The Femicide Pandemic

We are joined by Dr Beena Rajkumar, Dr Syeda Ali, and sexual-harassment lawyer Deeba Syed to unpack the femicide pandemic.

In honour of International Day for the Elimination of Violence against Women on the 25th of November, our guests discuss the impact of violence on women’s mental health and the tragic murders of Bibaa Henry, Nicole Smallman, Sarah Everard and Sabina Nessa.

Transcript

Ella Marchant: Hello and welcome to the Royal College of Psychiatrist's podcast with me Ella Marchant. 

International Day for the Elimination of Violence Against Women happens every year on the 25th of November and this year we have three very special guests on the podcast, who are here to discuss The Femicide Pandemic. 

In 2020, we saw the tragic deaths of Bibaa Henry and Nicole Smallman and in 2021, we very sadly lost Sabina Nessa and Sarah Everard. As well as these murders, violence against women has intensified during COVID and has been referred to by the United Nations as a Shadow Pandemic. 

On the podcast, we have Dr Beena Rajkumar, Dr Syeda Ali and Deeba Syed. Beena is a consultant psychiatrist and psychotherapist who is passionate about working with women who have experienced complex trauma. Syeda is the lead consultant forensic psychiatrist for a women's secure psychiatric service in the NorthWest of England. Many of her patients have experienced sex-based violence. Deeba is a sexual harassment lawyer and a violence against women and girls, VAWG, activist. This podcast contains discussions on sexual violence. 

So, I'd really love it If you could all introduce yourself. Beena, could we start with you please? 

Beena Rajkumar: Thank you, Ella. This podcast is such an important topical conversation that we must have as a society. I'm very privileged to be a part of this podcast. I'm Bina and I'm a consultant psychiatrist and psychotherapist working for the National Health Service. As a consultant psychiatrist, I work in a high dependence ward with women who have complex mental health problems, many of them who've experienced complex trauma. 

As a consultant psychotherapist, I work in the community with people who've experienced complex trauma. My interest in women's mental health stems from my own childhood. I've had a very matriarchal upbringing. I was raised by my mother, who was a very powerful feminist. And so when I became a psychiatrist, to become interested in women's mental health, just felt very normal, very organic. Thank you. 

EM: Syeda, could we please hear from you next, just a little introduction, and what's made you feel so passionate about this topic that we're talking about today? 

Syeda Ali: Well, thank you very much for inviting me. I'm Syeda. I'm the lead consultant forensic psychiatrist, for one of the largest women's secure hospitals in Britain. And obviously, I think you can tell, I've got a Muslim name, I'm from a Muslim background, I am British. But there are really important issues that relate to violence against women and girls that are hugely important to many people from my background. And particularly in my line of work, I see the impact of a lot of this. So it's something that I feel we really need to open up the conversation on. Thank you so much, and Deepika, please come to you as well.

Deeba Syed: Hi, there, it's such a privilege to be invited to join this discussion. I'm an employment solicitor, specialising in sexual harassment. I work at a women's rights charity, which gives free legal advice and support to women who have experienced VAWG. We are a frontline service and we are supporting women who are often having serious mental health complications and issues because of the violence that they've experienced. And so I'm just so honoured to hear what Syeda and Beena are going to say, because there's so much I think I could learn about this - just working in the VAWG sector. You know, we're working with other charities and other women's organisations and other equalities, organisations. And I think the sector has gone through a lot of trauma recently. I mean, we always do, but it's really important to have these conversations because I think we need to, kind of reflect on how this is impacting us all and the women who we're supporting. So, just really grateful to be here.

EM: And what led you to work in this area of law? Was there someone or something that happened that inspired you to specialise in this?

DS: I mean, I don't think it'll be a surprise to say, but a lot of women working in the VAWG sector have been affected by VAWG,  or their friends or their family or they themselves. That's why this topic is even more important because we're all especially triggered by you know, these events. Yeah, I just say like anybody else, VAWG's touched my life and that's why I'm passionate about helping other women in similar situations.

EM: Syeda could we please start with you? How do violent attacks on women affect the mental health of these women? What happens to them?

SA: Violence against women and girls has a huge impact. And it's not just on an individual woman, it's on the locality, the community, it's then having an impact more widely than that on society. Violence against women and girls is a pandemic. It's something that we know occurs at high rates across the world. Women are the largest oppressed group of people on Earth. And there's plenty of evidence for that. This is not new.

