Karen (not her real name) was in her bedroom on a psychiatric ward when a male nurse sexually assaulted her. It was during the pandemic and she had been sectioned for her own safety following a long history of mental ill health.
“I was in my pyjamas, sat at my desk, and he exposed himself and masturbated in front of me,” she says. “I screamed and threw a chair between us. I probably only managed to actually say no because I’d been in therapy for a year prior to that incident.”
Karen is not alone. A joint investigation by the Guardian and the British Medical Journal has found that thousands of vulnerable mental health patients have reported claims of being sexually abused in NHS hospitals.
Data released following freedom of information requests to NHS trusts in England showed that 35,606 “sexual safety incidents” were recorded in hospitals between 2017 and 2022. The term covers a spectrum of behaviours, from abusive remarks to rape, allegedly perpetrated by staff, patients or visitors.
Three-quarters of the reports – 26,434 – were made in mental health trusts, and nearly 2,500 of the alleged incidents of sexual violence and misconduct were by staff on patients.
Experts have warned that this phenomenon is a symptom of a system that is underfunded, understaffed and where it is easier to hide abuse. This is compounded by the fact that inpatients at mental health hospitals tend to stay much longer than those admitted to hospital for physical illnesses.
Andy Bell, chief executive of the Centre for Mental Health thinktank, says: “Closed institutions, where many patients are sectioned and in locked wards, are sadly more likely than other hospitals to place people at risk of abuse.
“Most staff working in inpatient mental health wards work exceptionally hard to help people to recover in a safe and compassionate way. But there are chronic staffing shortages, too many facilities are outdated, and bed occupancy levels in many wards are in excess of safe levels.”
Rob Behrens, the parliamentary and health service ombudsman, said: “We know that not only do mental health patients often not feel safe when receiving care, but they are not told how to complain about their experiences. If people are not empowered to speak up about their concerns, problems of safety will continue, and the situation will not improve.”
Too often, victims are not believed or concerns about their credibility and ability to withstand questioning in court mean that perpetrators of sexual abuse against mental health patients are less likely to be convicted of their crimes. Elizabeth Duncan, a partner at Slee Blackwell solicitors, says this makes legal action extremely difficult. “I have not had a single case involving sexual assault of a psychiatric patient that has resulted in a successful criminal prosecution or even a charging decision being supported by the CPS,” she says.
The former victims’ commissioner Vera Baird says the Guardian/BMJ investigation shows that the NHS is failing to protect vulnerable patients from predatory staff. “There’s a section of people who can be raped at will, and nothing happens. They just don’t get any justice, because all those reservations [about mental health] stop [the investigation] from going forward.”
Karen agrees. She says that when she reported her abuse, the other staff thought she was making it up. “Nobody believed me. They did nothing about it at all. Apart from saying that every person had to come into my room in pairs, because they were accusing me of making a false allegation.”
Jess (not her real name) from Colchester, Essex, feels she could not get justice after reporting being molested as an inpatient at the Lakes, a mental health unit run by Essex Partnership university NHS foundation trust.
She says a male health care assistant offered to give her a massage and a hug. Despite saying no, he pinned her to the bed and stuck his hand down her top.
Jess reported the assault immediately to the hospital and the police, but the member of staff was allowed to stay at work, before absconding, exacerbating her distress. She was awarded compensation and an apology from the trust in response to her civil claim over the assault and the trust’s failure to investigate properly.
The Leigh Day solicitor Cat Rubens, who represented Jess, said: “Too often, the safeguarding procedures and reporting systems are opaque and difficult for victims like Jess to navigate.
“Trusts are public bodies with responsibilities under the Human Rights Act to properly investigate allegations of sexual assault against mental health patients. When they fail to do so properly, they risk breaching Human Rights duties towards patients, as well as damaging the public’s trust in the healthcare profession.”
Following its 2018 report on sexual safety in mental wards, the Care Quality Commission now expects all mental health trusts to have a sexual safety lead, as well as “robust processes to identify and report sexual safety risks, mitigate those risks and ensure learning is acted on in response to any incidents”. Yet less than a quarter of mental health trusts have a dedicated sexual safety policy, the Guardian’s investigation found.
In January, the government announced an inquiry into patient safety in mental health hospitals following a series of scandals in which vulnerable patients were abused or neglected. But experts said ministers must go further. “[The review] must be followed by urgent and concerted action to protect people from abuse in our mental health care system,” says Bell. “That includes reforming the Mental Health Act so that patients have more safeguards and more of a say in how they are treated when they are most unwell.”
Meanwhile, the long-term mental and physical impact on victims can be devastating. Jess says she can’t move on, as the experience has made her PTSD worse.
“The trauma I went through is always there. Even now, I still have some flashbacks and I can get panicky,” she says. “I would find it very hard to go anywhere as an inpatient again, because I just feel so let down by the mental health system.”
The psychological trauma of her abuse in 2021 nearly cost Karen her life. “It’s made all hospitals feel incredibly unsafe,” she says. She was admitted to hospital this year with a pulmonary embolism, but had put off seeking treatment. “I should have gone before, but I was too scared of being abused,” she says. “It could have been fatal and I’m lucky to be alive. Even so, I spent the whole time terrified of any male staff on the ward.”
Karen is adamant that she will never go back to a psychiatric ward. “I would rather kill myself than risk being sectioned into hospital again, such is my phobia about the risk of sexual violence in hospital and the way I have been treated/accused when trying to seek help from those charged with caring for and protecting me.”
An Essex Partnership university NHS foundation trust (EPUT) spokesperson said: “We offer our sincere apologies for the distress experienced following this incident in 2018.
“Any form of sexual misconduct is completely unacceptable. We take all reports of inappropriate behaviour extremely seriously and clear systems are in place to ensure all reported incidents are recorded and investigated swiftly.”
A spokesperson for the CQC said: “While the majority of health and social care services are delivered in a safe environment, we know that more can be done to ensure the sexual safety of both staff and people receiving care, especially the most vulnerable.”
The CQC is committed to “tackling closed cultures which may prevent people from feeling safe or empowered to report incidents”, she added.
“There is also more to do to ensure that sexual safety incidents are reported and recorded in a consistent way that allows data to be shared and investigated more easily in order to understand and address risks to people’s safety.”
An NHS spokesperson said: “As part of NHS England’s mental health safety improvement programme, we commissioned the National Sexual Safety Collaborative for mental health and worked alongside the Royal College of Psychiatrists to produce sexual safety standards.
“We are now working to support frontline services to implement these improvements as part of a £36m investment in learning disability, autism and mental health inpatient services.”
Information and support for anyone affected by rape or sexual abuse issues is available from the following organisations. In the UK, Rape Crisis offers support on 0808 500 2222 in England and Wales, on 0808 801 0302 in Scotland, or on 0800 0246 991 in Northern Ireland. In the US, Rainn offers support on 800-656-4673. In Australia, support is available at 1800Respect (1800 737 732). Other international helplines can be found at ibiblio.org/rcip/internl.html
