Menstrual health in psychiatric inpatient settings (2024)

Screenshot of the first page of the report

This report explores experiences of menstruation within psychiatric inpatient settings. It highlights that patients in psychiatric hospitals are often insufficiently supported with needs relating to their menstrual health.

It aims to inform subsequent action and campaigns to address the menstrual injustices patients face, including through the production of patient-led guidelines to outline tangible actions mental health service providers and regulators can take to improve support for patients.

This report is the result of a survivor-led research project undertaken by Hat Porter (they/them), informed and motivated by their lived experiences of menstruation in mental health wards. This research was commissioned by NSUN.

Alternative formats (plaintext Word documents, Easy Read)

Full report – Word document:
Click here to download the plaintext (Word doc) version of the full report

Executive summary – Word document:
Click here to download the plaintext (Word doc) version of the executive summary

Guidelines – Word document:
Click here to download the plaintext (Word doc) version of the guidelines-only document

Easy read summary:
Click here for the Easy Read version of the executive summary (pdf)
Click here for the Easy Read version of the executive summary (Word document)

About the report

There is a lack of research, policy, and guidance around how psychiatric inpatient services should cater for the needs of patients who menstruate. This study examined staff and patient perspectives to consider experiences of menstrual health in psychiatric inpatient settings and to develop an understanding of how patients’ needs can be best supported.

This survivor-led project involved desk research, questionnaires and interviews, followed by a focus group to develop guidelines outlining actions mental health service providers should take to ensure patients’ needs relating to menstrual health are supported.

This report will be particularly relevant to people working within mental health trusts/settings, people working for professional bodies and organisations involved in the development and regulation of mental health services, and people interested in menstrual health and period poverty research, policy, and campaigns. We encourage trusts and regulators to make use of the guidelines created as part of this research project.

Findings

This research highlights that patients in psychiatric hospitals are often insufficiently supported with their menstrual health, which was described as degrading, dehumanising and distressing. This failure to meet patients’ needs could be viewed as amounting to neglect and menstrual injustice, which seems to arise from a combination of an overreliance on restrictive practices and an oversight of the importance of menstruation.

Patients reported limited access to a choice of good quality menstrual materials and products, including pain management medications and products, that met individual needs and preferences. Prohibition of access to materials was often described as being related to the perceived risks of these items, with rules and restrictions applied in a blanket way. Patients also described the impact of the loss of independence and privacy relating to menstruating in psychiatric inpatient settings, particularly when on continuous observations.

Psychiatric inpatient settings were described as amplifying feelings of shame and stigma associated with menstruation, which appeared to be shaped by institutional restrictions and unmet needs, as well as the responses and attitudes of staff toward menstruation. Patients’ physical health needs relating to menstruation were also often overlooked. Staff lacked knowledge about menstrual health and the majority of the staff sampled had never received training on this topic.

Many participants shared their experiences of navigating menstruation while mentally unwell, highlighting how illness, distress, and trauma influenced their relationship with menstruation. Considering the intricate interplay between shame and trauma, mental health wards should strive to be environments that actively promote healing by addressing and challenging feelings of shame, including in relation to the body and to menstruation.

Visual summary of research themes

Illustration by Tamara-Jade Kaz, 2024. www.tamarajadekaz.co.uk

Guidelines

Using the research findings and experiential knowledge, guidelines outlining how mental health services should support patients’ needs relating to menstruation were developed in collaboration with people with lived experience and stakeholders. They can be found in the full report and in the guidelines-only document linked at the top of this page, and cover the following areas:

  • The provision of appropriate menstrual products and materials 
  • The need to balance patients’ safety with access to the items they require during menstruation
  • The provision of information related to menstrual health 
  • The provision of appropriate support around pain, discomfort and disorder related to menstruation
  • The need to prioritise patients’ dignity and challenge shame and stigma around menstruation 
  • The importance of recognising the interactions between mental illness, distress, trauma and menstruation, and providing support around this
  • The need to challenge and avoid exclusion, discrimination, coercion, or violence relating to menstruation

The guidelines have been endorsed by Bloody Good Period, the Centre for Mental Health, Cysters, Mind, the Restraint Reduction Network, Rethink Mental Illness, the Royal College of Occupational Therapists, and WISH.