LISTENING TO WOMEN’S VOICES
BY
Carrie White, Branch Manager, WISH, Retford
Debbie Murdock, Women’s Services Manager, Rampton Hospital
‘Listening to Women’ (Humphries & Eaton, 1996) provided knowledge of the needs of women patients in secure environments together with an understanding of their lives, their views and their hopes for the future. Listening is a complex skill – the ability to listen without formulating ones own response, whilst listening, is something that is a core nursing skill. Various researchers have listened to women (McCaulley 1998, Gallop et al 1999) and challenges have been set out about reshaping services to maximise their potential to deliver gender sensitive care and treatment. Significant progress has been made in some areas, such as ensuring the provision of female staff on duty, ensuring access to same sex gender of doctors, and the development of services which focus on needs as well as diagnoses. However, there are still key gaps with regards to the effectiveness of different service models, ways of measuring need and in-depth and comparative research (Lart et al, 1998).
One particular recommendation that keeps appearing on national agenda’s yet seems to be making little impact on services is the following recommendation: ‘Wherever possible, mentally disorder offenders which include women should receive care and treatment under conditions of security no greater that is justified by the degree of danger they present to themselves or to others (Reed 1994, Mental Health Act Commission 1999). In September, the National Service Framework for Mental Health was published, and this too, reiterated that people should have timely access to an appropriate hospital bed in the least restrictive environment consistent with the need to protect them and the public (Department of Health, 1999). When are commissioners of services going to really listen to this message and finance the development of appropriate alternative services for women to enable change to happen?
Women with mental health and learning disabilities are a minority in secure environments (16% - 20%) but their voices do need to be listened to. Currently the NHS Executive has commissioned a group to listen to women throughout the United Kingdom with a view to collating responses and ensuring they shape a national strategy for women in mental health services, which include secure environments. It is this absence previously of a national strategy that has meant that recommendations from robust research studies have been left gather dust on shelves. Local policies are all well and good when applied to local practice, but when considering the needs of women in low, medium and high secure settings, a global view of developments is essential.
It was Alvin Toffler in ‘Future Shock’ who said that “change is the process by which the future invades our lives, and it is important to look at it, not merely from the grand perspectives of history, but also from the vantage point of the living, breathing individuals who experience it (1970). Women in secure environments are the people who are living the experience and whose voices need to be heard.
Women’s voices throughout the world are
being listened to. They were listen to in Beijing at the Fourth United World
Conference for Women (1995), they were listened to in Europe and their views
were incorporated in the Equal Opportunities, Amsterdam Treaty (1997).
Moving closer to home, women’s voices were listened to when this
Government appointed Tessa Jowell as the first Minister for Women, and published
their strategy for action on women’s issues which included the areas of
poverty, domestic violence and health (1996).
With all this happening within and without the
United Kingdom, we still end up coming back to the stumbling block of what is
happening locally with regard to services for women.
Many campaigners are calling for a smaller high secure component of care.
They suggest this could be facilitated by the development of women-only
wards in Regional Secure Units, this would have to be without a two year time
limit on the admission. One local
strategy acknowledges the importance of making progress in this area due to the
widespread concern about the welfare of women in secure services, where they are
a minority in a male dominated culture (Trent Regional Strategy 1999).
It actually recommends services for women being on one site.
However, change in services will only happen with the development of
integrated services, which facilitate skill sharing to enable alternatives to
admission to be developed and resourced. This
must include essential outreach work. In
addition to that there needs to be greater opportunity for women ready for
discharge from high secure units which build on the existing success of
discharge work.
When referring to discharge from high secure
establishments, it might be useful to set this in the context of an average
admission to discharge period of six years.
There is a fallacy among some people that women come into secure
environments and stay there forever, certainly the admission to discharge period
at Rampton Hospital identifies that this is a myth not a reality.
The issue of women receiving care and
treatment in conditions of security no greater than justified by the degree of
danger presented to themselves or others, is something that is also supported by
Women in Secure Hospitals (WISH). This
is an organisation which supports women within the system and aims to change the
system without. WISH believes that
the majority of women are detained in a higher level of security that is
necessary. It is estimated
that as 78% of women in high secure environments could receive appropriate care
and treatment in medium secure environments were it available.
In the same manner 69% of women in secure environments should be offered
placements in low secure environments.
Patient groups and service user organisations
have grown significantly in the past twenty years, however sustained service
user involvement in the planning of local services is still some way off (Sang,
1999). Working in partnership is a
process of two-way discovery and collaboration. It is a pre-condition of success that services that provide
care and treatment for women in secure environments work with organisations such
as WISH. There is evidence of a
paradigm shift in the culture of working with patients groups, although this is
in the context of support by some and resistance by others.
We have read that the NHS Executive may be
using the views of women in formulating the national strategy for women in
secure environments. In conjunction
with the NHS Executive and in collaboration with the University of North London,
WISH is facilitating an extensive formal Patient Consultation Exercise with
women across low, medium and high secure settings.
A report of these findings will, it is hoped, inform the National
Strategy for Women.
These are major steps forward in given women a
voice, but how far into the future will it be before they impact on services for
women? What about today’s women?
Are they being heard, are their needs being listened to?
In Listening to Women (Humpries & Eaton, 1996) women complained that
“they were not given the opportunity to interpret the events in their lives,
and that some professionals did not listen to their accounts of what those
events meant to them”. It would
see that sometimes the only people not listened to regarding themselves, are the
women in secure environments.
If we truly are to acknowledge that the client
is the expert when it comes to knowing what is hurting and knowing how to move
forward then it is time to start listening more to this group of women.
Many women were abused as children and a major part of abuse is denial of
the child’s experience and feelings surrounding that experience.
To deny a women’s reality in her therapeutic journey could be seen to
be perpetuating that abuse. We
would recommend to those managers and clinicians who are designing services for
the future to ensure that women have a voice, and to really listen to their
views and incorporate those in future service design and development.
There are often complex issues associated with
service design, which clinical teams make every effort to take positive action
on, to maximise the development of a gender sensitive service.
It is essential that services continue to work with organisations such as
WISH in their efforts to build on the quality of services provide for women
within the constraints of the current patriarchal systems.
Together, service user organisations and service providers can really
make a difference to women’s lives – but it needs us all to listen to each
other, and particularly to the voices of women in secure environments.
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