How The UK Is Failing Women’s Mental Health Needs

The first time Tess* sought help for her mental health problems she was 14 and the psychologist asked if she had any definite plans to kill herself. "I said no, I didn't, and that's the last I remember hearing from anybody there," she says. "Since then, I've found it pretty much impossible to get any support whatsoever." Fourteen years later, Tess has been in private therapy for two years. Meanwhile, the NHS stats published just last month show an increase in the number of women experiencing mental health problems across England – with one in five women reporting symptoms, and a horrifying one quarter of 16-24 year-old women self-harming. Tess now understands that her mental health problems were triggered by experiences of childhood neglect and abuse but says that, as a teen, "nobody had any time. It was like if you speak to a teenage girl who's really unhappy, you just go 'yeah ok, teenage girls are unhappy, have some Citalopram, off you go.' Looking back, I find it shocking that no one asks about what's going on at home." Even after reporting her experiences of sexual abuse, Tess was met with dismissiveness because the perpetrator was female. "I just got told 'that doesn't count' or 'don't be so silly'. It took me such a long time to understand that [the abuse] really affected my mental health, because every time I tried to report it everyone said 'shush'," she explains. Experiences like Tess's are exactly what prompted women's charity Agenda to launch its Women in Mind campaign, calling for women's specific needs – and particularly experiences of violence and abuse – to be prioritised and taken seriously in mental healthcare policy, strategy and delivery. "We're focused on women at risk, by which we mean women who have the most complex needs," explains Agenda's director Katharine Sacks-Jones. "What we hear consistently is that mental health is a huge issue for women who've had often very traumatic lives, and that there's a real lack of support out there." For survivors of abuse, Tess explains, "You're already questioning yourself a lot anyway, so I found that disbelief very difficult. It actively blocked me getting any help."

Back in April, Agenda submitted Freedom of Information (FOI) requests to NHS mental health trusts across England, asking how they consider women's needs in their service planning and delivery. "There were a couple of good examples, but the main mental health trusts really aren't thinking about women," Katharine says. 26-year-old Charlotte*, who has a diagnosis of Borderline Personality Disorder (BPD), says: "As a woman with BPD, I feel the hysterical, 'drama queen' stigma is frequently presented to me. Because women are more sensitive, we end up being told to get a grip, and I'm not taken as seriously as my male counterparts. It's a constant struggle to move away from questions like 'is it your time of the month?'" Charlotte has been hospitalised by mental ill health four times in the last three years, and has accessed crisis services many times too. At the time of writing, she's on an all-female ward in her local mental health unit, but says: "I've never been asked about my gender preferences when it comes to mental healthcare. I've found this hard when speaking about sexual assault and rape." She adds: "I've had four different care coordinators, which has been very rough as my condition requires stability, but thankfully only one of them has been male. My biggest concern is their ability to find enough female staff members – the ratio is usually about 30% female, so it can compromise my care and safety." Agenda's key recommendations within the Women in Mind campaign are for the soon-to-be-appointed Mental Health Equalities Champion to have a "gender-focused approach across the treatment spectrum"; for a strategy on women's mental health in every local area; and for every female mental health patient to be routinely asked about her experiences of violence. "Where relevant, they need professionals who are experts in physical and sexual violence to support them," Katharine says. "Often what we hear from women is that they'll just be prescribed medication and not get the support they need to deal with the underlying issues." For Rosie*, 29, getting any help at all was a real battle. "I was struggling with low mood, eating disorder behaviours, and thoughts of self-harm and suicide. Despite a history of previous suicide attempts and saying I felt similar, the GP did not act. He wasn't unkind, but I didn't feel taken seriously," she says. "I had to fight just to be put back on anti-depressants – the complete opposite of anything I'd experienced before," Rosie adds. "It took six to ten visits of fighting to eventually be referred for help, and the GP only gave in after I begged." Even for women experiencing lower level mental health problems, Katharine believes there are gendered issues "across the board". 30-year-old Luna struggled with anxiety and depression as a teenager and young adult, and says: "I felt like I was being judged for not being able to cope." She was referred for Cognitive Behavioural Therapy (CBT), but found that nothing else was available when CBT didn't work for her and, like Tess, ended up seeking therapy privately. When Lily, 26, sought help for anxiety and depression, aggravated by work-related stress, she says her female GP "was very understanding but didn't have much time to properly discuss options and help available for me." But, she adds: "I recently had a bad experience with a male doctor who acted as if he didn't believe me. I've attributed the fluctuation in my mood to my hormonal contraception – the implant – and he laughed it off as if it were ridiculous to suggest such a thing."

Indeed, when a recent study linked the contraceptive pill to depression, it merely confirmed what many women have been saying for years. Jess, 26, went to her GP complaining of anxiety after being prescribed Microgynon, but says her doctor never said the two could be linked. "I suggested it myself after reading about other women's experiences on the internet. I feel much less anxious after saying laters to synthetic hormones," she says. Of course, mental healthcare is hugely over-stretched and under-resourced, whether you're male or female, young or old. "I think [NHS staff] are trying their best under enormous pressure," Lily says. "The needs of both young men and women need to be better addressed, but specifically I'd like to see doctors taking young female patients more seriously when they say they're struggling." Women in Mind is particularly keen to highlight the false economy of the 'revolving door' system that women like Charlotte find themselves trapped in. "By not helping women get to the root of their problems, what you see instead is women bouncing from mental health crisis to mental health crisis – and ultimately that's more costly," Katharine points out. "We need to get better at detection, and understanding the different ways men and women are coming into contact with the system. GPs obviously have a crucial role to play in that," she adds. "Only dealing with people when they reach crisis point is costing us more than if we helped people earlier on and prevented those crises from arising."
Time to Change has launched the #smallthings campaign which discusses other practical ways to help support someone with depression and mental health problems.

If you are struggling with mental health problems, contact Mind (http://www.mind.org.uk) on 0300 123 3393 or Rethink (https://www.rethink.org) on 0300 5000 927. In a crisis, call the free, 24/7 Samaritans helpline on 116 123