HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector.

Unicorns are likely an easier thing to find than enthusiasm for patient choice in the current NHS climate, but for mental health the idea has always been a thing of myth.

For my news investigation today on mixed sex wards HSJ interviewed three former patients, whose stories reveal the full meaning and importance of choice.

“If I’m in crisis I need somewhere to go I cannot go to any of those hospitals, so it’s like you constantly fear being unwell, because there is nothing anyone can do.” This was the experience of a young woman, Rivkah Grant, who had been placed on a mixed-sex ward in north London, after suffering a sexual assault at the hands of a male NHS employee.

Following the assault she was placed on a mixed sex ward not once but twice. The first occasion was shortly after the incident.

Beyond the issue of the original assault – which the staff member has been convicted of — did staff think about the impact of placing Ms Grant onto a ward where she would be surrounded by male patients?

Perhaps, but the fact she was placed onto the ward for a second time suggests little real choice was given even if the question was asked. It is likely the trust felt it had no alternative to offer – Barnet is probably one of the most under bedded areas in London.

Another woman I spoke to, Andrea Woodside, who experienced sexual abuse as a child, described how she was “re-traumatised” multiple times on mental health inpatient units.

On one occasion, a male member of staff was sexually inappropriate towards her. On another occasion, while on a mixed-sex ward, she was harassed by a male patient.

“It is a fundamental human right to feel safe,” Ms Woodside told HSJ, yet she was never asked whether she would feel safe on a mixed ward.

As with Ms Grant, her experiences left her fearful of going back into an inpatient environment.

She said: “I was out of hospital for such a long time [thinking], ’you’ve just got to deal with this on your own you don’t want to go back to that place because it is hell.’

“I think you evaluate what is more painful; suffering at home or suffering on that ward.”

Shine a light

A third patient who spoke with HSJ but wanted to remain anonymous described how she had been sexually and financially exploited while on a mixed sex ward in 2008, but said getting rid of them would not be a silver bullet.

She said: “Even if you have only single sex wards, which I think is a good safety measure and I do think all wards should be single sex, you’re not going to get completely away from the exploitation.”

She said that at the time of the incident in 2008, the trust did not properly explore what had happened to her, saying ”it all got buried” — leaving the perpetrator “to potentially exploit other people” on the ward.

The patient said the problem was complex, with increased and better training needed for staff so they “shine a light” on the issue rather than shy away from it.

“The reason I ended up there was because of my past, but I wasn’t re-traumatised around sexual exploitation I was solely traumatised by the mental health system which will affect the rest of my life, I will carry the scars of that. That isn’t thought about enough in terms of the trauma they caused,” she added.

It is perhaps unfair to chastise individual trusts for not being able to offer patients the choice of a single sex ward. It will after all take a mammoth amount of capital to replace more than 668 mixed sex wards which are in operation.

Neither the government nor NHS England have indicated in their responses to HSJ a desire to address this issue – although the latter has strongly backed the elimination of dormitory wards.

However, this shouldn’t stop services asking how a patient’s past trauma can impact their experiences of ward during admission and pro-actively acknowledging when those wards inflict fresh trauma.

Mental Health Matters is written by HSJ’s mental health correspondent Rebecca Thomas. Tell her what you think, or suggest issues she could cover, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.