I was specifically, really, raised the issues that I see every day working with my patients. I would say possibly 99% of the women with whom I work in our psychiatric secure service have experienced trauma due to a form of violence against them at some point. The violence can take place at any time during the lifespan. As well as thinking about, sort of, ripple effects, you think from the moment a child is born, if that is a female child, that child could be at risk in different parts of the world of being terminated because it's a female foetus. From the minute she's then born, if she survives, through all of that, a woman may be at risk, or sorry, a girl child, rather, may be at risk of all sorts of oppression. We know about female genital mutilation, that's quite a prominent issue at the moment. 

You go through life having much different opportunities and expectations heaped upon you, compared to if you are a boy child. There are patriarchal expectations, different roles, all sorts of things heaped upon women. Not just about, sort of, what we do every day, how we appear, and essentially how we serve others. I think that's one of the most difficult things is that the woman's role across the world, or a girl's role as well, has been defined by men, in many cases, as about serving another system. Whether it's just serving the man in the family with food, which is a very simple family level, to serving the patriarchy or serving capitalism by working for free a lot of the time. For example, raising the next generation of capitalist workers, you know, to pay for our pensions essentially. From the minute you are conceived as a female child, you are going to experience some form of adversity. 

In comparison to men, the women I work with who've experienced a lot of trauma, they have multiple mental health issues. Now, this can lead to anxiety, loss of confidence, and things grow and snowball from there. 

Many of the women who I look after have experienced severe depression, they're at increased risk of suicide, some of them become so unwell, that they become a risk to others. Trauma is known to be a contributory factor to psychosis as well. We've looked after a lot of women here who become a risk to their children, or to other people - that's rare. But we get a lot of those women admitted to us. Post-traumatic stress disorder is increasingly recognised as a huge morbidity cause in this country and elsewhere. Further work has been done on that we now know about complex PTSD. So, this allows more for different types of trauma. Not just bodily harm, but also the slow burn, of coercion, of erosion of somebody's confidence, of their ability, of their rights, of their financial abilities, their ability to go out to work, all of these things. They sort of coalesce and become a perfect storm of adversity for so many women. I think the starkest thing that I would like to end on really, for that question is, what really, really stood out for me was the rate of death of women due to intimate partner violence during lockdown. I think we know, probably; a woman dies every two to three days in this country and that rate increased during lockdown. The pandemic has disproportionately affected women, and disproportionately led to increased violence against women and girls. 

EM: And over this past year, we've had a devastating number of high profile deaths. Last year, we had Nicole Smallman and Bibaa Henry. This year recently, we've had Sabina Nessa and of course, Sarah Everard as well. How do you feel personally affected?

SA: On a personal level I feel very shaken by it. And yet at the same time, it feels almost like it's not news. This has been going on for such a long time. It's interesting that now we have much more prominent news coverage of these things. But every single woman I know, I've done this, you're careful, you police yourself, you risk assess every man that you meet, however subtly. You know, we meet people in every walk of life and we will be, subtly, as women risk-assessing those men thinking; is this guy of creep? Is this guy a risk to me? We police what we wear, we police where we walk, I'm not free to walk down the street, around my home in the dark, without flat shoes, and making sure that I never have my hair in a ponytail. And always having my key between my fingers, and always making sure that my phone's fully charged. Being very careful about transport. The freedom, the curtailment of freedom to which women have to submit ourselves in order to stay alive is quite something. On a personal level. 

What really struck me was the disrespect shown to be Bibaa Henry, by the very people who ought to have been looking after her and dealing in a respectful way following her death. I believe that some police officers took photographs of her dead body, with her afterwards.

EM: Thank you so much for that. And Beena, can we just go on to your next please? How do you personally see the lives of women the mental health of women, as affected by violent?

BR:  Thank you Ella. I want to agree with Syeda, that what lies at the heart of gender-based violence is the patriarchal narrative. A narrative that tells women, you are not equal, you are less than us. It fosters gender equality, and gender-based violence and threats of violence or coercion, intend to make women feel vulnerable and afraid and to feel a sense of shame. However, I'm very, very keen that we don't medicalise gender-based violence. Because if you look, there are so many women who experienced gender-based violence. Everyone who experiences gender-based violence do not go on to develop mental health problems. It does affect one's sense of self, one's self-esteem, one's ability to trust people, one's ability to reach out for help. One's sense of confidence. Even though all of this is affected, what we do see is that women are good at, you know, when women have good supportive social structures. 

When they have good protective factors like good early attachments, we know that they can reach out for help. They can connect with others they can heal through connecting with others, connecting with other survivors, changing their narrative to a more empowered narrative. Healing through connections, spirituality, and meditation, dancing, exercise, bodywork. This does happen. However, as as Syeda said, violence, gender-based violence has a devastating impact on women and women can go on to develop mental health problems.

