Up to 33% of female in-patients on psychiatric wards experience unwanted sexual comments and pestering of women patients is also common (56%). Reference Lawn and McDonald1 Harassment has been a particular problem for one our patients, a male-to-female transsexual who required admission for depression and suicidal thoughts. She has found hospital admission particularly difficult both due to prejudice from fellow patients and because of what she describes as ‘transphobic’ abuse from staff. Even during the first hours of her admission it became clear that our in-patient service was not going to find it easy to meet her needs and she was moved between wards, allocated a bed in a female area, then in a male area, and then finally moved to a single bedroom in a mixed ward.
Although these were real practical issues (i.e. trust wards operate either as same-gender wards or as wards with specific male/female areas with gender-specific bathrooms), it also seemed that staff's attitude was a major factor in the patient's feeling harassed and discriminated against. Following a complaint to management she has agreed to meet with ward managers to discuss the issues.
Helpfully for the medical staff, the patient also agreed for her case to be presented at the academic programme to which all grades of doctors attend. She preferred to be present throughout the presentation of her history, talked of her own experiences and participated in the subsequent discussion.
A questionnaire survey of the attendees at the presentation revealed that most understood the difficulty experienced by the patient and appreciated the issues of harassment and discriminatory practice as she described them. The majority (76%) had no training in transgender issues and would welcome some.
The Department of Health guidelines on transgender issues 2 do not specifically refer to in-patient accommodation but are more focused on staff attitudes.
It would be interesting to see whether in-patient accommodation would prevent the harassment described by our patient or whether staff awareness is the more vital component.
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