Jennie Williams

Working with Mental Health Service Users to Change Mental Health Services

During the last ten years in the UK, service user consultation and collaboration has gradually entered the vocabulary of people providing and purchasing mental health services. However, we are not convinced that much needed change in mental health services will be achieved as a function of increased commitment to market consumerism. We argue here that service user consultation and collaboration should take account of the effects of social inequalities on mental health and on mental health services. This perspective highlights the need for fundamental change in mental health services, and helps us to appreciate the strength of resistance to change, and to understand some of the dynamics involved. We describe here how this perspective has motivated and shaped our own efforts to collaborate responsibly with service users to change mental health services.

Abuse in mental health services: some theoretical considerations

The mental health field is viewed by some as reluctant to tackle the problem of abuse. While ‘adult protection’ offers one way forward, the authors of this paper caution against over‐enthusiastic borrowing from this paradigm. Instead they argue that mental health services will only become intolerant of abuse when there is widespread acceptance of the role of power abuse in psychological distress and disturbance.

Mental Health Services for ‘Difficult’ women: Reflections on Some Recent Developments

The provision of mental health services to women has come sharply into focus for providers of secure psychiatric services in the UK. Womens services are being developed in response to the known risks of mixed-sex provision, and a growing appreciation of the ways that women in secure services can be further disadvantaged by their minority status. Our intention here is to present evidence and reflections to help inform this development. The evidence is drawn from our recent work in this field, which includes carrying out a review of local mental health services for ‘difficult’ women, and developing and piloting a national training programme for staff working with women in secure services. The reflections we offer are informed by the conviction that taking social inequalities into account is central to making sense of womens mental health difficulties, and improving service responses to womens needs. While there are signs that many mental health workers in secure services are beginning to share these convictions, the challenge now is to provide the necessary authorization, training and support that will enable them to translate these understandings into empowerment practice with women.

Meeting the mental health needs of older women: taking social inequality into account

Whilst there is increasing acceptance that social inequalities have implications for mental health, there is minimal acknowledgement of their effects on the development and treatment of mental ill health in older people. This paper focuses on older women, as they are the majority sufferers of mental illness in later life, and are particularly vulnerable to the cumulative effects of lifelong and age-related inequalities. The authors, who draw upon literature from the fields of gerontology and mental health, argue that for effective care to be developed, older womens mental ill health needs to be seen within the context of their past and present experience of social inequalities. Evidence particularly relates to socio-economic disadvantages as well as to the consequences of discrimination. It is argued that psychological vulnerability is further compounded by the gendered effects of social policy, and by a care system which constructs mental health needs as unrelated to oppression, and dislocated from their economic, social and historical roots. Finally, the authors outline the key components of a care and service system which takes account of social inequalities, and which accords centrality to the experiences, views and opinions of older women with mental health problems.

Service Responses to Women with Mental Health Needs

There are individual mental health professionals who respond to women with mental health needs with warmth and intelligence; staff whose practice is antioppressive and fully cognisant of the impacts of poverty, domestic violence and racism upon their patients’ lives; and there are doctors, nurses and therapists who work in solidarity with the women in their care and who fully appreciate their practical and emotional struggles. However, only a handful of mental health services could be described in such terms. Most services fail to provide the support and safety women with mental health needs require and many routinely demean women, dismiss their distress and replicate the dynamics of abuse and exclusion that have characterised their previous lives. This article suggests we have reached a turning point in Britain in relation to mental health service provision for women. Not only is there considerable evidence of an association between women’s social experience and their mental health, but this association is also acknowledged by the majority of mental health workers. Many staff also recognise that the professional training they received provided them with a wholly inadequate preparation for engaging helpfully with their patients. As individuals some have abandoned the medical paradigm altogether and no longer ask ‘What is wrong with this woman?’ but rather ‘What has happened to this woman?’ In this paper we draw upon evidence from a range of sources to explore these issues, including some of the work we have ourselves carried out in the last two years. Particularly relevant in this context is information gathered as part of a national programme to develop and pilot training for staff in secure services who work with women with mental health needs (Scott & ParryCrooke, 2001). As part of the training needs assessment phase of this programme, data was collected by questionnaire from 63 multi-disciplinary staff and through interviews with 60 staff in six secure services. We also draw upon findings from a recent survey (Williams et al, 2001a) of attitudes to mental health services for women, which was carried out to inform the Mental Health Strategy for Women currently being developed by the Department of Health.

Working with Women in Special Hospitals

This is an edited version of a conversation that took place between myself and four other clinical psychologists who had been actively involved in developing better services for women living in Ashworth and Rampton hospitals - two of the three high security psychiatric hospitals in England. There have been long-standing concerns about the quality of the services provided by these Special Hospitals,1 and a public inquiry2 in 1992 identified services to women as a particular cause for concern. This inquiry was followed by a period of optimism during which time these psychologists had worked hard to improve services to women in the Special Hospitals. We met in late 1996 to talk about their frustrations and disappointments, to learn from their experiences, and to remember the women who live in these hospitals. This was not an easy conversation, and it was also limited by a pending tribunal and the ever present threat of legal action. The Special Hospitals have continued to feature in news headlines, and their future is being publicly debated. We want this debate to be informed by an understanding of the ways in which Special Hospitals continue to fail women. There is nothing to suggest that they provide women with what they need, or that they are likely to do so in the future. The development of better community mental health services is the only way forward.