“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

I'm very much not a fan of people identifying their way into opposite-sex spaces, but TBH when it comes to psychiatric wards, complaining about this is like complaining to the waiter that there's a fly in your fly soup.

When I'm forced to mix all day with men I don't know, who are very unpredictable and might be terrified or disinhibited or delusional, with staff all hidden away in the nurses' office and any number of opportunities for things to go wrong, and nothing to actually stop a male patient going in female spaces, PLUS some fairly suspect male staff too… and when you know that any report you make will be dismissed as "well, you know, he's poorly too" if he's a patient, or as "are you sure you're not just looking for attention" followed by a swift rediagnosis to BPD if he's staff…

With all that, why would I focus on the fact that a transwoman patient sleeps in a bedroom 6m from mine rather than 16m?

With all that, why would I focus on the fact that a transwoman patient sleeps in a bedroom 6m from mine rather than 16m?

because it is entirely possible to be uncomfortable and frightened about both situations?

Yeah… I know technically that's the case, and I know the principle matters, but have you been an inpatient on a "single-sex accommodation" mixed psychiatric ward? You really don't feel separated from the men at all anyway, so this all just feels… kind of hollow.

ArabellaScott and PiedBeauty thanks for your kind words. DH has Parkinson's and has totally screwed up his medication and was having hallucinations. He's in the best hospital in the UK, possibly Europe, for Parkinson's and the expertise is outstanding. The ward staff are plentiful and well trained. But it is mixed but separated although there's another ward which I suspect may be for people with even more severe problems.

From the little girls seated next to the unsupported boys to help manage their behaviour.

To the teenage girls nodding along with mix-sexed toilets because it's really important to be kind.

To the grown-ass women who think they'll be the one to save him/change him or otherwise rescue him.

To the mentally ill women affirming their co-patients' gender delusions.

To the female victims of abuse in Scotland's jails being traumatised all over again, because their feels aren't the feels that matter.

WOMEN AREN'T COMMUNITY CENTRES FOR MEN.

To try and clarify: I really do get that single-sex spaces are important and that the kind of study OP is talking about is trying to nibble away at every space we have until they're all completely gone. It is an important discussion to have.

But when I see women discussing this and almost taking it as read (as they should be able to!) that of course men and women aren't locked up together barely-supervised when they're at their most vulnerable and unpredictable, and see people carrying on the discussion on the premise that the proposed changes could result in a huge difference to women's safety, I can't let it pass without crying out that in practice, it'll make little difference because it can already feel pretty bloody unsafe.

It's an emotional subject for me, so while I try to remind myself of the importance of identifying into the "single-sex accommodation", the near-pointlessness of that accommodation on a mixed ward is at the front of my mind always.

Yeah… I know technically that's the case, and I know the principle matters, but have you been an inpatient on a "single-sex accommodation" mixed psychiatric ward? You really don't feel separated from the men at all anyway, so this all just feels… kind of hollow.

I'm not sure what you're trying to say here. There's a really good comment by a pp upthread that makes a similar point to the one about single sex education: single sex makes girls' education better, on the whole. Mixed sex is better for boys than single sex. So how often do the girls get prioritised?

I'm not a man, I've never been in a psych ward and so on. But i will never not advocate for women having the single sex spaces they want.

JarByTheDoor has said what I wanted to say about this.

No, we shouldn't be moving to a state whereby anyone can be identifying into single sex accommodation of the opposite sex. But equally, we also need to be aware that most "single sex" accommodation is not what people are envisioning anyway.

What is being advocated for is the opposite direction we should be going, we should be moving towards proper single sex wards which are fully segregated, and I'd argue that ought to include the staffing given how vulnerable female inpatients are to assault from male staff, particularly in MH settings.

@Shelefttheweb
"This particular study compared mortality or transitioned men with the rest of the male population."

"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."

That makes a lot of sense to me. Thank you.

Well quite. They say that mixed wards are more manageable than men's wards. (Though I've also heard people describe women's wards as eventful — but that might be 1. a sexist assumption that women together are all drama all the time, or 2. to do with psychiatric characteristics of women who tend to be placed in single-sex rather than mixed wards e.g. those placed in specialist PD wards.)

What I'm trying to say is that while it's great and important to try and hold back the tide of "gender"-based division, both for the wards themselves and to uphold the wider principle, the actual environment in "single sex accommodation" wards is such that I doubt a lot of people would even notice if a man happened to be accommodated in one of the rooms allocated to female patients or vice versa. In fact, it happened last time I was in (because of a sex imbalance in admissions I guess), and made no real difference except we saw him having to traipse across the ward to the gents' showers in his boxers and carrying his towel.

