Inequalities in women’s medium or low secure mental health settings: a scoping review

Abstract

Purpose The more disadvantaged members of society generally experience poorer outcomes following the development of mental ill-health. The purpose of this paper is to scope the literature and synthesise findings on the inequalities and mental health within secure mental health settings. Design/methodology/approach Six electronic databases were searched to identify relevant studies. These were included if they examined the association between inequalities and mental health in women’s secure mental health settings. Findings Of the 608 studies reviewed, 14 met the inclusion criteria. In these papers, violence and/or abuse were described as the most prevalent inequalities. The second most frequent group of inequalities identified were socio-economic. Only three published studies researched the impact of ethnicities. Physical health, alcohol abuse and a dysfunctional family upbringing were only mentioned in one of the studies. Gender identity, transitioning and sexual orientation was not considered in any papers. These are areas, which require further investigation to determine their specific impact in this setting. Research limitations/implications This review highlights the dearth of high-quality research-based evidence underpinning an understanding of the impact of inequalities on women in secure mental health settings. The existing studies suggest that inequalities have a very particular impact and that intersectionality plays a key role. Further research is required to further understand how inequalities impact the lives of women in secure mental health settings. Practical implications The inequalities that women experience in relation to mental health need to be further researched in the context of intersectionality. There are also research gaps in terms of gender identity, sexual orientation and socio-economic background. Further primary research using a more complex methodological paradigm is required to explore these factors and their impact on mental health service provision. Social implications The role of inequalities should be considered as part of an overall care package, including the experiences of adverse childhood experiences and this should contribute towards the development of a trauma-based care approach. Originality/value To the best of the authors’ knowledge, this is the first study to scope literature about inequalities experienced in women’s secure psychiatric settings considering intersectionality.

Staff perceptions of patient inequalities in a UK secure mental healthcare setting

“…Furthermore, staff were able to identify the impact of the discriminatory factors including isolation, neglect and inadequate support in their environment. This indicates not only an awareness of what inequalities are but also their impact; allowing them to contextualise the risk behaviour and the triggers which have contributed to the patients’ journey to secure care (Trumm et al. , 2021).…”

“…Furthermore, staff were able to identify the impact of the discriminatory factors including isolation, neglect and inadequate support in their environment. This indicates not only an awareness of what inequalities are but also their impact; allowing them to contextualise the risk behaviour and the triggers which have contributed to the patients' journey to secure care (Trumm et al, 2021). Further, Goffman's theory of stigma may highlight staffs awareness of mechanisms in society which marginalise and discriminate against the vulnerable in society, whilst demonstrating how they may be aware of how these may impact the patient.…”