A writer of non-binary gender, with lived experience of sexual violence and hospitalisation for their mental health, makes the case for co-designed safe spaces.
Calls to ban mixed-sex mental health wards have been made recently. In many areas of the UK, NHS policy is that all wards are single-sex, and it looks likely that more hospitals will be adopting this approach in the future.
The idea is that single-sex wards help to promote dignity and that patients feel safer in these wards. This is especially important for women, as women with severe mental illness are far more likely to have experienced domestic abuse and sexual violence over the last year.
As a survivor of sexual violence myself, I can empathise with the need for single-sex spaces: I often feeling unsafe in mixed environments.
However, as a non-binary person, I also know the struggle that single-sex environments bring. Every day, the prospect of deciding what bathroom to use, or where to get changed when I go to the gym, fills me with anxiety. The thought of having to choose between two gendered hospital wards while in a mental health crisis fills me with dread - and the more likely prospect being that the choice would be taken from me is almost unbearable to think about.
The impact of misgendering
Transgender and non-binary people like myself face many challenges in single-sex spaces, ranging from the emotional impact of these spaces to the very real threat to our safety within them.
For non-binary people, there is no appropriate single-sex ward for us. Whether we are in a male or a female ward, we will be misgendered. In my day-to-day life, being referred to as a woman brings about a sharp pang, a feeling of disgust with my body, my voice and my mannerisms. It is not hard for me to imagine that this feeling would be enough to tip me over the edge when already in crisis.
Whether we are on a male or a female ward, we are denying a part of our existence, at a time where we are already vulnerable and struggling. The weight of this denial and erasure carries significant risk, with 48% of transgender, including non-binary people, attempting to take their own life at some point in their lives.
Another worry weighing on my mind is how an appropriate ward would be determined. Is it based on our assigned sex at birth? Or is it based on our gender presentation? Would we get a choice in this matter?
The problem is that gender identity and presentation can all vary wildly from the sex we were assigned at birth. Many of us fall somewhere in the middle, with our presentations too masculine for women's spaces, where we're whispered about and feared - assumed to be predatory or violent; yet also too feminine to be in a male-centric space, where we are at risk of sexual harassment and assault.
NHS awareness needs to increase
Yet another concern is for the privacy and dignity we would be afforded. Anyone who has been a psychiatric inpatient can vouch for the fact that hospitals do not always do the best job at upholding our privacy. In my last admission, staff opened my bedroom door constantly, without knocking, and while other patients were around. This is a major concern for everyone, though as someone who spends an inordinate amount of time analysing the gendered parts of my body, trying to minimise them, and obsessing over what others see when they look at me, it made me feel especially vulnerable and afraid.
Thankfully, no one had seen me. But what if they had? What if, through a nurse's disregard for my privacy, another patient had seen the very parts of my body that cause me physical and emotional agony on a daily basis, that I try so hard to keep hidden from others? Stories like this are not uncommon - many of my friends have been dangerously outed on psychiatric wards due to careless mistakes from staff. Outing transgender and non-binary people is dangerous, as it increases our risk of harassment and assault. These additional worries can add to the already stressful and traumatic experience that psychiatric hospitalisation often is.
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I have often been asked what I believe to be the solution to this problem. The answer is that I don't know. I doubt there is a single solution, as it's a complex problem; various groups have their own needs, all of which are important and must be respected. I have no desire to make things harder for my fellow survivors, or to erase the very real fears of women, who are entitled to an environment where they feel safe.
Yet I also can't ignore my own apprehension at the prospect of all hospitals becoming single-sex, and what this means for others in the transgender community.
What is clear to me is that first, the NHS must be aware of this issue, and then consult the transgender community on how our needs can be met. The NHS has started to train staff members in LGBT awareness, and this is a fantastic start. We should build upon this general LGBT awareness and train staff on how to support transgender patients especially, as we are far too often the subject of medical discrimination.
We need to have meaningful discussions, everyone affected needs to have a seat at the table so we can build hospitals that meet our needs.