Mental health articles

OF mental health care and mentally ill

Gender and mental disorder

The literature consistently reports fewer women to be in receipt of specialist mental health services than men. Though this may reflect a lower prevalence of mental disorder among women, evidence suggests that the phenomenon is a marker for the diagnostic practices and expectations of practitioners, which are different for men than for women. For example, Perkins and Rowland (1991) identified a tendency for male patients to be encouraged to find employment, while women were more likely to be expected to improve their self-care and domestic skills. Further, it is known that most women are reluctant to share facilities with male patients, whom they often experience as threatening.

Whether or not these reasons are sufficient to explain the under-representation of women in specialist mental health services, it remains that women are a minority group whose needs are often overlooked. Owen and colleagues consider these issues in depth and propose strategies to improve mental health services for women.

A key experience that predominantly affects women and which contributes to mental health problems is domestic violence. Not only does this bring anguish to the women involved, but there is now evidence of lifelong effects on children who witness such violence. Furthermore, abused women may not approach relevant services for help, partly through the fear of retribution from their partners but also because to do so would threaten their social roles, for example as mother, housekeeper, wife, etc.

Ramsay et al. (2002) have recently completed a systematic review of domestic violence with particular emphasis on the role of health care workers in screening for this form of abuse. From this it is far from clear that screening per se is advantageous and further evidence is needed to elicit the benefits of specific interventions.

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