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Developing a policy to deal with sexual assault on psychiatric in-patient wards

  • Tara Lawn (a1) and Elizabeth McDonald (a2)
Abstract

Sexual harassment and assault on psychiatric wards is an ongoing concern. A number of incidents have been reported in the media. This paper focuses on a policy drafted to deal with allegations of sexual assault or rape on an in-patient psychiatric ward. We aimed to produce a practical, easy-to-follow guide for junior doctors and ward staff who may face complex and possibly contentious issues surrounding consent, capacity to consent and police involvement.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Bayney, R. & Ikkos, G. (2003) Managing criminal acts on the psychiatric ward: understanding the police view. Advances in Psychiatric Treatment, 9, 359367.
Cole, M. (2003) Sexual assaults in psychiatric in-patient units – the importance of a consistent approach. Psychiatric Bulletin, 27, 2528.
Cole, M., Baldwin, D. & Thomas, P. (2003) Sexual assault on wards: staff actions and reactions. International Journal of Psychiatry in Clinical Practice, 7, 239242.
Gudjonsson, G. H., Hayes, G. D. & Rowlands, P. (2000) Fitness to be interviewed and psychological vulnerability: the views of doctors, lawyers and police officers. Journal of Forensic Psychiatry, 11, 7492.
Home Office (2000) Setting the Boundaries: Reforming the Law on Sex Offences. Home Office Communication Directorate.
National Patient Safety Agency (2006) With Safety in Mind: Mental Health Services and Patient Safety. Patient Safety Observatory Report 2/ July 2006. National Patient Safety Agency.
Royal College of Psychiatrists (1996) Sexual Abuse and Harassment in Psychiatric Settings. Royal College of Psychiatrists.
Royal College of Psychiatrists (2001) Response: Setting the Boundaries; Reforming the Law on Sex Offences. Royal College of Psychiatrists.
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Warner, J., Pitts, N., Crawford, M. J., et al (2004) Sexual activity among patients in psychiatric hospital wards. Journal of the Royal Society of Medicine, 97, 477479.
Welch, S. J. & Clements, G.W. (1996) Development of a policy on sexuality for hospitalized chronic psychiatric patients. Canadian Journal of Psychiatry, 41, 273279.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Developing a policy to deal with sexual assault on psychiatric in-patient wards

  • Tara Lawn (a1) and Elizabeth McDonald (a2)
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eLetters

Dealing with transphobic harassment: the experience of a transsexual inpatient

Janet Chiu, ST2 trainee in psychiatry
01 April 2009

We read with interest the paper by Lawn and McDonald (2009) in which they described developing a policy to deal with sexual assault on psychiatric inpatient wards, and noted with dismay the high rate of sexualharassment quoted in the paper ie up to 33% of female inpatients experience unwanted sexual comments, and that pestering of women patients at 56% was so common. The authors’ description of implementing a policy, flowchart and guidance seem particularly helpful to junior doctors. Our trust does not yet have a easily accessible similar policy.

Harassment has been a particular problem for one our patients, a maleto female transsexual, who required admission for depression and suicidal thoughts: she has found hospital admission particularly difficult both dueto prejudice from fellow patients and, what she describes as transphobic abuse from staff. Even during the first hours of her admission it became clear that our inpatient service was not going to find it easy to meet herneeds and she was moved between wards, allocated a bed in a female area, then in a male area, and then finally to a single bedroom in a mixed ward.

Although these were real practical issues, ie Trust wards operate either as single sex wards or as wards with specific male/female areas with gender specific bathrooms, it also seemed that staff’s attitude was amajor factor in her feeling of harassment, and gave her a sense of discrimination. Following a complaint to management she has agreed to meetwith ward managers to discuss the issues.

Helpfully for the medical staff, she also agreed to for her case to be presented at the Academic Programme, to which all grades of doctors attend. Rather than have the more formal presentation of a history and then the patient brought in ‘for display’, our patient preferred to be present throughout and gave a talk of her own experiences and participatedin the subsequent discussion.

A questionnaire survey of the attenders at the presentation revealed that, of the twenty one responders, most did understand the difficulty experienced by the patient, and appreciated the issues of harassment and discriminatory practice as she described them. The experience of learning directly from the patient was commented on. 76% of the attendees had no training in transgender issues and would welcome some.

The DoH guidelines for “Trans: a practical guide for the NHS” do not specifically refer to inpatient accommodation but are more focussed on staff attitudes.

The experience of Ms X is requiring our Trust to look in detail at these issues: firstly inpatient accommodation for transsexual patients, and secondly, training for staff in gender specific issues.

It will be interesting to see if inpatient accommodation would prevent the harassment described by our patient or whether staff awarenessis the more vital component.

References:Lawn T & Mcdonald E (2009) Developing a policy to dealwith sexual assault on psychiatric inpatient wards Psychiatric Bulletin, 33, 108-111Trans: a practical guide for the NHS (2008) Department of Health
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Conflict of interest: None Declared

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A policy to deal with sexual assault on psychiatric in-patient wards.

Daphne R D Wallace, Consultant Psychiatrist (retired)
20 March 2009

In their Special Article in this month’s Bulletin (March 2009) Lawn and McDonald outline a clear policy that they have developed for dealing with sexual assault on in-patient psychiatric wards. I welcome their account and in particular their flow chart and the accompanying guidance for its use.In their references they list the Royal College of Psychiatrists document CR52 (1996) entitled Sexual Abuse and Harassment in Psychiatric Settings. I regret that they do not refer to the subsequent College Report CR145. Sexual Boundary Issues in Psychiatric Settings (available Online Only)Published in August 2007. ‘This revision(quoting from the website) of the original College Report CR52: Sexual Abuse and Harassment in Psychiatric Settings (Royal College of Psychiatrists, 1996) has led to a review within a wider remit, taking into account major developments in thelegal framework within which patients are treated and encompassing a broader discussion on sexuality. Issues of capacity and consent are relevant for all areas of care, and psychiatric professionals have to balance principles of autonomy and protection. Particularly relevant in this context are the Human Rights Act (1998), the Sexual Offences Act (2003),the Mental Capacity Act (2003), and additional legislation regarding standards of care for both adults and children. The area is one of high risk in terms of likelihood and impact because of the vulnerability of the patient group. Recommendations are made in the light of the Kerr/Haslam Report (2005), the Patient Safety Observatory Report 2 (NPSA 2006), and the government report Safeguarding Patients (2007).’ ... More

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