Lancashire Care NHS Trust delivers a stark example of Victim Blaming and delivers changes that maximise the distress of vulnerable women in its care.
In October 2014, The Orchard Psychiatric unit in Lancaster was closed to women. This change was made without consultation with service users or the wider community and the result is that any woman in Lancaster and its surrounding towns and villages will no longer be able to access local inpatient psychiatric care.
The closest psychiatric hospital with female beds is in Blackpool, a 50 minute drive from Lancaster. Women will also be sent to Blackburn, Burnley, Chorley and as far as Manchester and beyond. The shortage of psychiatric beds in the Lancashire Care NHS Trust has always meant that patients could be sent to hospitals out of their area, but moved back into the area once a bed became available. Now there are no female inpatient beds in Lancaster, seriously ill women from that area will be separated from their families, friends and support networks at a time when they are most in need of that support.
While information about why the closure was made is sparse, due to the lack of a consultation process, there have been two reasons given by the trust for this decision. Firstly, it is to help protect vulnerable women and secondly, because there is a greater demand for male beds. The first of these reasons falls under Victim Blaming and the second is gender discrimination as the trust prioritises the needs of men over women.
Need for Beds?
Before this move, the Lancashire Care NHS Trust already held more male than female beds across the trust. Information about numbers can be found on their website - http://www.lancashirecare.nhs.uk/Services/Adult-Mental-Health/Inpatient-Care.php.
The Orchard had 10 Male and 8 Female beds. Occupation rates in the Female area ran at 100%, with beds being filled the same day, and in some cases just hours after a patient was discharged. There were frequent occasions where a female bed would be used temporarily for another woman, while the patient it belonged to was on home leave or at the general hospital in order to cope with demand.
There is a definite need for female beds in the area, so why is the demand for male beds more important than local psychiatric care for women?
If lack of male beds is an issue then that should be addressed by the trust by looking to increase the number of male beds without denying access to a whole group of people under their care. Women should not be denied local access to inpatient psychiatric care due to a lack of male beds. The needs of women with mental illness are not less important than the needs of men. The need of women to be close to their families, children and support networks is not less important than male beds.
Victim Blaming and Maximising distress
The suggestion that the move to make The Orchard a single sex ward is to protect vulnerable women seems to be a clear case of Victim Blaming as instead of addressing the problem of male aggression, it is blaming women for their vulnerability. It says to women "You may be vulnerable, so to protect you, we are going to deny you access to local inpatient care."
Before the closure there were 10 male beds and 8 female beds in the unit. The male and female areas were separate and could only be entered via key-card access, so the men and women could only access their own bed areas. Individual rooms in the unit were also locked via key-card, providing extra security. A single sex lounge was available in both the male and female areas of the ward. In addition to these areas, there were communal areas, including a dining room, games room, lounge and inner courtyard. In the other hospitals of the trust, Chorley operates a similar system with single sex and communal areas and Ormskirk has a fully mixed ward. This would suggest that there are reasons other than vulnerability for denying women access to The Orchard.
Rather than protecting vulnerable women, removing local inpatient care will increase their vulnerability and significantly increase their distress. Sending women 30-70 miles away from their home for treatment means that they won't have access to their families, friends or support networks. Research on isolating women from their support networks is well documented as having negative effects. Women are also still overwhelmingly the primary care givers to children and carers for older adults. Treating women 30+ miles from their home means less opportunities for contact with their children and people they care for, causing distress on both sides.
If there has been a problem with male to female aggression in the communal areas, then the trust should address how that is managed. There are single sex units available for men who are seriously ill, and therefore at risk of harming others and otherwise aggressive males. A better solution would be for staff to ensure that known aggressors or those shown to be aggressive are moved to male wards, able to deal with those problems, rather than place the blame on women's vulnerability and deny them access to the local services that they need.
Removing access to local care is likely to discourage women from seeking help and accepting voluntary admission, and will discourage their families from seeking help for their relatives, knowing they will be sent miles away from home. This can lead to increased detentions under the Mental Health act, with women not willing to accept voluntary admission, or by deteriorating to the point where a section is inevitable.
This closure leaves the women of Lancaster and the surrounding areas with stark choices. Should they accept treatment for their mental illness isolated away from home, or stay with the support of their families and friends, knowing that they may be detained against their will anyway?
Either way, the decision of the trust to close the female beds at The Orchard is likely to have significant negative consequences for the women and their families.