If we look at domestic violence, we've had the landmark study the Birmingham Study by Chandan et al. Which showed that women who experienced domestic violence have a three fold risk of increasing mental health problems. This includes anxiety, PTSD, depression, and serious mental illness like schizophrenia and bipolar affective disorder. As Syeda said, we know that there is a link between gender-based violence and trauma and a serious mental illnesses, psychosis, and so on. The intersectionality issue is very important as we know. I think Syeda touched on that. Women from lower socio-economic groups, from ethnic minority groups are especially vulnerable to not reaching out for help, and importantly, not feeling that mental health support that they get within mainstreams services can cater for their needs. And we also must think about the experience of abuse and addictions. They are very linked. It makes people sometimes want to drink or do drugs just to get through the day. And when women have substance misuse and alcohol-related problems, they experience more shame and more stigma. 

And I think one thing that we must really recognise is the young women between the ages of 16 and 24. The Psychiatry Morbidity Survey has clearly shown that there is an increased risk of have mental health problems among this group of people. This group of young women are especially vulnerable. Remember, they are very tech savvy, they are an online generation, and they are at a risk of developing - You know, we know that one in seven women between the ages of 16 to 24 experienced online abuse, which includes threats to show intimate videos and photos, 90% of young girls are sent unsolicited sexual pictures and videos. 

And if we look at this group of young women, we've seen increased rates of mental illness, one in seven of young women between the ages of 16 to 24, go on to develop post traumatic stress disorder. And if we compare this is around four times higher rates when compared with the prevalence of mental illness amongst young men of the same age group. So yes, I think gender-based violence has a devastating impact on on women.

EM: Thank you Beena that was beautifully spoken. And I'm so grateful that you were able to involve statistics in that to reinforce what you're saying. Deeba, has anything that Syeda and Beena said resonated with you?

DS: Yes, absolutely. Just, you know, to add to what everyone said already, which has been so powerful. My work is based in the workplace, I think just a sort of really important point to make is that women experience violence, in every single setting that they are in whether this school, university, the workplace, at home, walking down the street. 

What's really struck me in my work is just that. I don't think sexual harassment even covers it, I don't think that should be what it's called, I think it should just be called sexual violence, abuse, and harassment just in the workplace. Because a lot of what we're dealing with are women who are experiencing relationships, which are based on power and control, and they are abusive, and that person might not be their intimate partner, but they certainly hold financial power over them. 

And it can be very difficult to escape that kind of situation, if you are financially dependent on that job. I think, one of the things that struck me most when the pandemic started, because obviously, we're like, thinking, oh, goodness, everyone's working from home, you know, is there going to be a sexual harassment at workplace problem anymore? And, you know, what we came to find is actually the perpetrators who her were harassing them, they weren't stopping just because there was a pandemic, you know, they were finding other ways to get to them. So, whether that was through their social media, they were finding their personal details, they're getting up there old CVs, and they're old databases to find their personal contacts. We had women telling us, the perpetrator was turning up at their houses, and these people are very clever, they're very committed, if they want to harass or kind of do that to a woman, there'll be very committed to do that. 

I'd say the other thing, we are trying, you know, our mission is to help women seek access, to access justice, from perpetrators, who have committed harassment or other criminal offences or other civil offences against them. But we are expecting those women to do that, within an extraordinarily short period of time. So, in my particular area, women have to bring a claim within three months of the harassment, and that does not obviously encompass the serious mental health implications of what they are going through. We published data from our first year, and for our first year of giving advice on this advice line, free legal advice to women who've been sexually harassed in the workplace. And 30% of all our callers had actually been signed off sick from work. So, that gives you. I mean, that number doesn't really give you the full picture - but it gives you a small number we were dealing with at that time. Such a high number of it, were actually being signed off sick from work because of the stress, the depression, the PTSD.

The simple inability to be able to do their work anymore. Just made it you know, physically kind of impossible for them to operate in the workplace. And all at the same time, we're expecting these people to start to trigger a legal process. And if you don't do that within three months, then you can't have access to justice, I'm afraid. It's been a really important campaign recently, to get the time limit for common assault, extended from six months to 24 months, which still is not enough time. You've got sort of serious problems within the legal and the justice system as well in terms of where these people can look for support. 

