Alarming scale of sexual violence and abuse on mental health wards

Over the past month, Rape Crisis England & Wales have been closely following the important work of investigative journalists from Sky News and the Independent who have been shedding light on the scandal – and scale – of sexual violence and abuse on mental health wards in England.

These investigations have uncovered deeply concerning incidents and safeguarding failures within mental health inpatient settings - almost 4,000 sexual safety ‘incidents’ were reported between January and August 2023, perpetrated by a combination of professionals and fellow patients. We commend the enormous courage and tenacity of the survivors who came forward to speak about their experiences of sexual harassment, rape and sexual abuse, raising awareness of this issue.

This was not the first piece of work on the issue of sexual safety in health settings. In 2018, the Care Quality Commission (the independent regulator of health and social care in England) created a report on sexual safety in mental health wards. The report found that patients felt staff did not keep them safe, were unsupported in addressing sexual safety issues, were desensitised to sexual violence and abuse and that there was poor multi-agency working.

Last Spring, the Guardian and the BMJ published the results of their investigation which showed that NHS trusts had recorded more than 35,000 cases of rape, sexual assault, harassment, stalking, and abusive remarks between 2017 and 2022 across all NHS settings. That same investigation found that 56 gang rapes had been reported on NHS premises, across 10 police forces in England.

The scale of this abuse, perpetrated against people who are already vulnerable due to their mental ill health, and who are being treated in inpatient settings, is appalling. Many people who require a safe space to process their trauma have already been abused by people whom they trusted, and experiences like this will only compound their trauma.

Anyone receiving support for their health and wellbeing, in any setting whatsoever, deserves to be kept safe from abuse and harm, and addressing this urgent situation requires strong leadership, multi-agency coordination, and accountability. RCEW have serious concerns that the responsibility for sexual violence and abuse on mental health wards has shifted around the health system including the health trust, ICB, NHS England, CQC, Royal College of Psychiatrists as well as health and wellbeing boards and more. Everyone holds partial responsibility for making change, yet there is a lack of clarity over the ultimate coordination and delivery of desperately needed change.

Ciara Bergman, CEO of Rape Crisis England & Wales, shared:

“We have been raising our concerns about the widespread safeguarding issues with those within the health system for many years. It is disturbing that even after the important CQC report published in 2018 on Sexual Safety, so little has seemingly changed. Women and girls deserve to feel safe wherever they are, but particularly when they are at their most vulnerable. We are concerned that without major intervention and leadership at the highest levels, this could lead to sexual violence and abuse simply being accepted as inevitable, when it is absolutely preventable.”

We recognise that there have been some important developments around sexual violence in recent years. There is a renewal of the Sexual Assault and Abuse Strategy, and NHS England has advised all Trusts and local health systems (integrated care systems) to appoint a domestic abuse and sexual violence lead. There is a significant opportunity to address our shared interest in making wards safer, and so we urge all those leads to collaborate meaningfully with us, and at a local level, your local specialist Rape Crisis centre.

We call for:

1. A named Minister with the responsibility to drive change to ensure the sexual safety of women and girls on mental health wards. Failures of this scale require political will and leadership.
2. A public inquiry into sexual violence and abuse within mental health inpatient wards. We believe that this is occurring on a significant scale, and that the data collection is variable. The issue must be quantified, and survivors must have the opportunity to give evidence safely. The Academy of Medical Royal Colleges and others have already called for a broader inquiry – a full independent inquiry into the epidemic of sexual assault in the NHS.
3. Guidance on conducting robust sexual safety risk-assessments must be properly adhered to, recognising the need for women-only wards. The risks around mixed wards are well documented, and guidance on this is already available.
4. All NHS trusts must have - and publish - a dedicated policy to deal with sexual assault and harassment.
5. Engagement between mental health trusts, integrated health systems, and specialist sexual violence and abuse service providers such as Rape Crisis centres. The scale of the issue requires expert involvement from the specialist sexual violence and abuse sector, with proper pathways of support for victims and survivors who require independent, specialist, wraparound sexual violence and abuse support.
6. Inpatient care must transform how they approach their work with traumatised people and work with the specialist sexual violence sector on how to implement trauma-informed principles, so that survivors are able to re-establish their lives. This ranges from communication, environment, to medicalisation and treatment.