politics – Patching the Soul

‘Women’s centres should not be part of the criminal justice system.’

‘The idea that if something is painted pink and has the tagline of ‘empowering women’ then it is helping women, is not only harmful but is simplistic and dangerous.‘

So says Dr Gemma Ahearne from the University of Liverpool in her blog The Problem with Women’s Centres. I discovered her work when trying to understand what is happening to women’s centres now, having been aware of them right from the heady days of the second wave of feminism, when women were out there in the community doing things for themselves in the 1980s, setting up services for women. I’ve always found them to be an important resource for the women I saw in my clinic. A place where they could not only get the emotional support they needed in a relaxed, ‘women only’, non-institutional environment but also get practical help with the key issues facing them, from sexual abuse, domestic violence to benefits advice and hunger. Some women I knew attended long-running groups in the local centre. Some centres and services were specifically set up to provide help with mental health such as the, now sadly closed, Women’s Therapy Centre in London and Self-Injury Support in Bristol, still going strong and nationally, on-line. Others provided and still do offer counselling and group work based on the kind of feminist psychotherapy interventions developed by people such as Pamela Trevithick who pioneered groups for working class women experiencing depression with the organisation, Womankind. (as an aside I met a psychiatrist recently who had never heard of feminist psychotherapy…am I just old??).

We know that women’s centres provide important effective support for women. They do work. Outside of what is offered by NHS Talking Therapies and limited counselling available from voluntary organisations they are the only other free resource available for women who experience significantly more common mental health disorders, anxiety and depression, than men, and are prescribed twice as many antidepressants. If we are really serious about helping women to find alternatives to medication, they are absolutely key. But there have always been funding problems, so it was disappointing but not surprising to hear from a friend of the demise of Salford Woman’s Centre, based in the city where I used to work. Ruth Hunt wrote about this, and the need to keep women’s centres going in the Morning Star recently.

Baroness Corston also recommended them as key in keeping women out of prison in her 2007 report, prompted by the increasing rate of suicide in women in custody. As a result there was a considerable increase in criminal justice funding and involvement in women’s centres, of different hues, in the community. They can all be found simply by typing in https://www.womensservicesmap.com – some are traditional women’s centres open to allcomers but also receiving funding, sometimes the majority, from criminal justice. Others are doing entirely criminal justice focussed work and require a professional referral. Then there are the ones in-between that are primarily focussed on helping ‘vulnerable’ women who have been or are at risk of being involved with criminal justice, but anyone is welcomed, as continued funding depends on keeping up the numbers. I learned much more about the conflicting roles that many women’s centres now perform from reading Gemma Ahearne’s book chapter Sister’s Keepers: the Case of Women’s Centres also reproduced on her blog here.

This was not an easy read:

..’.the centre performs conflicting roles, on one hand it is there to support women by offering domestic violence support, education courses, free food, sanitary products, counselling and free legal advice, and on the other hand it is there to punish women. This paradox cannot be ignored, for women who go there on a statutory basis experience many of the pains of imprisonment, simply displaced on this alternative site. The idea that if something is painted pink and has the tagline of ‘empowering women’ then it is helping women, is not only harmful but is simplistic and dangerous.’ Ahearne 2022

Gemma spent some time working in one of the centres that is primarily focussed on criminal justice referrals but also anyone else can also attend. Her blog is a sobering read. This is not the kind of women’s centre that the pioneer women who set up services in the 1980s had in mind. Far from it. Yes, women can get many different types of advice and support in a ‘one-stop-shop’ but she describes an atmosphere of surveillance, a place where therapeutic groups including those on domestic violence are not run by qualified staff, with limited one-to-one work to develop trust and where, for heaven’s sake, making friends to meet outside is actively discouraged! Those doing community payback work were required to wear bright orange tabards which seemed a demeaning form of punishment. To be honest, what came to my mind was a new workhouse – a system of controlling women (as ever) from deprived communities who are being catalogued as the new ‘undeserving’ and ‘deserving’ poor. There is a focus on recognising that your lifestyle is your ‘choice’ regardless of what you’ve been through and learning how to not question the trauma that the state itself is inflicting on you too, as a woman. It’s certainly not aimed at supporting women to become activists, as the original women’s centres did and still do. Rather the opposite, to encourage you to conform. Attending somewhere like this may well help some women but could retraumatise many others. Women experiencing complex mental health problems of the kind that many attendees at women’s centres face, especially those who have been in the criminal justice system, require skilled help from trained and supervised staff, not simply warehousing in the community (a term that is also sometimes used in relation to long term in-patient wards for problematic women with a diagnosis of personality disorder).