And a lot of those times that experience is really, really traumatising to them in a completely new way. It's another form of violence really, that they experienced at the hands of state and institutions. Often at the hands of men, police officers, people within the criminal justice system, judges, people who don't understand these issues, we don't understand the kind of the fundamental facts about violence against women, but I'm thinking particularly domestic abuse and sexual violence, rape myths, those kinds of things are really pervasive in every kind of part of society. And those women, they're struggling to be believed, let alone ever access, justice. So, we've got really, really, really big problems here. 

It's very difficult to get women the access to the support and services that they need. The VAWG sector, for example, has been, it has experienced a level of cuts, which is unprecedented. The VAWG sector is chronically underfunded for years. And given how we've spoken all at length about the size of the problem of gender-based violence, and it's just sort of incredible that it's still so poorly funded, in terms of getting these women access to the support that they need. I think there was a really interesting report that the home office did, I think it was in 2019, saying that domestic abuse cost the economy 66 billion pounds a year, just in terms of women needing to access you know, the criminal justice system, the NHS, that list goes on and on. So, it boggles my mind that really, you know, you should be funnelling money into prevention, because you're saving money in the long term, you're obviously, hopefully making a dent in this huge problem, which is gender-based violence. But we're still struggling to be heard. 

So, I think what's really interesting about all this media coverage recently, everyone always asked me; why do you think this is? And it's, you know, it's probably multiple reasons. I think, in my sort of experience, I think there are just more women working in journalism. And so they want to cover this. And I often asked journalists, I'm like; how many men working your team? I find that they will be the ones who will be driven to kind of cover these stories. So, that's really good. But then, I don't often get men calling us who want to cover the story. It normally takes a tenacious, sort of junior woman journalist to, to kind of want to cover these stories. But I think as well, we've got to remember that every death, every act of violence is a tragedy. It's not measured by how much media coverage it gets. And we and I think we all know why Sarah Everard got more media coverage than Bibaa Henry and Nicole Smallman. Yeah, I think what we need to do is start going a bit deeper in thinking about how we value women's lives just more in general, but in how we are ordering those lives as well, in terms of importance - that black and brown women just are worth less.

EM: Thank you for that Deeba. Beena, could I hear from you, please?

BR: Hi, Ella. Thank you. It was just exactly that point that I wanted to pick up from what Deeba was saying. It's such an important point because I think we have to have a radical shift in the narrative in the global narrative about this topic. It's about time we stop this victim-shaming and victim-blaming and saying that something's wrong with a woman. This is a humanitarian crisis. As Deeba said this gender-based violence is a humanitarian crisis. I'm sorry, I keep going back to stats. A woman dies at the hands of a man every three days. Yeah, and 60% of these deaths are by someone, she's been a current partner with or a previous partner. We're not saying that men don't experience violence, men experience domestic violence, men experience sexual violence. It does happen, but women who have higher rates of domestic violence and higher rates of repeated victimisation and are more likely to experience serious harm or death as a result of the violence. 

As Deepa said, it doesn't matter which walk of life you are from, it doesn't matter where you are. In UK, one in four women will experience domestic abuse, and one in five will experience sexual assault during her lifetime and sexual violence in the year March 2020 84%. of the sexual violence. Sexual violence victims were women and 50% of the women who experienced sexual violence reported to the police. So, only 15% reported to the police. 5.7% of those reported cases actually lead to convictions. In January 2021, a YouGov poll showed that 97% of women aged 18 to 24, experienced, sexual harassment in public places, that's how much, 94%, 97% of women aged between 18 to 24. And 70% of women of all ages, experienced sexual harassment in public space. Out of these only 94%, 95% did not report it at all. So, this statistic shows that this is such a common problem. 

Women don't feel safe. And more importantly, women feel that they can't report it because their voice will not be heard. I think the Sarah Everard case is really really important because it sparked, it shone the spotlight on gender-based violence. But it's also it was the perpetrator. The perpetrator was a policeman and a policeman, who if you look at what happened prior to the murder, he flashed women in his police force, he was apparently called the rapist. But this was not picked up. This wasn't vetted. This makes us think about this incident. And think about him not as a single rotten apple, but think about something that systemically wrong. I think what is positive about the Sarah Everard's story is, collectively women have in our psyche and our gut, psychic collective consciousness, we've experienced a lot of fear, we've experienced a lot of shame. But now we are experiencing anger.

I think the narrative is to express that anger and say, stop this. This is a collective issue, shine the spotlight on the perpetrators. And let's change the narrative to what can we all do? What can men do to keep women safe, we want men to be with us on this journey, to challenge any conversation that promotes gender-inequality in locker rooms, and so on. We want this to be a systemic effort, just like how the COVID-19 is a Pandemic. This is a Shadow Pandemic. And we want everyone to recognise this as a universal humanitarian crisis, and to rise up and play their role in addressing the gender based violence. There is such a thing as the socially acceptable victim, there is more of an outcry. If the victim is looks like us, or sounds like us. We've got to challenge this. So, women of colour women who make different choices to us, women who are, say, sexual workers, women who have problems with substance misuse. 

