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Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma

BACKGROUND: Gender is routinely pitched as a key determinant of vulnerability for staff and residents on acute mental health inpatient units. Since the 1960's mixed gender units have become more prominent in Western health systems, yet questions remain around the configuration of these units, i...

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Autores principales: Morton, Elizabeth Kathleen, McKenzie, Sarah K., Cooper, Amy, Every-Palmer, Susanna, Jenkin, Gabrielle Lisa Simone
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9548606/
https://www.ncbi.nlm.nih.gov/pubmed/36226107
http://dx.doi.org/10.3389/fpsyt.2022.940130
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author Morton, Elizabeth Kathleen
McKenzie, Sarah K.
Cooper, Amy
Every-Palmer, Susanna
Jenkin, Gabrielle Lisa Simone
author_facet Morton, Elizabeth Kathleen
McKenzie, Sarah K.
Cooper, Amy
Every-Palmer, Susanna
Jenkin, Gabrielle Lisa Simone
author_sort Morton, Elizabeth Kathleen
collection PubMed
description BACKGROUND: Gender is routinely pitched as a key determinant of vulnerability for staff and residents on acute mental health inpatient units. Since the 1960's mixed gender units have become more prominent in Western health systems, yet questions remain around the configuration of these units, including how to ensure emotional and physical safety of those living and working in them. METHODS: This paper draws on a large study of the lived experiences of 42 staff and 43 service users from different acute mental health units in New Zealand. We conducted thematic analysis of interview data from four units with diverse architectural layouts to identify key themes central to decisions around gender and spatial design. RESULTS: Key themes emerged around gender-related trauma histories, safety perceptions and vulnerabilities, accommodation of gender-diverse and non-binary mental health service users, and gender-specific needs and differences. A further theme, of it goes beyond gender emphasized that there are many other non-gender attributes that influence vulnerability on the unit. CONCLUSIONS: While findings emphasize the need for safe places for vulnerable people, trauma-informed care, access to staff who “understand,” and recreation that is meaningful to the individual, we question if the dilemma of gender-separation vs. gender-mixing is an outmoded design consideration. Instead, we argue that a flexible, person-centered approach to provision of care, which values autonomy, privacy, and safety as defined by each service user, and that promotes choice-making, obviates a model where gender accommodations are fore. We found that a gender-exclusive narrative of vulnerability understates the role of other identifiers in dynamics of risk and vulnerability, including age, physicality, past violence, trauma history, mental unwellness, and substance use. We conclude gender need not be a central factor in decisions around design of prospective built unit environments or in occupational and clinical decisions. Instead, we suggest flexible spatial layouts that accommodate multiple vulnerabilities.
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spelling pubmed-95486062022-10-11 Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma Morton, Elizabeth Kathleen McKenzie, Sarah K. Cooper, Amy Every-Palmer, Susanna Jenkin, Gabrielle Lisa Simone Front Psychiatry Psychiatry BACKGROUND: Gender is routinely pitched as a key determinant of vulnerability for staff and residents on acute mental health inpatient units. Since the 1960's mixed gender units have become more prominent in Western health systems, yet questions remain around the configuration of these units, including how to ensure emotional and physical safety of those living and working in them. METHODS: This paper draws on a large study of the lived experiences of 42 staff and 43 service users from different acute mental health units in New Zealand. We conducted thematic analysis of interview data from four units with diverse architectural layouts to identify key themes central to decisions around gender and spatial design. RESULTS: Key themes emerged around gender-related trauma histories, safety perceptions and vulnerabilities, accommodation of gender-diverse and non-binary mental health service users, and gender-specific needs and differences. A further theme, of it goes beyond gender emphasized that there are many other non-gender attributes that influence vulnerability on the unit. CONCLUSIONS: While findings emphasize the need for safe places for vulnerable people, trauma-informed care, access to staff who “understand,” and recreation that is meaningful to the individual, we question if the dilemma of gender-separation vs. gender-mixing is an outmoded design consideration. Instead, we argue that a flexible, person-centered approach to provision of care, which values autonomy, privacy, and safety as defined by each service user, and that promotes choice-making, obviates a model where gender accommodations are fore. We found that a gender-exclusive narrative of vulnerability understates the role of other identifiers in dynamics of risk and vulnerability, including age, physicality, past violence, trauma history, mental unwellness, and substance use. We conclude gender need not be a central factor in decisions around design of prospective built unit environments or in occupational and clinical decisions. Instead, we suggest flexible spatial layouts that accommodate multiple vulnerabilities. Frontiers Media S.A. 2022-09-23 /pmc/articles/PMC9548606/ /pubmed/36226107 http://dx.doi.org/10.3389/fpsyt.2022.940130 Text en Copyright © 2022 Morton, McKenzie, Cooper, Every-Palmer and Jenkin. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Morton, Elizabeth Kathleen
McKenzie, Sarah K.
Cooper, Amy
Every-Palmer, Susanna
Jenkin, Gabrielle Lisa Simone
Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma
title Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma
title_full Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma
title_fullStr Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma
title_full_unstemmed Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma
title_short Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma
title_sort gender and intersecting vulnerabilities on the mental health unit: rethinking the dilemma
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9548606/
https://www.ncbi.nlm.nih.gov/pubmed/36226107
http://dx.doi.org/10.3389/fpsyt.2022.940130
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