Single-Sex Psychiatric Services to Protect Women

Mary V. Seeman, MD, DSc

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In This Article

Abstract and Introduction

Background: Most psychiatric services (eg, inpatient units, day therapy centers, outpatient clinics, and community clinics) are not currently segregated by sex, but recent developments -- such as increasing psychiatric acuity and increasing numbers of comorbidities -- have raised the level of violence and perceived threat in psychiatric facilities and have made a proportion of the more vulnerable patients feel unsafe.
Aim: The purpose of this review is to examine the concept of vulnerability as it applies to female psychiatric patients and to review the literature on the determinants of violence in psychiatric facilities and on preferences among psychiatric patients with respect to same-sex vs mixed-sex psychiatric services.
Results: Literature from Great Britain and from disability organizations supports same-sex facilities as options for women who feel unsafe in mixed-sex facilities. Outcomes with respect to violent incidents have not been evaluated.
Conclusions: Same-sex psychiatric facilities need to be implemented in a variety of communities and careful research conducted to examine potential benefits in specific populations.

Mixed wards in hospitals are a comparatively new phenomenon. Not so long ago, whole hospitals, especially psychiatric hospitals, were built in such a way as to keep the sexes apart at all times and to ensure that male and female patients never met. High double walls and grounds separated men from women. Nurses and attendants were always of the same sex as their patients; anything else was considered immoral. This has all changed, of course, and psychiatric facilities are now designed to accommodate both sexes. In 1999, however, because of reports of increases in violence and sexual assaults on psychiatric units and the perception of increasing threat with time, the National Health Service (NHS) Executive in Britain issued a call for the elimination of mixed sex psychiatric wards: "The Government is committed to phasing out mixed sex hospital accommodation and no new mixed sex wards will be approved. The NHS has been set the clear objective to work towards the elimination of mixed sex accommodation in 95% of Health Authority areas by the year 2002. . . . As part of the strategy to provide safe services, . . .this guidance outlines the practical steps which NHS staff should take to ensure the safety, privacy and dignity of patients, and suggests good practice for building design."[1]

It has been repeatedly reported that approximately 50% of female psychiatric patients are victims of sexual abuse.[2,3,4,5] This is not to suggest that the abuse necessarily occurs in treatment facilities but to underscore the sensitivity of this population to environments that are perceived as perpetuating abuse and powerlessness at the hands of (usually) male authority.[6,7] This is the rationale for reconsidering single-sex services.

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