(Trigger warning: sexual harassment, abuse, self-harm, suicide).
[Edited to add: when I first wrote this post, I wrote about an experience which I later deleted. I deleted it because I started the sentence “I have never been abused, but…” and went on to describe something which, on reflection, probably was a form of sexual abuse. I never classified it as such before because I did not remember it clearly enough to be sure what happened as I was very young, but writing it down (and then deleting it, and writing it back in, and deleting it again) made me see it in a different light. I still find it hard to know what language to use to describe something for which my memories predate my knowledge of the appropriate words, but if I was asked again now whether I have ever been abused, I might answer differently.]
I am being assessed for one of the seven or eight admissions I have had to the women’s crisis house. “We ask all the women who come here this,” says the therapist assessing me. “Have you ever been sexually, physically, or emotionally abused?” I tell her no. They ask everybody the question so that people who have been abused know it is safe to talk about it in that space.
I tell her no, and I know that this puts me in the minority; estimates for the proportion of adult women with severe mental health problems who are survivors of abuse begin at about 70%.*
I tell her no, but still, the question makes me think.
I tell her I have never been abused, but when I was 11, I was walking home from school alone and an older boy walked towards me, dropped his trousers and his underpants, and walked past me without a word.
I tell her have never been abused, but when I was 13, a man followed me around the Gower Street branch of Waterstones for half an hour masturbating.
I tell her have never been abused, but when strange men croon Smile, darling, at me in the street I am frightened they will hurt me; if I don’t comply, they shout, Fuck off, bitch.
I tell her I have never been abused, but the experiences I have had tell me that being a woman in public is not always safe. Other people’s feelings about it can become my problem very quickly.
What this means for my mental health is that when I am in a crisis, and I am anxious, I am more anxious around men I don’t know. It means I am frightened of being on a mixed ward where I can’t run away if a man decides he really wants me to see his penis, or tells me to smile, or else. I am frightened of being left in the custody of a male security guard while I am waiting to be assessed, of being on close 1:1 observation with a man who works on a ward. I am less likely to tell a male member of A&E staff that I am suicidal, or let him assess my injuries if I have self-harmed; when control of my body is all I have, it is harder to give up that control to a man. Even if he is a doctor. Even if he is trying to fix it.
This doesn’t mean I am never able to work with men or use mixed-gender services where they are longer-term and community-based – where I have time to learn to trust the men involved and where I know I can walk out of the building if I need to. But imagine how much my fears must be magnified for women who have been coerced or beaten or otherwise abused by their partners, their fathers, their sons; for refugee women who have fled countries where they were raped by men in uniform; for trans women who are frequently subject to physical and psychological violence.
Mental health services should operate on the assumption that women who are frightened are more frightened of men. They will be right most of the time. Whereas if they assume this isn’t the case, things go wrong quite a lot of the time; gender-based needs are sometimes accommodated if you ask to see a woman or to be under a women’s service, or if somebody on the staff notices who you are frightened of and joins the dots. But how many people feel able to ask for it? It took me a year to realise I was allowed to, and sometimes asking to see a woman is treated as an insult to men working for services. We need to create an environment where these options are routinely offered upon assessment. Not every woman will be bothered either way. But some will be, and most of them would be too scared to ask of their own accord.
Some mental health trusts do fantastic work around this, but nobody is collecting the relevant data, so it is difficult to campaign for change at a broader level. Nobody is asking how many times a woman on a ward has been left on 1:1 observation overnight with a man (read: how many times a frightened woman has been expected to go to bed while a strange man watches her sleep). Nobody is asking how often a man from the crisis team visits a woman alone in her home. Nobody is asking how many times a woman has asked to see a female member of staff. And as budgets get ever-tighter, gender sensitivity is increasingly seen as an optional extra, particularly in crisis care. This is not ok. The Care Quality Commission needs to start collecting data on these questions as a routine part of their inspections and they need to start holding services to account for how they respond to these needs. Maybe that way, we can begin to feel safe in our bodies when we are struggling – and this can be our starting point, as we move on from our crises, for learning to feel safe in our minds.
* This UCL study found that “69% of women and 49% of men with severe mental illness reported adulthood domestic violence.” 40% reported being raped. Obviously there’s some overlap between those 2 groups, but that’s a lot of women, especially considering that the study looks at incidences in adulthood and so doesn’t include traumatic childhood abuse. Anecdotally, almost every woman I meet through mental health services has experienced some kind of abuse at some point in her life.
A version of this blog appears on the website of the Crisis Care Concordat.