NSUN response: investigation into sexual abuse within mental health trusts 

Content note: sexual abuse 

Monday saw the publication of a major investigation via The Independent and Sky News into sexual assaults and incidents within the UK psychiatric system. The 18-month investigation reported at least 19,899 accounts of “sexual incidents” having taken place in the past five years across more than 30 NHS trusts, with less than 5% being reported to the police over the same period. The article published in The Independent paints the results of this investigation as a shocking failure. However, for those more familiar with the psychiatric system and the history of abuse within inpatient settings, these findings will come as less of a surprise.  

Mental health organisations and user-led groups have long campaigned against the harm and abuse that is prevalent across psychiatric wards and within the mental health system more broadly, and while it is a welcome relief to see mainstream coverage of some of these failures, it is essential that the focus and fault of these findings lie with the structures that make abuse possible, rather than the people who these systems are supposed to protect.  

Responses to the investigation have seen many people call for single-sex wards as a solution to the accounts of sexual violence, imagining that a space segregated by gender might reduce the number of incidents of sexual violence. The investigation accounted for more than 500 instances of sexual assault since 2019 on mixed-sex wards, and while these numbers are deeply concerning, we can assume that the remaining reported incidents — around 19,399 — occurred outside of mixed-sex wards and are therefore not a result of specific configurations within hospital settings, but rather the structures themselves.  

Abuse is not solely perpetrated by patients, nor by people of a specific gender, but rather is a result of malpractice and toxic cultures that allow abuse and neglect to take place on wards, and decades of austerity: a lack of funding, inappropriate staffing levels, and insufficient training. The forced implementation of single-sex wards will not fix cultures of harm within psychiatric care or guarantee protection from sexual violence, including from staff. Indeed, the investigation reports that only six out of fifty hospitals were able to prove that their care met NHS standards created to protect patients from sexual harm, which should go much further than solely considering the gender makeup of wards.

Many readers’ responses have focused on the implausibility of the high number of incidents which have remained unreported, and the lack of police involvement over five years. However, for many individuals with lived experience of mental ill-health, distress or trauma, and particularly for those with experience of inpatient hospital settings, police involvement is no reassurance, and no guarantee of justice. We know that people in distress — particularly people of colour — experience criminalisation, abuse, and dehumanising treatment at the hands of the police, within mental health care ‘models’, and outside of them.  

While the investigation sheds valuable light on the ongoing violence enacted against patients within mental health trusts, it is essential that this conversation does not isolate and individualise these incidents, but instead draws on the history of institutional abuse, neglect and malpractice within mental health hospital settings in pushing for a radical cultural change within our mental health services that works to genuinely protect people from abuse and harm.