Access to physical health interventions for women in secure services

By Dr Ellen Camboe, Academic Clinical Fellow, East London NHS Foundation Trust

This article appears in our latest newsletter which can be downloaded here.

The gap between mortality in patients with severe mental illness (SMI) and the general population is widening and is particularly apparent in women1. This trend is exaggerated in specialist mental health service populations, demonstrated in a recent study with Scottish forensic patients over a 20 year follow up, showing that women died on average 24 years prematurely. This is an even worse picture than for men in secure hospitals who die, on average, 15 years before men in the general population2.

Despite this, physical health monitoring and screening programmes are far too often not a priority in the day-to-day running of a women’s forensic mental health ward. Where there is a focus on physical health, there are often barriers in accessing adequate and equitable care3. For instance, many long-term patients are not routinely invited for breast cancer screening as they are often not registered with a local GP practice. This is despite women in forensic patients being high risk for breast cancer (due to high rates of obesity, smoking, and antipsychotic induced hyperprolactinaemia)4.

The same is true for other cancer screening programs such as colon cancer screening and cervical screening. There is an additional concern that women who have history of sexual assaults are less likely to engage in cervical screening when it is offered5. Anecdotally, physical examinations and investigations may also be difficult in the context of historic sexual abuse.

Advocating for equitable access to screening programmes and physical health care for women must now become a priority for those working in forensic services. Inaction and complacency are no longer an option and will require examination of the systems in which we are working and consideration of the trauma that our patients have experienced.

1) Anne Høye, et al., Increasing mortality in schizophrenia: Are women at particular risk? A follow-up of 1111 patients admitted during 1980–2006 in Northern Norway, Schizophrenia Research, Volume 132, Issues 2–3, 2011, Pages 228-232, ISSN 0920-9964,
2) Rees, C., & Thomson, L. (2020). Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years. BJPsych Open, 6(4), E62. doi:10.1192/bjo.2020.40
3) Chaimowitz GA et al. Stigmatization of psychiatric and justice involved populations during the COVID-19 pandemic. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Mar 2;106:110150. doi: 10.1016/j.pnpbp.2020.110150. Epub 2020 Oct 21. PMID: 33098908; PMCID: PMC7577257.
4) Issam Makhoul, 24 – Therapeutic Strategies for Breast Cancer, Editor(s): Kirby I. Bland, Edward M.Copeland, V. Suzanne Klimberg, William J. Gradishar, The Breast (Fifth Edition), Elsevier, 2018, Pages
315-330.e7, ISBN 9780323359559,
5) Cadman L, Waller J, Ashdown-Barr L, et al. Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study Journal of Family Planning and Reproductive Health
Care 2012;38:214-220.

Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.

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