It’s time to speak up: sexual safety on inpatient mental health units

By Haley Jackson, Research and Clinical Effectiveness Nurse, Humber Teaching Foundation NHS Trust, Email: haley.jackson@nhs.net, Twitter: @haleyj102

In my recent evidence and practice article1 I explored current practices around sexual safety in mental health inpatient services and discussed a need for change. People admitted to or working in hospital or care settings should be provided with environments which are safe and therapeutic to support recovery. However, as highlighted in the 2018 Sexual Safety on Mental Health Wards Care Quality Commission (CQC) Report2 patients and staff members in mental health wards are at risk of witnessing or being a victim to unwanted sexual comments, inappropriate touching or sexual assault. Back in 2006, The National Patient Safety Association (NPSA) raised concerns calling for greater awareness and reporting of sexual safety incidents, plus supported a push for single-sex settings. Yet little appears to have changed. In just a three month period between April and June 2017 there were 1,120 sexual incidents reported in England2. Of the 919 reports, 65% of the victims were patients, whilst 3% were visitors and 32% staff members. These figures are possibly just the tip of the iceberg as assessment, recording and reporting incidents of sexual safety remains inconsistent and lacks organisational support3,4.

 
Mental health settings cater for people with significant health, cognitive, trauma and socially stigmatising issues. Many have increased vulnerability to sexual abuse having being exposed to previous trauma, including domestic violence, physical, sexual or emotional abuse5. Therefore professionals assessing people in crisis should ensure they ask the right questions to fully understand the extent of patients’ vulnerability. This will reduce the chance that patients may be exposed to further abuse or inappropriately placed due to a lack of available beds. One study reported some 68% of psychiatric nurses reported being sexually harassed at work during the previous year, whilst 3% reported being sexually assaulted6. Nurses have historically shrugged off being victim to comments, inappropriate touching, or sexual acts directed at them as ‘part of the job’ and attributed abuse to patients’ capacity, cognition and psychiatric diagnosis7. Cultures are changing and organisations should encourage staff members or patients to challenge sexual incidents and report them no matter how trivial they may seem. However, to date there has been little impact on incidence.


The identification and reporting of a sexual safety incident is heavily dependent upon personal interpretation, interpersonal boundaries and cultural differences8. What is experienced as inconsequential by one person, may be distressing and re-traumatising for another. Despite varying levels of harm, reporters often classify incidents as low harm, and prioritise physical harm higher than psychological harm2. There is a need for clearer guidance to ensure reporting is not only accurate but ensures the impact on the victim is fully considered. Improvements to victim follow-up and support after a sexual safety incident is imperative to encourage open and honest discussion about the sexual safety in mental health settings.

1. Jackson H (2020) Reporting and recording sexual safety incidents in inpatient mental health settings. Mental Health Practice. Vol 23, 4 doi: 10.7748/mhp.2020.e1446
2. Care Quality Commission (CQC) (2018) Sexual Safety on Mental Health Wards. https://www.cqc.org.uk/publications/major-report/sexual-safety-mental-health-wards
3. Banja J (2014) Preventing sexual attacks in healthcare facilities: risk management considerations. Journal of Healthcare Risk Management. Vol 33, 3, pp.5-12. doi: 10.1002/jhrm.21130
4. Nielsen M, Kjær S, Aldrich P et al (2017) Sexual harassment in care work – dilemmas and consequences: a qualitative investigation. International Journal of Nursing Studies. Vol 70, pp.122-130. doi: 10.1016/j.ijnurstu.2017.02.018
5. Foley and Cummins (2018) Reporting Sexual Violence on Mental Health Wards. http://usir.salford.ac.uk/id/eprint/46498/
6. Nijman H, Bowers L, Oud N et al (2005) Psychiatric nurses’ experiences with inpatient aggression. Aggressive Behavior. Vol 31, pp.217–227
7. (Flannery and Walker 2008). Flannery R, Juliano J, Cronin S et al (2006) Characteristics of assaultive psychiatric patients: fifteen-year analysis of the assaulted staff action program (ASAP). Psychiatric Quarterly. Vol 77, 3, pp.239-249. doi: 10.1007/s11126-006-9011-1
8. Royal College of Psychiatrists (2007) Challenging Behaviour: A Unified Approach. Rcpsych. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr144.pdf?sfvrsn=73e437e8_2

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