Menstruation in psychiatric inpatient settings
Hat Porter explores the experiences of menstruating whilst in psychiatric inpatient settings, informed by their own lived experience and their latest research, conducted with support from the National Survivor User Network (NSUN).
Periods can be a bit rubbish at the best of times. However, for patients in mental health wards, often hours from home, unable to leave and facing huge restrictions, menstruation can be an experience surrounded by humiliation, indignity and injustice.
I am an autistic, mad, researcher, artist and activist. Throughout my teenage years and early twenties, I spent a long time in and out of mental health wards, amounting to years in total. During these hospital admissions, I would never have access to the period products I needed. Perhaps the staff would’ve given me some if I’d asked, but I was always too scared to do so. When I tried to bring some pads in after being on leave, I was searched and they were confiscated as a risk item. When I needed period products, I always had to improvise and make do with whatever I could fashion out of toilet paper.
It wasn’t until years later that I realised just how unjust and neglectful all of this was. It made me feel like I was the problem: like I was disgusting for the natural cycles of my body. I never realised that I deserved better.
“When I needed period products, I always had to improvise and make do with whatever I could fashion out of toilet paper. ”
I recently conducted some survivor-led research, supported by the user-led mental health charity, NSUN. Exploring experiences of menstrual health in psychiatric inpatient settings is a topic that, until this point, has been largely overlooked in mental health research, policy and practice.
My research involved questionnaires, interviews and reviewing policy documents, through which I identified 4 key themes. These themes related to institutional and interpersonal contexts where patients’ experiences were influenced both by the restrictive institutional environments of the hospital, as well as the interactions with staff and how staff met, or did not meet, their care and support needs.
The themes were:
accessing menstrual materials
the lack of privacy when menstruating
the influence of staff attitudes and approaches
the support patients needed with physical or psychological challenges related to their menstrual cycle.
The research highlighted that generally, patients were not adequately supported with their menstrual health whilst in hospital. This left people facing deprivation, neglect and injustice and often feeling humiliated and degraded.
Patients faced restrictions in their access to period products as well as other items, such as hot water bottles, soaps, hygiene items and medications. These were often banned, based upon the perceived risk of the items, though usually not because of the patients’ individual risk.
Where period products were available, these were often poor quality and didn’t meet patients’ needs, including the sensory needs for autistic patients. Staff generally controlled supplies of period products, meaning patients usually had to request the products one at a time. This compromised their control, privacy and dignity and for those unable to ask, whatever the reason, deprived them of period products entirely.
“Some participants described feeling that mental health services viewed their physical health as “someone else’s problem”...”
Participants also found mental health wards to be very exposing and lacked privacy when menstruating. This was frequently discussed in relation to being observed continuously by staff or where ensuite bathrooms didn’t have doors.
Menstruation was widely overlooked, making patients feel burdensome, like an inconvenience and as though it hadn’t occurred to staff that patients will menstruate. Many patients experienced psychiatric wards as enhancing their sense of shame and negative attitudes towards menstruation, especially where staff were overtly disgusted or expressed negative views.
In many cases, patients were not adequately supported with their physical needs around menstruation: patients’ pain was dismissed and for those who also had gynaecological conditions or heavy and painful menstruation, this experience was exacerbated. Some participants described feeling that mental health services viewed their physical health as “someone else’s problem” and did not recognise the complex relationships between mental and physical health or view their needs holistically.
Finally, some patients shared how their mental health, distress and trauma has shaped the way they related to their menstrual cycle, for example finding some types of period pains and using certain period products to be triggering in the context of sexual trauma.
Following the research phases, I held a focus group with people who also have lived experience, to develop some guidelines which outline the tangible actions services can take to address and support patients’ needs. The guidelines have been supported and endorsed by a range of key stakeholders, including the Royal College of Occupational Therapists, Mind, Rethink and Bloody Good Period, however, more work is needed to address the harms and injustices which were so clearly highlighted by this research.
As always, I would like to thank the participants and guidelines co-authors who were so open in sharing their experiences and making this research possible. This work was supported by NSUN, who were incredible from start to finish.
The full research report, guidelines, an Easy Read summary, an illustration and a video recording of the report launch presentation are available at: https://www.nsun.org.uk/resource/menstrual-health-in-psychiatric-inpatient-settings-2024/
