Girls who are detained die by suicide at twice the rate of boys. Why are we failing our young women in crisis?

Women and girls detained under the Mental Health Act have often experienced abuse, yet they are not asked about it. The process can traumatise them all over again

Women and girls in Britain in a state of mental distress are being failed when they are detained under the Mental Health Act: they are not listened to, they are restrained at alarming rates, and far too many are dying in our mental health units.

An independent review into the Mental Health Act has today called for the law to be overhauled. This is undoubtedly a promising development, but there is a real lack of focus on women and girls in the review and on women of colour – despite the fact that it reveals that black women are being detained under the Act at disproportionate rates. This reflects a trend across mental health services and is particularly concerning given what we know about women and girls’ experiences.

Women and girls who are detained are often at their most vulnerable and desperate. Many will have self-harmed or attempted suicide, detained because they pose a risk to themselves. This is a crucial time to get them the support and protection they need. But the Mental Health Act is not keeping them safe – and, worse, it is sometimes putting them at even greater risk.

Data we obtained from the Care Quality Commission (CQC) shows that in 2015 the number of self-inflicted deaths of women detained under the Mental Health Act overtook those of men for the first time, a trend that continued in 2016. The more than twice as many girls and young women died as boys and young men. This is particularly stark when you consider that, in the general population, men are far more likely than women to die by suicide.

So what is happening to women detained under the Act that accounts for this appalling trend?

Evidence shows that women’s specific needs are often not considered across mental health services. For example, the majority of women and girls detained have experienced abuse, which is itself a driver of poor mental health. But when they are detained, women are often not asked about these experiences. This results in women receiving care which, at best, does not support them to overcome this trauma. At worst, it can traumatise them all over again.

This is typified by the routine use of restraint against women and girls. Not only is it frightening and humiliating, it can traumatise those who have been physically or sexually abused. That is before considering that it can also be life-threatening: 32 women who were detained under the Mental Health Act died after experiencing restraint over a five year period, according to figures obtained by Agenda.

Rules to ensure single-sex accommodation for those who are detained are still being broken, and sexual assaults occur at shocking rates on wards across the country. Women tell us how distressing it can be to be held under close observation by male nurses – particularly for those who have previously been abused by men.

In this context, it is a huge oversight for the review published today to not have made issues of gender and mental health more prominent. We would also like to have seen more understanding of the specific needs of Black, Asian and Minority Ethnic women who face additional barriers to getting appropriate care because of their gender and their race.

But there is one extremely positive change: the proposed new approach to agreeing a patient’s “nearest relative”. This outdated model automatically enables the person considered closest to a patient to have certain powers related to their care. This puts women trying to escape abuse at real risk from partners or family members. We know of at least one instance of a woman’s former husband being informed of her location because he was considered her closest relative.The new “nominated person” model, which Agenda and others have been calling for, would enable women to choose who is involved in their care. The government has now promised it will take this proposal forward into legislation.

Another welcome proposal is the review’s call for detention to be used only as a last resort, and for greater investment in community support so that patients can get help before they reach crisis. Women have already told us that it took a suicide attempt before any help was made available.

So there are important and potentially life-saving changes in this review – but we are left to wonder what might have been if it had made the needs of women and girls had been integral to the analysis. In this time of Brexit and political turbulence, there are only small windows of opportunity to make a difference with policy. We must not forget women and girls at these crucial moments.

Jessica Southgate is a policy manager at Agenda