if I could help it.

Where the hell are all these "genuinely single sex wards" anyway? I've never been in one. I've known of one, one place I've lived, but that was specifically for women with personality disorder diagnoses. Every ward I've been on was mixed sex, with "single sex accommodation", which amounts to men's bedrooms and bathrooms being in a different but barely differentiated area of the ward to women's bedrooms and bathrooms. Patients are strongly encouraged to stay out of their bedrooms and in the communal areas (day room, dining room, garden if there is one, maybe some other spaces) all day, often with very few staff around and plenty of areas you might find yourself with hardly anyone else about. And there's nothing to actually stop the men going in the women's rooms if they wanted to, or vice versa. On one ward, the dark, deserted women's day lounge could only be accessed by walking to the far end of the men's corridor, so obviously nobody ever went there because it didn't feel safe.

Yeah it's nice not to have to share a dorm or a shower room with a man, but it doesn't feel single sex. Psychiatric patients generally aren't allowed to stay in their beds or even in their rooms — they're encouraged to socialise with the other men and women because this will help them transition back to normal life. Like fuck it will — there's nothing to do, you feel like shit, and everyone else in there is mental too, and since there are half as many beds as twenty years ago, they're even more unwell on average. It's not like the front wards in the old asylums. Everyone there is extremely, acutely psychiatrically ill.

And on the half as many beds front, this is one of the justifications they give for why truly single sex wards are impossible — you would have to build in too much spare capacity, since ratio of men to women needing care varies and you can't be having empty beds. So third and fourth spaces are right out.

Actually I think they've got rid of dorms altogether now. At least I hope so.

@shattered25 I was in mixed adult wards at 16 and 17 and I agree it can be bad. At least for me being under 18 on those admissions the staff tried to keep a bit more of an eye on me; you didn't even have that.

Actually I lie, not all of them had "single-sex accommodation"; some of them were back before that standard came in though they still generally tried to have men's and women's sleeping areas differentiated, and nobody gave a shit about it at all in the adolescent ward, besides trying not to actually have mixed dorms.