IN this timely book, professor Linda Gask illustrates the desperate need for change in the treatment of women in the mental health system using her professional and personal experience. Women can’t all be out of their minds.
 
Gask is the author of two previous books, True North and The Other Side of Silence, and as a retired consultant psychiatrist, she has both used mental health services and worked in the field as a practising psychiatrist, academic and author.
 
She was recently featured on the moving BBC Scotland Disclosure documentary about suicide in women in their 40s and 50s.
 
Problems with mental health, in particular suicide rates, have meant the spotlight has often been on men. Why have you focused on women?
 
A few years ago, I was asked to participate in a debate for Women’s Week in Manchester to oppose the motion “Men are the losers now.” I understand why many people in our society might agree with that statement. Indeed, the suicide rate for men is three times that of women, but it started me thinking about all the many ways that women are still losing out in our society.
 
How are women losing out?
 
Women’s emotional pain is often downplayed, and the illnesses they more commonly suffer from, such as eating disorders, get less investment in terms of treatment and research.
 
Other pain is not taken seriously. When women self-harm because of their distress and despair, they are told they are wasting the time of health services, and when they suffer unexplained or persistent physical pain, their suffering is again underestimated, and they are told it is “in their head.”
 
Neither the real-life problems they face, nor the reality of the mental illnesses they may experience, are given due attention in terms of adequate care or research funding.
 
What can psychiatry and the mental health system do to improve care for women?
 
There are several things we need to do:
 
• We need to look at services through a gendered lens. “Gender-neutral care” doesn’t take women’s needs into account — it’s largely about what suits men.
 
• Psychiatry needs to consider how a focus only on diagnosis can mean that the woman herself becomes seen as the “problem” rather than addressing too the social conditions women face in our society. Domestic and sexual violence, poverty, emotional and sexual abuse are all more common for women and play a key part in how and why her problems developed and what needs to happen to improve her life.
 
• We need much more education for psychiatrists on the impact of hormones on women’s mental health needs and care.
 
• We must stop using the terms “Borderline Personality Disorder” (BPD) and “Emotionally Unstable Personality Disorder” (EUPD). Not only do they cause further harm, but women are being misdiagnosed, and their distress and despair are written off as “attention seeking.” Many have experienced traumatic lives, and others may be neurodivergent or have serious problems with their mood which are not being addressed.
 
• There must be an expansion of therapy options for women. Six weeks of CBT is never going to help a woman who is depressed because of experiencing years of trauma.
 
• We need more knowledge, training and care for eating disorders. It’s a problem more women than men experience and gets less attention.
 
• We must improve the state of in-patient care for women. Women facing the barriers outlined above are regularly dying in our hospitals.
 
As you say in your second point, symptoms and a diagnosis (like BPD) can mask social hardships and trauma, making women feel they are the problem  — that something is “wrong” with them.
 
Women are disadvantaged in many ways in our society, which contributes to them suffering twice as many common mental health problems. For eating disorders, this is three times more than men. They are also more likely than men to self-harm, especially younger women.
 
Women are subject to sexism and misogyny throughout their lives, with more exposure to childhood domestic and sexual violence and harassment. To survive, women are more likely to be reliant on benefits, live in insecure housing, and be single parents, unpaid carers and in low-paid and precarious work.
 
The greater the poverty, the more likely they will experience mental health problems and when other intersectional factors such as ethnic minority status, LGBTQ+ and disability are factored in, the level of disadvantage multiplies.
 
Women are often dismissed as being “hormonal,” but you’re saying they do play an important role, and as such, there needs to be much more education for psychiatrists.
 
Our moods are affected by our hormones, and for some of us, times such as adolescence and the perimenopause can be very difficult. If a woman has a history of postnatal mental illness, she is more likely to have mental health problems in the perimenopause.
 
Melanie Reid from the Times said Out of Her Mind was essential reading for mothers of daughters. That reminds us young women might be having these problems in adolescence and on top could be exposed to unfettered social media. But few seem to be taking this seriously.
 
Youngsters have so little escape from surveillance by critical peers on social media. They have poorer mental ill-health than they did a decade ago, particularly young women in their late teens. Meanwhile, we have politicians and some psychologists playing down the seriousness of this problem and saying they need to toughen up.
 
Women’s distress has never been taken seriously, and this must change.
 
Out of Her Mind: How We Are Failing Women’s Mental Health and What Must Change by Professor Linda Gask is out now from Cambridge University Press.