No, it's not okay for us to see the violence that happens to them as somehow it's less of a problem and look the other way. No, it has everybody every woman's universal human right, to feel safe. And that has to be honoured for every woman, irrespective of your background or what you do. We have a right to feel safe and to be safe.

EM: Syeda you put your hand up next. I would absolutely love to hear what you have to say.

SA: Well, I just want to say thank you very much to Deeba whose information there was absolutely eye-watering and also eye-opening. And also to Beena for what she's described as well, much of which I agree with. I just wanted to raise a point about the idea of co-opting men into fighting for women's rights. I feel really strongly that yes, that would be lovely, but is the patriarchy really going to fight itself? When you are part of a system that benefits you, the motivation usually isn't there, which is why patriarchy and misogyny have lasted so long, they are hand-in-hand, because one can't exist really without the other. 

So, I think that the other thing that I wanted to raise really was, it's very easy to despair. But it's okay to despair. And then you have to move, and then you have to decide you're going to take some action. But the actions that are required feel so big right now, that's what is also a source of despair. We have to look at poverty, and make sure that women don't live in poverty, because that increases their risk of violence being perpetrated against them.

We have to look very closely at education. There's a reason why the Taliban have not allowed women to be educated or girls to be educated for probably, I think it's about 50 days now or something like that. They don't want women educated, they don't want women to know that they have rights, according to their own religion. Why would they want that? So, education is hugely important. And it's not just of women, it is of men and boys, and it starts in the home with how we raise our sons. How our husbands speak with us how the men we know, challenge each other instead of colluding. 

As Beena said; locker room talk - it's not acceptable. It's one of those petri dishes where the mold and the fungus of misogyny just grows. So, we've got to go wider but also look at ourselves at the same time, wherever corruption starts, it's because an individual is corrupt or wrong, isn't it? And we have to look deep into ourselves to make sure; what am I doing as an as an individual to challenge this. And that I think, is actually harder in some ways, than persuading big government or big companies or bigger organisations. In some ways, of what is right, because it starts with your own personal values. And I think that's something that many people probably don't want to take a look into that mirror and see through reflection. I think that's something that's really hard.

We've got to look at justice, we've got to look at health, we've got to look at poverty, there are so many ways that we can, we can take some action, but ultimately, you've got to start with yourself. And with educating yourself.

EM: Deeba, I can see your hand up and I saw you responding very enthusiastically.

DS: Yeah, no, I was on mute. But I was like nodding my head furiously because that is exactly it. But  just to go back to to Wayne Couzens as well. It did not surprise me at all, that this person was a problematic person in the workplace. He was on a WhatsApp group where they would, you know, him and the colleagues would send misogynistic texts to each other. He was nicknamed the rapist, right? And it's long occurred to me doing this work in the workplace, that these individuals, right, these perpetrators who have such a clear problem with women, there's no research done on this. This is the other problem, but there's just not enough work that's been done on gender-based violence to understand but, I'm pretty sure that these are the same people who are in domestic abuse relationships at home, and then they come into work and they treat the woman they work with appalling. I think all of these things are connected.

I think these people have had a long history, normally of their behaviour, just like when Couzens, it's a perfect example of that, the flashing and the way that it escalates, it escalates into murder, right. And it's I think that's true of all perpetrators, they have usually got a period, a specific pattern of behaviour. So, when women come forward about things that are happening in the workplace, which are, quote, unquote, banter, and seen as sort of smaller things. I do worry about what is that person going to go on? To commit? They look at what they're getting away with now, it is really worrying. And I think, God, if they all knew that he was called the rapist, and they all knew that this guy had sort of history and a pattern of, sort of was well known. These perpetrators are always well known for their behaviour as well and it becomes sort of open secret. If somebody had just got in there sooner and kind of given this guy some kind of consequence for his behaviour, you know, who knows?

So, it does really worry me because I think there is not there. It's not sort of tackled as a holistic problem. When really this should be, you know, a major red flag. And just to say, about what you were saying earlier, you know, when we talk about prevention, we're still having these painful conversations about rape alarms and CCTV. And those, all of that it's too late, it's way too late. What you need to do is make sure women are not in that vulnerable position in the first place where they can be exploited. That starts completely, fundamentally starts with inequality, gender inequality in the fact that women are just by definition of the patriarchy, we have to be in a subordinate position and that, and that is only possible if we have access to less money and health care and less rights, right, we don't have the same amount of rights.

