writing – 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)

It’s been quite a week for the grandees of my profession.

First they’ve been sharing their views on why today’s resident doctors shouldn’t strike and then telling us why we should return to limiting the number of women who should go into medicine.

It’s embarrassing belonging to the same professional generation as those recently sharing these views. I started medical school in 1974 in Edinburgh and qualified in 1979, so I’ve been a doctor for 46 years this year, although I retired from my full-time job as an academic psychiatrist in 2013. Professor Sikora, who has been a doctor for more than 50 years told the Telegraph he was appalled at doctors striking. The sub-heading of the piece is Money buys you neither love or happiness. I cannot tell if that is a direct quote as the rest is behind a paywall. However, I can tell you that when you are poor, money helps.

I very much doubt that I would have gone to medical school today. I come from a working-class family. No-one had been near a university or had ever wanted to. My father worked repairing seaside amusements, and my mother in a radio factory. It was a real step up when she got the job at the Coop greengrocers counter. She always borrowed to get through the week. Everything in the house was bought on tick. I had a full grant for every year except my first, when my parents had to contribute £50, and my fees were all paid. I lived frugally but well. Better than friends whose wealthy parents didn’t fulfil their parental contribution. After I left university, having found house jobs (FY1 now) near Edinburgh, I moved down to England. I had low-cost hospital accommodation when I needed it, hot meals at night, free parking, and no debt. We (I was married by then) were able to get a mortgage immediately, although my ex-husband’s salary took precedence. I bought my own home without difficulty when we divorced. I worked long hours, and it was tough but as a consultant I had great secretarial support. I suspect that has all gone now too, though managers seem to still have PAs?

I met those with views about women in medicine like Dr Meirion Thomas, during my career. I think I was supposed to feel grateful that at least I had been allowed to graduate in the first place, unlike the Edinburgh Seven, heroines of my alma mater, who were unable to, despite out-performing the men. The consultant orthopaedic surgeon in Falkirk Royal Infirmary would not speak directly to me because I was a woman. All instructions were relayed via the ward sister. The postgraduate tutor in the general hospital where I became a consultant expressed similar views to our medical students even in the 1990s.

There were times I thought about emigrating (to Canada) but I stayed. There was a cohort of us in my generation from the working class, who, after the second world war, benefited from free first-class education from secondary school through university. Despite the valiant efforts of those trying to widen access only 5% of those entering medical school still come from the lowest socioeconomic group. If I was making that journey today, I personally could not have coped with having to work throughout my degree, as many now do, nor the huge amount of debt afterwards. We also know the NHS has never been a good employer. I not only treated many employees, some episodes of my own severe depression were triggered by my interactions with management. I gave evidence against one Chief Executive at an inquiry into his behaviour, which didn’t help my career at the time. Seeing resident doctors being asked to pay for their accommodation when on-call (see recently on social media) suggests to me that concern for their welfare remains low in many places.

I never went on strike during my career, because I never needed to, but if I were working today as a resident doctor, I have no doubt that I would. I would also have considered emigrating to anywhere that would value my skills and treat me with more respect – and pay me better. If there are now more women doctors than men, so be it. Get more men to apply to medical school. When and if women have children is up to them. The NHS must change to support them. They are the future, and if they drop out, leave medicine, or leave the country, they will be gone. We cannot have dinosaurs still telling them they shouldn’t be here.

I support striking doctors unreservedly.

Professor Linda Gask

My latest book Out of Her Mind: How we are failing women’s mental health and what must change is published by Cambridge University Press