Tag: women

We need to talk about women’s centres

lindagaskLeave a comment

‘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)

We need gender-sensitive mental health care

lindagaskLeave a comment

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.

What is happening to the mental health of young women?

lindagaskLeave a comment

Society seems to have great difficulty in talking about the mental health of women just now. That’s problematic when the latest figures show the gender gap between men and women remains and is especially stark for young girls and women. The proportion of all those aged 16-24 with a common mental health condition rose from 17.5% in 2007 to 25.8% in 2023-4. However, the proportion of young women reporting a mental health condition is now the highest on record, at 36.1% in comparison with 16.3% of men. This news went almost unregistered by the media in Britain at the end of June.

It’s just girls isn’t it?

The authors of the latest iteration of the Adult Psychiatric Morbidity Survey (2023-4) say in their Conversation article, ‘Mental health in England really is getting worse. One in five adults are struggling.’ They also challenge the claim of overdiagnosis. “The APMS has been conducted with consistent methods over decades, using the same robust mental health assessments with large, random samples of the population. This means the results are largely not affected by changes in levels of mental health awareness or stigma, and changes in levels of diagnosis or service contact.”  These data are epidemiological estimates based on official criteria. (Helpfully the survey also shows self – diagnosis rates too for comparison, and these are higher).

So what is happening for young women? And why do we seem to find it so hard to discuss it? 

We know this is a worldwide phenomenon and in many countries suicide rates are increasing more rapidly in young women than in men. A recent Australian study reported an annual prevalence of nearly 50% for mental disorder in young women. Socioeconomic factors play a significant part in why both men and women develop mental health conditions – debt, unemployment, chronic ill-health, homelessness – but women are more likely than men to be in precarious work, to be reliant on benefits to survive, be single-parents and unpaid carers. Poverty matters, and if you add in intersectional factors such as being from an ethnic minority and/or LGBTQA+ risks to mental health multiply. Women are also more likely to have faced early traumas such as sexual abuse and then must deal with sexual harassment and gender-based violence in their everyday lives.  If in doubt, look at the pages of Everyone’s Invited which spells out the experiences of many young women very clearly. We have rising levels of misogyny, which is rightly leading us to question what is happening to young men and what needs to change for them. But this fails to take into account what happens to those who experience and survive the damage caused by the behaviour of boys and men, and the harm this is causing to the psychosocial development of young women. Gender based violence and abuse alongside being in poverty creates a web of adversity and mental ill-health in women’s lives.

Growing up now as a girl is very different from how it was for me in the 1960s and 70s. The pressures in terms of getting an education, feeling good about your body image, navigating sex and relationships and discovering and developing an identity are considerable and amplified by social media, which I’m so relieved I never had to contend with. 

Women are more often seeking help for anxiety, depression, eating disorders and self-harm but their mental health issues are not being considered through a gender specific lens. The menstrual cycle plays an important part in the mental health and well-being of young women but has been largely disregarded in the past in mental health care. We still need to know, for example, much more about the interactions between ovarian hormones and early life trauma in women. The APMS reveals that more men are getting access to care than they previously did. However, waiting times for psychological therapy remain long, the majority on those lists are women and the therapy provided will most likely not be tailored to the specific needs of women who have experienced trauma and violence. It is all too easy, as a young woman, to receive a diagnosis of Borderline Personality Disorder when you have been subject to repeated abuse and trauma.

 Is it surprising that new claimants for disability benefits in the UK are more likely to be younger, for mental health related problems and to be women? Limiting access to those benefits will increase poverty and continue the cycle of despair and adversity. Instead, we must rethink the way we support women and girls. Many will need access to a tailored, person-centred, biopsychosocial assessment, designed around their needs and preferences but its most definitely not a problem to be solved with more medication. To stem the increasing problems young women are facing demands that society recognises it, talks about it and has the political will to address the serious challenges young women currently face such as gender-based violence and misogyny. As women we are expected to not complain too much, ‘put up and shut up’ and if we do need help, ask for it ‘appropriately’ which doesn’t include harming ourselves, even though our needs often go unnoticed anyway. We often are accused of exaggerating or faking it. There is a continuing pattern of raising concerns about women’s mental health and society failing to act.