That's what the whole women's rights movement is about, right? I've spoken to plenty of police women who are working in police forces, and they experience harassment, sexual violence at the hands of other police officers. And so often they say that these organisations will close ranks, they protect each other, because it suits them to protect each other. And they're able to do that, so the violence just carries on being perpetrated.

I think people find it very upsetting to kind of say, you know, maybe the police's is institutionally misogynistic. I think we still really want to reject that. But as long as we have like total reverence for these organisations, it's going to be really difficult for those women to ever access justice or perpetrators to ever be to be found. It was like it was what you were saying Beena about those statistics. It's so important when we talk about statistics to remember that barely any women are reporting. Those statistics are just a tiny fraction of it, and they're already appalling.

Imagine if every woman actually came forward every single time she experienced VAWG. And I think another really important thing to point out is that women don't just experience VAWG once in their lifetime. A lot of the women I support, if they're experiencing sexual harassment in the workplace, they might be specifically especially triggered, because they've experienced domestic abuse from their husband, because they were raped or assaulted when they were a teenager. So, when they experience VAWG again, it's bringing back all those other previous experiences of VAWG. And every woman just kind of has to accumulate that and carry that around in their body and in their person for the entirety of their life.

And I think there's still a lot of disbelief that oh, you can be assaulted more than once in your life, we still sort of struggling to, to understand that because we cling to these kind of myths that, nothing that bad could happen to you twice. When that's not true.

EM: We...we've touched a little bit on how the death of Nicole Smallman, Bibaa Henry, Sabina Nessa and Sarah Everard, have personally affected us as women. But how is the mental health of women affected by things that happen to other women, not just to them?

BR: I think individually as Syeda and Deeba pointed out, it has raised a sense of, I think, hopelessness, because look at the perpetrator in Sarah Everard's case, it was a policeman. Look at Nicole Smallman and Bibaa Henry, you know how the police reacted, they took selfies for 36 hours, there's a poor response. So, I think there's a sense of helplessness and a sense of despair, a sense of hopelessness. But again, I want to possibly sounding optimistic because, you know, my psyche can only bear so much of pessimism. So, I feel there's also that collective anger and that collective rage that women have experienced and are expressing that says; enough, stop this narrative, stop the victim shaming and victim blaming, let's shine the spotlight on the perpetrator. Let's look at what men need to do to keep women safe. 

Could I just respond very quickly to the very, very important point that Syeda raised, that I completely understand that scepticism towards my call for men to join us in the battle, to say, what lies at the heart of gender-based violence is patriarchy, and, you know, gender-based violence perpetuates the patriarchy. And of course, why would somebody want to dismantle something that gives them power? I completely understand that. But if you look at the root cause of patriarchy, it is it the whole, you know, it's it starts from childhood. It's very damaging for men too. And it starts with little boys at the messages that we give little boys in our homes and schools. It starts with men, you know, adult men, not colluding with a system but challenging it in locker rooms and, and work places when they hear these patriarchal conversations. 

EM: Deeba, can we come to you? Which gender stereotypes do you think perpetuate violence against women? If you could possibly sum that up?

Deeba Syed: I feel sympathetic to what Beena is saying, although I agree with Syeda as well. Like, men are not going to dismantle their own power structure, and that's why it's there. But um, I do think violence against women is rooted in a kind of a sense of insecurity in men and a need to assert dominance because they feel not dominant enough, I guess. And I don't know exactly what the reason for that is. 

Women are always the target because we are fundamentally lower and weaker. And that's, I think that's why gender-based violence kind of perpetuates because there's always - and I think that's really interesting about street harassment or public sexual harassment, I should say, it's such an immediate, instant way that you can humiliate and dominate someone. And they never do it - you know - they're not doing it to men, they're doing it to women, because they are a susceptible target. Very unlikely to fight back the risk of danger is there. I think that's true of all gender-based violence, isn't it? That's why it's gendered because when we look at perpetrators, usually they are not treating other people like that they're not randomly treating people like that in the home or in the workplace or on the street. They are specifically doing that to women. And I think that's what people have struggled to understand.

