Womens Mental Health: into the Mainstream

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Womens Mental Health into the Mainstream

• Vicky Macdougall
• Womens Lead
• Glos NHS Partnership
• 01452 310967

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Why is Gender Important

• There are differences in the family and social
  context of womens and mens lives the experience
  and impact of life events, the presentation and
  character of their mental ill health and
  consequently their care and treatment needs. This
  needs to be understood by policy makers and those
  planning and delivering services. Mental health
  care must be responsive to these needs.
• (Womens Mental Health Into the Mainstream DOH
  Dec 02).

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• Women make up over half the population
• Play a significant role in the workforce
• Assume the major responsibility for home,
  children, and other dependant family members
• Women experience low social status and value
• Social isolation and poverty are much more common
  in women as is sexual abuse, domestic violence
  and sexual violence.
• This interplay has a major effect on womens
  mental health

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Women and the Mental HealthDebate

• Womens needs are mainstream
• But we have factual evidence that womens needs
  have been neglected
• Men and Women deserve good psychiatric services
• Mental health professionals and the public need
  to go through a learning process
• Underlining the importance of womens services is
  part of the process

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Women and mental healthHow is it different ?

• There are established gender differences in the
  frequency, clinical expression and outcome of
  psychiatric disorders in women.
• Epidemiology
• Social concomitants of mental health problems in
  women
• Women have periods with exclusive mental health
  problems

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Epidemiology and Mental HealthFemale / Male

• Depression
• Anxiety
• Panic attacks
• Phobia
• PTSD
• Eating disorders
• DSH
• Suicide
• Borderline PD

• 2/1
• 3/1
• 3/1
• 4/1
• 2/1
• 10/1
• 3/1
• 1/3
• 7/1

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Epidemiology

• Depression is on the increase in women
• It is underestimated and under recognized
• Being a women is a predictive factor of
  depression in primary care patients (WHO, 2001)
• In 2020, depression in will be the leading cause
  for long term disability in women
• (Murray, Lopez, 1996, WHO, The Global Burden of
  Disease)

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Schizophrenia one of the most debilitating
conditions

• Schizophrenia shows clinical, treatment and
  outcome differences in women
• Women have later age of onset
• They have less negative symptoms but more
  affective disorders
• They respond better to medication
• They need lower doses of medication
• They have better social interaction and better
  outcome
• (Seeman, 1985, Castle 2000, Riecher-Rossler, 1999)

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Women have specific mental health problems

• Premenstrual Dysphoric Disorder (PMDD) has a
  narrower definition than PMT or PMS
• 75 of women have minor psychological changes
  during menstruation
• PMDD is defined by DSM-1V and is seen in 3-5 of
  women
• Postnatal Depression 10 -15 of women
  following delivery
• Postpartum psychosis 0.1 of all deliveriesrare
  but very alarming condition

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WHY MOTHERS DIE?National confidential inquiry on
why women die in pregnancy and child birth (2002)

• There are a substantial number of women who die
  during the postnatal period all associated to a
  lack of recognition of their mental health
  problems
• Yet this is a period when they have the highest
  involvement with services(Health visitor GP,
  OBSGyne consultant, midwives) Oates, 2001.

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Psychosocial factors associated with mental
health problems

• Disturbed mother-child relationship linked to
  adult depression Theories of attachment,
  (Veijalact et al, 1998)
• Brown and Harris (1978) Community study of
  depression (Social origins of Depression)
• Stressful life events affect FgtM
• Vulnerability located in social context
• Unsupportive spouse, unemployment,
• 3 or more children under age 11 and having lost a
  parent all associated with depression.

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Social concomitants of mental health problems

• Domestic violence (DV) 1,000,000 reported
  episodes in 2000 in UK
• Only ¼ of incidents of DV ever reported to the
  police
• Only 10 of all reported incidents ever go to
  court
• Domestic violence is closely linked to anxiety,
  depression, DSH, PTSD, alcohol, drug abuse and
  eating disorders.
• Over 50 of women who are in contact with mental
  health services have a history of domestic abuse
  (DOH 2002)
• Costs of DV Mental health care 3176 million
  (Wallaby, 2004)

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Women and Violence

• Rape Sex specific violence is a global problem
  and human tragedy (WHO, 2002)
• Physical violence increases in pregnancy
• Emotional abuse
• CSA (sexual abuse) 4/5 of cases are women
• CSA closely linked to adult depression (Cheasty
  et al, 1998), DSH, Eating disorders, Borderline
  Personality Disorder , Substance Abuse
• There is a real increase in the reporting
  incidence of all the above

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Women and alcohol

• There is an increase in the number of women with
  a diagnosis of substance abuse
• Substance abuse is closely linked with violence,
  emotional abuse, anxiety and depression
• Mothers who abuse substances risk losing their
  children
• There is an increase of alcohol consumption in
  young women

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DSH is an index of deprivation

• 70 of all reported DSH are women
• DSH is closely linked to unemployment,
  overcrowding, domestic violence and substance
  abuse
• There is a 10-fold increase of DSH and 5-fold
  risk of completed suicide in women who abuse
  substances.
• The proportion of women who need hospitalization
  for DHS is on the increase (Hawton, 1999)

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Women and criminal justice system

• There were 4200 women in prisons in the UK in
  2001
• In 1997 there were 3000 women in prison
• The increase is alarming
• 50 of those women warrant a psychiatric
  diagnosis.
• 50 of those women are mothers.
• They have a long list of psychological and social
  unmet needs

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How are we going to address the issues?

• By listening to women
• Better understanding and recognition of the
  conditions
• Address social components of mental health
  problems i.e. discrimination, stigma, violence
  and the lack of support
• Address the needs of therapies to reduce
  disability
• Better understanding of pharmacological treatment
• A range of alternative treatments including
  talking therapies

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Celebrations

• Primary Mental health teams and their guided self
  help materials for depression
• Training on gender, and the impact that being a
  woman has on their mental health
• Input to the Thorn course (psychosocial
  interventions)
• Integrated care pathways
• Deliberate self harm training
• Dialectical behavioural therapy
• Women only accommodation for mothers with mental
  health problems and children
• Women only voices groups
• Womens groups

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Continued

• Woman Only Ward in Charlton Lane
• Research by Service Users on in Patient Services
• Women Only Groups on In- Patients
• A Domestic Violence Policy for the Trust
• Domestic Violence and How to Ask the Question
  programme being developed
• The Womens Agenda is now going to be
  incorporated in the Trusts Business Plan
• Joint Working With Eastwood Park Breaking Down
  the Barriers
• Sexual Abuse Groups for Women Survivors
• Me!

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Nationally

• The appointment of National Domestic Violence Co
  ordinator ( Christine Mann).
• Interministerial group working on Domestic
  Violence
• Domestic Violence policy template on the DOH
  website
• DOH Resource manual..in publication Education
  and training materials
• The appointment of a womens lead Nationally
• ( NIMHE).
• Six areas to lead on Domestic Violence projects
  (NIMHE)
• Gender Equality Agenda. (July 2003 DTI)