We need more and better women’s centres with safe funding not dependent on criminal justice to keep them going.

Thanks to Dr Gemma Ahearne for the conversation!

Out of Her Mind: How we are failing women’s mental health and what must change is on sale now.

Further reading:

Ahearne G. Empowerment or punishment? The curious case of women’s centres. In Experiences of Punishment, Abuse and Justice by Women and Families 2023 Mar 28 (pp. 32-47). Policy Press.

Elfleet H. NEOLIBERAL FEMINISED GOVERNMENTALITY: THE ROLE AND FUNCTION OF A POST CORSTON REPORT (2007) WOMEN’S CENTRE IN THE NORTH-WEST OF ENGLAND. British Journal of Community Justice (BJCJ). 2022 Jan 1;18(1)

My medical education, more than 40 years ago, was centred around the male body as the normative human being.

As the American feminist and legal activist Catherine Mackinnon wrote only a few years later in Difference and Dominance: on sex discrimination: ‘A male body is the human body; all those extra things women have are studied in ob/gyn’. That was at a time when there was no imperative even to include women in randomised controlled trials of treatment, and they were excluded for many more years because the impact of their pesky hormonal fluctuations got in the way of standardising groups and making comparison between subjects.

My psychiatry education was similarly centred around the normative male patient, even though so many of the patients I cared for were female. I learned nothing of the impact of hormones and the different effects of psychotropics on the male and female bodies. The psychiatric equivalent of ‘ob/gyn’ became perinatal psychiatry.

Mackinnon wrote:

…’man has become the measure of all things. Under the sameness standard, women are measured according to our correspondence with man, our equality judged by our proximity to his measure. Under the difference standard, we are measured according to our lack of correspondence with him, our womanhood judged by our distance from his measure. Gender neutrality is thus simply the male standard, and the special protection rule is the female standard, but do not be deceived: masculinity is the referent for both.’

This came to mind last week, when I was speaking to an audience in Manchester, discussing the difference between suicide rates in men and women, and hearing how being a woman is almost viewed as ‘protective’ in comparison to being a man, because men, who take their lives at three times the rate of women, are the reference point. Then again, this week, when reading Emma Pryce Jone’s fantastic piece for World Suicide Prevention day in Australia last month about how all the suffering of those who are ‘othered’ is somehow disregarded in public education around suicide:

…‘the phrase’ don’t suffer in silence’ is central to messaging around men’s suicide, but for many women that is precisely what defines womanhood: suffering in silence.’

When researching and writing Out of Her Mind the gender neutrality of not only mental health research but also care provision itself, and the reporting of mental health issues in most of the media, soon became apparent. It was sometimes very difficult to get sex/gender breakdowns from government documents of even simple things like who was on a waiting list for psychological therapies. Reports in the press and on TV of suicides and abusive care in mental health units and the extent of sexual assault taking place in our hospitals usually feature photographs or film of young women (for example the Panorama programme about the unit in Manchester, or the young people’s unit in Glasgow) yet whether, or how much, this might be a gendered issue is not discussed. Agenda Alliance’s research with young women, Pushed Out Left Out their final Girls Speak demonstrated in 2022:

…when statutory services, and some non-specialist youth services, assume so called “gender-neutral” or “gender-blind” approaches, this leads to the specific and gendered needs of young women being overlooked and underestimated. Ultimately, there is nothing neutral about “gender-neutral” policy that fails to consider the distinct needs of girls and young women.’

This is true of so much of mental health care from the lack of attention until recently of the failure to provide adequate period products in wards to the disregard of the sexual health needs of women with severe mental illness.

Gender neutrality is a concept that attempts to remove the notion of being male or female from a person or entity. It also encourages people, regardless of their sexual orientation or identity to feel accepted, hence the adoption of gender-neutral language in recent years. But it is problematic when applied across the board to something like the provision of mental health care. Care must be informed by knowledge and understanding of gender differences and how they relate to childhood and adult life experiences, social, cultural and realities of family life, the experience and course of illness and treatment needs and responses. Some places have already begun to consider this – for example the Republic of Ireland. In contrast, women were barely mentioned in the last mental health strategy where I live in Scotland.

We need not only gender sensitive research, with sex/gender disaggregation of data, but gender sensitive mental health care and we need it now.

It’s long overdue.

Out of Her Mind: How we are failing women’s mental health and what must change is on sale now.