I found having conversations with men, particularly about what happened after Sabina Nessa was; oh, you know, that's just a random lunatic, right? That would never actually happen. Because the presumption is that these are freak attacks, there's no pattern, there's no rhyme or reason. That's what the police were trying to do after Sarah Everard, they were trying to minimise it; you know, this is very rare, this wouldn't happen. But I think we're still kind of, in that stranger danger place where you know, it's unlikely to stop happening. I think you would say exactly what you said, Beena, there was collective righteous rage. We were being treated like we're being hysterical.

Again, just look at how the Sarah Everard vigil was policed, right that it was so disproportionate. The fact that we couldn't come together and mourn kind of peacefully, and it turned into a completely violent scene, when it didn't have to be. We need to just be very, very organised and clever in how we are responding to these proposed solutions.

So, I don't know if you saw the Met. The Met put out a statement saying that women should wave down a bus. We all know how ridiculous that is in so many different ways. But we've got to kind of put that pressure up and kind of say; look this kind of response is not good enough. And this isn't going to be enough anymore. We're going to have to look at ourselves really properly.

There has been a bit of pressure, they're going to do an inquiry, the Mets going to do a kind of more informal inquiry, not statutory inquiry. But into looking at how Wayne Couzens was recruited and how there might be similar problems in the in terms of their vetting process. We've had inquiries before, we've had reports before, it was back when Steven Lawrence was murdered. The McPherson report, concluded that the police were institutionally racist. And I think it's about time that we have some report acknowledging the institutional misogyny inside the police as well.

EM: And Syeda, I'd like to come to you next please because you work with women every single day. What do you feel mental health services could do to better support women who are impacted by violence? 

SA: I think there are many, many aspects because mental health is the motto of the College of the Royal College of Psychiatrists says there is no health without mental health, and it's quite right. This is a big job. So, I think that we have to start from the very roots of psychiatry.

If you think about even the basic classification system that we use for mental disorder, that's altered so much during the 20th and 21st centuries. Women's issues are being recognised, we now look at PTSD and complex PTSD will be more widely accepted and understood in the new iteration of our basic classification system of mental and behavioural disorders. I think that's hugely important.

So, we have to also look at making sure that we've got very specialised services for women, my experience of treating women patients is, it's very different from looking after male patients, my female patients will have a completely different social role. They are often mothers, sisters, daughters, they have caring responsibilities, they have responsibility for so much in their lives. All of these are great stresses, which are issues that will make it more challenging to get them on back on an even keel, back to the level of functioning that we expect of a woman, we don't actually expect the same of male patients, they don't hold the same social role. When I worked in male services. Interestingly, it would be for the more unusual male offender with a serious mental illness who, who would have visits, say from their mum.

We do find that with our women patients, they've got an entire family and entire social network and ecosystem around them. Everything is different. The role of a woman is so different, and it's reflected in how we have to care for women. So, we need more resources, we need to alter the the amount of services that we've got for them. We need to make sure that services are accessible, women may not be able to leave a home in order to access the help that they need. They're much more likely to be hurting themselves than hurting other people and attracting attention from various other services such as the criminal justice service or system. So I think it's such a big question.

We need more research, we need more data, there has to be motivation to collect all of this. Something that really shocks me is that the hospital I work in, we have many surrounding hospitals with so few beds for women, even the newest hospital, close by in my region, built a tiny number of beds for women in patients. I was shocked. So, out of 123 beds, I think, perhaps 18 were for women. That to me is quite shocking. That to me says we're just not going to go there with looking after women because it's expensive, and it's challenging. And it's different from the psychiatry of men that were taught at medical school, and all the way through Higher Training. And so we're not going to go there.

Also, what Deeba and Beena said about the impact of female psychiatric morbidity on the economy in the country, in financial terms, as well as social terms, that should be something that motivates those who allocate resources to ensure that resources are adequate. At the very least, it seems to be something that's you know; well it's women, so it doesn't really matter.

I just want to very, very quickly just respond as well to your question earlier about the impact of the the deaths that we've spoken about, very quickly. How did I feel? Bloody angry, but also very energised? We're not going to take this anymore. I spoke to male colleagues about these deaths, and nearly all of them said, it's not all men. And my response to all of them was, well, it's too many men, isn't it? It's too many men. So, they were quite quick to try and wriggle out of having any responsibility for being part of the culture that perpetuates what results eventually, in the death of innocent women. This is not acceptable.

The other thing that I just want to raise as well as all of these systems, even if they say they're gender neutral, whether they are the law health, they are man-made the word that I think is important there is they are manmade. So, we have to look at tailoring everything that we offer, specifically towards women, particularly in mental health. 

EM: Beena please can I come to you next. I want to know what you think mental health services could do. Syeda said earlier that women have an entire ecosystem around them. Is this something that you've seen in your female patients as well?