Isn’t it time we listened to young women, believed what they are telling us about their lives and talked about it rather than just let each new report drift by and disappear into the ether?

Then let’s get together and do something about it. 

My latest book: Out of Her Mind: how we are failing women’s mental health and what must change, is on sale now.

On writing a book about women’s mental health

lindagaskLeave a comment

For the last 5 years I’ve been working on a new book about women, mental health and feminism, addressing two big questions – how are we failing women’s mental health? and what needs to change?

                  Over the last decade, we’ve been rightly concerned about men’s mental health. Men continue to take their own lives at 3 times the rate of women. However, women are suffering too, and the size and nature of the mental health problems and illness they experience seems to get lost beyond that desperate headline. Just as women’s physical health is much more than about our reproductive system, the mental health crisis we currently face is much more than about perinatal mental illness. Girls and women are twice as likely to experience depression and anxiety, ‘common’ mental health problems and intersectional factors such as race, LGBTQ+ and disability, along with poverty, simply magnify this difference further. Girls and women are much more likely to self-harm than boys and men, experience 2 to 3 times more post-traumatic stress disorder, more commonly have eating disorders and are 3 times more likely to be given the diagnosis of borderline personality disorder, a diagnosis that I argue (controversially still for some) should be finally consigned to the bin. Young women are presenting with more anxiety and depression than ever before and since the pandemic there has been a considerable increase in their distress and requests for help from services than have been unable to cope. Some of those who have been failed by ‘mental health care’ in our hospitals and community services are tragically dying too.

                  Why is this happening to women?

                  Has feminism failed?

I have no doubt that what happens to women in our society plays a huge part. Women not only experience more sexual abuse in childhood, but they are also subject to greater intimate partner violence as adults than are men. There is an epidemic of male violence towards women in our society and it is happening too within our mental health services. Misogyny and sexual harassment are rife. Women are more likely to be single parents, working in low paid, precarious jobs, and be forced to live on benefits.  And it is clear that when women who experience trauma cannot get the understanding and help they need, they alone can become the problem, rather than helping to address the circumstances that contributed.

Women who discovered during the pandemic that their jobs were considered of less value than those of men, so they could return to full-time childcare, certainly felt failed by feminism. The silenced women in the street of Afghanistan must surely feel the same too.

In the 1980s when I started training in psychiatry there was a real resurgence in feminist interest in mental health. In ‘Out of Her Mind’ I’ve explored what has changed since then. Most recently some feminist writers have denied the reality of ‘depression’ and accused psychiatrists of simply labelling the impact that trauma has on women as mental illness. In my view that denies the reality of what many women are experiencing and can be perceived as another form of gaslighting. Instead of repeating the mantras of the past about the evils of psychiatry, even though I can and do acknowledge horrendous things have happened and still do, to women in mental health care, we must also focus down on the experiences of individual women, here and now. What needs to change?

Listening to this woman’s story has always been my starting point. What has happened to her? What is she experiencing? What does she need now to help her move forwards? 

As a psychiatrist I work from a biopsychosocial perspective, and looking through biological, social and psychological lenses, identify what increased her vulnerability to mental illness, and what has stresses in her life have caused it to occur right now. However, we must add a fourth lens to these three, the political. What part does her status as a woman in this society, particularly if she is also subject to intersectional inequalities, play in her experience of emotional distress and mental illness? 

What can all this tell us both about what might help her? 

                  I began to write this book while not only researching but most of all listening to many stories from women not only in the UK but elsewhere too, as well as interviewing expert commentators. Those stories add to the many I have collected in my own mental filling cabinet during the years when I was working as a psychiatrist. The book is framed as a narrative of how I returned to my own feminist roots as a doctor who spent so much of working life both working with and trying to help women. Everyone whose story and/or opinion is included in the book gave permission and had the opportunity to comment on/make changes to text that was finally included – over 120 people. I’m immensely grateful to those who gave me their time. 

You can purchase the book here its called ‘Out of Her mind’

A final note I’ve donated a large proportion of the advance I received from the publisher, Cambridge, to three charities: WISH, Self-Injury Support and Southall Black Sisters. They continue to help, daily, those who are facing sometimes incredibly challenging problems.