• More than 1,000 sexual assaults reported on mixed-sex mental health wards since 2017
  • Government was told by its own Mental Health Act review to “tighten” guidance on single-sex wards
  • At least 668 mixed-sex wards and 803 mixed communal areas still in use by mental health trusts
  • Calls for investment to replace wards and tighten guidance

Hundreds of sexual assaults are reported each year on mixed-sex mental health wards in England, HSJ can reveal, highlighting the urgent need for investment to improve facilities.

New figures obtained by HSJ show there have been at least 1,019 reports of sexual assaults between men and women on mixed wards since April 2017 to October 2019.

This compares to just 286 reports of incidents on single-sex mental health wards over the same period.

Of those reports made on mixed-sex wards, 491 were considered serious enough to refer to safeguarding, and 104 were reported to the police.

The level of incidents still being reported suggests patients are not being protected from sexual assault on mixed wards, despite the issue being highlighted by several national reports in recent years.

HSJ’s figures – provided by 47 mental health trusts out of a total 56have sparked calls for government to tighten rules on mixed-sex wards in mental health, and to fund the building improvements, which are often needed.

It comes one year after Sir Simon Wessely’s review of the Mental Health Act for government recommended it “tighten” its definition of single-sex accommodation, to ensure wards are “genuinely” single sex. It found evidence of serious sexual assaults of people detained under the MHA.

Government has previously pledged to eliminate mixed-sex accommodation across all NHS hospitals, and monthly data on breaches shows all trusts but one, Pennine Care, are reporting zero breaches of current rules.

However, these rules do not require genuine single-sex wards, and Sir Simon’s Mental Health Act review, along with others, have said that they are too weak. They require single-sex accommodation to have separate sleeping areas, access to bathrooms and toilets without having to pass another gender’s area, and female-only day rooms.

But they do not require completely single-sex wards – in many cases accommodation involves, for example, corridors for different gender patients on the same ward, with shared spaces.

The figures supplied to HSJ under freedom of information rules reveal there are hundreds of mixed-gender wards and communal areas still in use: The trusts which responded had in total 668 mixed-sex wards and 803 mixed-sex communal areas.

‘Constant fear’

In 2016, 30-year-old Rivkah Grant, while an inpatient on a single-sex ward run by Barnet, Enfield and Haringey Mental Health Trust, suffered a sexual assault at the hands of a male member of staff.

After reporting the sexual assault, Ms Grant was made to stay an additional night in the same bed where the incident occurred, and was then moved to the trust’s Trent Ward, she told HSJ.

The Trent Ward meets current national requirements for single-sex accommodation as it has separate corridors for male and female patients. However, part of the ward is mixed and, according to Ms Grant, if a patient needs to leave the ward or see the doctor they have to walk through the male area. 

She said: “The entrance to the garden is through the female-only area. There was one incident where a male patient ran up and down uncontrollably along the female-only corridor.

“The room I was in was right by the entrance to the main corridor so there were men standing almost outside my room. I couldn’t go anywhere without going through a mixed area and that meant going through four, five, six men.

“There was no way of going out of my room — I just had to lock myself in of my room the whole time.”

The staff member accused of sexually assaulting Ms Grant has since been convicted. At the beginning of 2019, Ms Grant was again admitted onto Trent Ward.

“I was scared to say no [to admission] because I didn’t want to be on a section, and I just kept myself in my room for a week,” she recounted. “The only wards in our area are the ones I was assaulted on, the dorms in St Ann’s Hospital, and the mixed-sex wards in Barnet.

“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.”

A spokesman for Barnet Enfield and Haringey Mental Health Trust said it has recently introduced new guidance to staff based on best practice from the CQC and is part of a national initiative focussing on improving sexual safety on wards.

Another woman, Andrea Woodside, who experienced sexual abuse as a child, was sexually harassed while on a mixed-sex ward. In one incident a male patient was able to follow her into the female bathrooms.

She told HSJ: “No one has ever asked me in my experience, ‘Do you feel safe in this ward? Do you feel retraumatised? Have you experienced any kind of sexual harassment or abuse?’ My experience over the years was that you are lucky that you got a bed, it’s kind of ‘beggars can’t be choosers.’”

‘Unnecessary and avoidable risk’

HSJ asked trusts whether they planned to replace mixed-sex wards, and 21 out of 27 which replied said they did not, because they adhered to the current single-sex accommodation guidance.

Mental health charities said this situation was not good enough.

Mind warned: “For many people, the reason they are being supported in a mental health setting is because they have experienced sexual assault. They should be able to expect that they won’t be re-traumatised by their environment. This is why these wards have no place in a modern healthcare system.

“It is also not good enough for wards to be meeting the technical definition of a single sex space, knowing that people continue to be endangered. If national guidance does not offer sufficient protection for people, then services must go above and beyond it to sufficiently protect people when they may be at their most vulnerable.”

It also said: “The new government must urgently bring the NHS mental health estate into the 21st century.”

Rethink called on government to implement the MHA Act review findings and argued: “Mixed sex wards pose an unnecessary and avoidable risk to patients. The [review] recognised that increased funding is necessary to reduce the number of sexual assaults… it’s imperative [government] implements the recommendations.”

HSJ’s findings come a year and a half after the Care Quality Commission published a report raising concerns over sexual safety in mental health services. It did not recommend eliminating mixed-sex wards, because it would involve “significant investment” and may reduce “flexibility” in bed provision.

This prompted NHS England to commission a voluntary support scheme to trusts to aid their approach to sexual safety from the Royal College of Psychiatrists’. The college told HSJ that “urgent” investment was needed in mental health estate, but that it was confident its scheme would bring improvements.

The Department of Health and Social Care did not respond when asked by HSJ if it would change its definition of single-sex accommodation in line with the Mental Health Act Review’s recommendation, but said its response to the review would be published soon.

It added: “Sexual abuse in the NHS will never be tolerated. We take every allegation of abuse extremely seriously and we expect every report of sexual assault on patients or staff to be immediately investigated by trusts.

“Men and women should not share hospital accommodation and we’ve cut mixed-sex accommodation breaches by over 85 per cent since 2010.”

NHS England were approached for comment.