While, if I'm being purely rational, I'm on board theoretically and even practically with a fightback against gender-based division on psych wards, the fact is that if I have to go into a psychiatric ward again in the near future I will be vulnerable and feel vulnerable because I have no private space, I mostly can't leave, men are almost everywhere, staff supervision is minimal, we're all unwell on top of that, and there are few ways for me to protect myself from risk.

I may be put in uncomfortable and undignified circumstances with men who are grossly disinhibited, very confused, or may misunderstand my relationship to them (e.g. from personal experience, which is far milder than some other people's experiences I've heard: thinking they can act like my close friend and trying to give me expensive gifts while acting terrifyingly aggressively to others; displaying their genitals to me; persuading the 16yo me into taking drugs; squaring up to me; and so on). I'll also be around men who have a great deal of institutional, epistemic and physical power over me that I have to trust they will not abuse. (Almost all the men I've met in psych hospitals, both patients and staff, have been perfectly nice, normal blokes, obviously — but they're no less dangerous than men typically are, and some are dealing with difficult challenges that can make situations feel more volatile.)

I may also myself be disinhibited and act in ways I normally wouldn't — sex, for example. As it happens I'm attracted almost exclusively to women, but it's common for women (and men, obviously) who are manic to be open to having lots of sex they wouldn't normally have, and things could very easily go very wrong in a mixed ward in a way that's less likely on single-sex wards.

So… this is a very different environment to places like the previously strictly single-sex environments of women's shelters and women's prisons. If I had to prioritise action solely for psychiatric wards, then I personally would want to prioritise separating men's and women's wards over every other sex- or gender-related issue, including questions over where the occasional trans person might be placed. However, I can't only think about psychiatric wards; I have to think about the broader picture, where fighting back on "single sex accommodation" in psych wards is one part of a bigger battle, and can't be ignored.

Does that make any more sense?

This is where it gets difficult for everyone: Buck and the biological women. It's awkward. Buck is a biological female (so belongs on the women's ward) but looks like a man.
I've never spoken to Buck, but from seeing his - I'm happy to call him a he - videos about how children shouldn't be taking puberty blockers or cross sex hormones, and how gender dysphoria is a mental illness, I would suggest he might be at least open to a conversation about the best way forward.
The middle ground can't be that trans men like Buck are rejected from women's wards because they look male, but not legally allowed on male wards because they are biologically female. Likewise for trans women. That really is noman's land for any trans person.

The logical answer seems to point to side rooms and other similar reasonable adjustments if a trans person feels they can't be on a ward commensurate with their biological sex I.e. they are on the single sex ward that matches their biological sex but can have a discrete room if they prefer. Equally, it's incumbent on us to accept that some biological women (not many) will choose to present as men.

I appreciate that's then "pathologising" gender dysphoria.... but that's surely what's needed. The sooner it can be acknowledged as a mental health condition, the better. Biological sex is real, gender identity is belief. Changing your body to match a belief needs management as a mental health condition.

What a shame they didn’t try doing an unbiased review or they would have concluded

• Recognise that single sex wards are the best standard of care for the vast majority of women and girls and take steps to assess and mitigate possible negative impact on the tiny tiny minority of females for which this may not be the case.

What is being advocated for is the opposite direction we should be going, we should be moving towards proper single sex wards which are fully segregated, and I'd argue that ought to include the staffing given how vulnerable female inpatients are to assault from male staff, particularly in MH settings.

I'd back that, though I've not personally experienced the kind of assault from male staff that I know some of my peers have.

I spent many years recovering from the trauma of a lengthy adolescent admission which involved a toxic ward culture, frequent and excessive restraint, pain-based compliance techniques, public humiliation, forced drugging, and all the kinds of things you'd see on a Panorama exposé (funnily enough, I never once "needed" to be restrained during any of my adult psych ward admissions), but if I'd experienced some of the male staff assaults I've heard other women talk about I'm not sure I'd have survived. I mentioned the extra layers of institutional and epistemic power, and those lie heavy on the shoulders of victims of those kinds of crimes, and if they speak out the echoes reverberate through their psych notes, but distorted.

Sod the "socialisation". We're ill, not feral.

Thank you @PermanentTemporary @Shelefttheweb