BR: Thank you Syeda. Beautiful points that I completely agree with. Like Syeda, I work in a women's service to. I worked, I spent my entire career working with women, as a psychiatrist. And I think the women's mental health taskforce report is very, very, very crucial. I completely agree with the report, it showed that women have a higher experience of trauma, and a higher way of expressing that trauma. But our services in mental health are not built, they're very, as Syeda said, gender neutral. And they are not tailored for the needs of these women.

So, our services have to be gender sensitive, trauma informed approaches, we have to take trauma informed approach across the country with our services, and it has to be gender sensitive. That is absolutely key. And I will push this till my last breath. sounds dramatic. Why is this so important? Because when we have somebody who's experienced gendered violence, gender-based violence, and they also have a mental illness, let's say depression, and if we as psychiatrists are just focusing on the depression. What message are we giving them? We are giving them the message that the trauma is invisible. What the perpetrator did to the women was, you know, is not seen, it's not heard. And we are saying, we are giving them the message that something is wrong with you, and you need to be treated. It's very, very important that we are very clear about this narrative. And we change that narrative.

So, trauma informed approaches help us to change that narrative. In moving from what's wrong with you? To, what happened to you? For us, trauma informed approaches, looking at the trauma, keeping it centre stage, I think there are amazing voluntary sector services out there who do excellent domestic violence outreach. Advocacy services, who helped, you know, with housing, finances, looking at all those issue alongside the mental health issues is very, very important. So us, co-working, and us taking a systemic approach and working alongside other agencies, and keeping important issues like safeguarding advocacy, all that at the heart of our care is very, very important. I think we really need to commission the service and work alongside them. Trauma-informed gender specific care and mental health services has to be our way forward, otherwise we are re-traumatising our women. And we are adding to the narrative that something's wrong with you. We are increasing their sense of shame, increasing their sense of threat, increasing their sense of isolation. That's just absolutely not acceptable.

EM: Thank you so much, Beena, thank you for that was amazing.

And Deeba, something that really struck me early on in the conversation that we had was that you give free advice to women who have been sexually harassed in the workplace, these women also probably will need to access mental health services. And it can be very overwhelming for someone in such a vulnerable position to be seeking support from several different services.

DS: And then we just add to what Bina was saying, this is what you said; about stop asking what's wrong with you, and start asking what happened? This is so fundamental, because we, especially the women I work with, when they do have a resulting mental health issue from the harassment and discrimination that they have had happen to them. As soon as they are diagnosed with anything, it's so easy to kind of gaslight that person and act like their memory cannot be trusted. When we are trying to support them through workplace investigations and things like that. That will be, you know, the fact that they have any kind of mental health complication will be weaponised against them. Their account of the events can't be trusted, that they no longer have credibility, especially that happens all the time in the justice process a lot.

BR: Ella, could I just come in there with one very, very important point. Something that the Women's SIG is pushing for is this point that Deeba raised. I think it's really, really important. So, that education, we want gender-based violence to be in the curriculum of medical students, of core trainees. We want that education to start in schools actually, right from the beginning. We want this education and training to be a core part of a way of tackling this.

EM: Yes, thank you so much Beena and it is so important that that training happens early on. The question that I asked you Deeba was; you give free advice to women who are being sexually harassed in the workplace. These women also need mental health support from these different services that are not integrated.

DS: Yet, they're often just sent around the houses. They've contacted loads of different organisations, they're relying on free support as well, you know it's charity support. So,it's never going to be the same as having sort of a dedicated person who's there to look after you, there's just simply no resource for it. And it's devastating, it's just absolutely devastating to their lives, that also has a massive impact on their mental health. The fact that they have to repeat their story over and over and over. It just makes the whole situation worse for them. I really don't blame women who just don't want to come forward at all. I really, really don't blame them. I never sort of encourage anyone to do anything. They don't want to I'm just there to support them in the decisions and give them the information and the support and the advice.

They are all heroes for even entertaining it or trying to do any of these processes. Especially the legal process, you know, which is entirely optional. You don't have to do that process at all if you don't want to. Any woman who's doing it is remarkable because it takes so much strength, so much mental fortitude, especially after what they've gone through.

EM: Thank you to Dr Beena Rajkumar, Dr Syeda Ali and Deeba Syed for coming onto the podcast and speaking so openly. If you'd like to find out more about women in mental health, please visit our website at www.rpsych.ac.uk, go to the members page then select Special Interest Group then women in mental health. Thank you for listening to the Royal College of Psychiatrist's podcast with me Ella Marchant.