Unspoken: Verbal Sexual Harassment by Patients in Psychiatry

Abstract

Aims

Patient-initiated verbal sexual harassment (PIVSH) is common in the healthcare workplace, however institutes often neglect to address it. Objectives: (1) Define extent of PIVSH among staff at South London and the Maudsley Trust (sLaM), (2) Characterise the impact of PIVSH on staff, (3) Understand barriers to reporting PIVSH, (4) Inform policy and training to support staff.

Methods

A questionnaire from Scruggs et al. (2020) was adapted with types of PIVSH on a standardised scale of severity from ‘most’ to ‘least’ harassing. The anonymous, retrospective, online survey was disseminated to sLaM staff via Trust-wide communications, staff networks and Whatsapp groups. Descriptive statistics were used to analyse quantitative data (PIVSH frequency, confidence to respond to PIVSH, reporting practices). Respondents used free text to describe the impact of PIVSH, reasons for not reporting harassment, and views on the role of the Trust and supervisors in addressing PIVSH. Qualitative data were analysed using thematic analysis and externally validated.

Results

42 responses were received across staff groups. 95.2% respondents had experienced PIVSH in the last year. 26.2% had formally reported an incident of PIVSH, with only 30.8% stating the report had been actioned by a senior. ‘Less severe’ harassment types were the most common, and the type staff were least confident to address. Five themes were identified in thematic analysis:

1. 1. Nature of PIVSH: Unwanted, covert, influenced by victim demographics, the situation, and motivation of the perpetrator

2. 2. Response to PIVSH: Victim's emotional and practical response, and of the wider MDT

3. 3. Impact on trainee: Personal (desensitisation, feeling unsupported) and professional (time off, moved teams, avoidance of wards)

4. 4. Barriers to action: Practical barriers to reporting (lack of time, complexity) and organisational culture (‘patient unwell’ justification, trivialisation, lack of trust in management)

5. 5. Areas of improvement identified: Written policy on PIVSH clearly communicated to staff and patients; wider cultural changes of zero tolerance to PIVSH; open discussion and reporting, backed up by education and training; formalised support post-PIVSH event

Conclusion

There is a negative impact of PIVSH on staff at sLaM and it is not properly recognised. The NHS is its staff and we cannot afford to neglect their well-being. Action as a result of this survey will include:

1. 1. Creation of a training package with Maudsley Simulation

2. 2. Development of informational posters for clinical spaces

3. 3. Write up-to-date trust policy on PIVSH