1. TREATMENT CONSIDERATIONS
FOR WOMEN PSYCHIATRIC
PATIENTS
Donna E Stewart, MD, FRCPC
University Professor and Chair of Women’s Health,
Senior Scientist, University Health Network,
University of Toronto, Canada

2. INTERNATIONAL CONSENSUS
STATEMENT ON WOMEN’S MENTAL
HEALTH
Approved WPA General Assembly
Cairo 2005
World Psychiatry 2006;5: 61-64

3. WOMEN’S MENTAL HEALTH
• WHO: Can only be understood by considering
the biological, social, cultural, economic and
personal context of their lives
• WFMH 1996: “Psychological distress for women
often has social origins. Discrimination against
women in employment, education, food,
healthcare, and resources for economic
development, renders them vulnerable to
physical and sexual violence, psychiatric
disorders and psychological distress.”

4. CONTEXT
• Women’s Mental health must be considered
within the context of women’s lives, and cannot
be achieved without access to basic human
rights:
- autonomy of the person, education,
safety, economic security, property and
legal rights, employment, physical health,
including sexual and reproductive rights,
access to health care, adequate food, water
and shelter

5. CONSENSUS
• Mental health a critical aspect of public health
• Health promotion, prevention, policy
• Social, economic, cultural aspects as well as
biological
• Focus on broad determinants of mental health
• Education is the key to empowerment: schools are
vital
• Primary health care sites for MH promotion, ID, Rx
• MH information and services available for all groups
• Strong gender perspectives to guide multidisciplinary
teams and stakeholders
• Only by societal attitude shifts will women realize their
full potential and MH

6. Positive women’s mental health benefits the
health of women themselves, their
families, and the general population, and
promotes women’s participation in
professions and leadership

7. TREATMENT
• The setting for care should be
nonstigmatizing and within their economic
means, by adequately skilled health
professionals with access to appropriate
treatments
• Treatment settings should be safe, and
free from breaches of fiduciary trust by
health care providers and staff

8. • Women’s preferences for informed
medical decision making should be
respected whenever possible
• Quality of care should be assessed by
indicators that are consistent with best
current knowledge, informed by gender-
sensitive research
• Women who have been sexually abused,
or who have strong preferences for female
health care providers, should be
accommodated whenever possible

9. • Appropriate services for adolescent,
peripartum, midlife, older, immigrant,
refugee, disabled and incarcerated women
are essential
• Acute and continuing care, supportive and
rehabilitative mental health services
across the life span are essential to enable
mentally ill women to achieve their optimal
level of functioning and wellbeing

10. RECOMMENDATIONS
Appropriate governmental,
nongovernmental, health and international
organizations should integrate girls’ and
women’s mental health as a priority in
policy and program development and:

11. 1. Support psychological health promotion
programs that encompass the life context
of girls and women to include equal
access to basic human rights, education
and employment, the elimination of
violence and discrimination and the
reduction of poverty
2. Support women’s marital, sexual and
reproductive choices and ensure access
to safe motherhood

12. 3. Support public education and awareness
campaigns that increase recognition and
reduce the stigma of mental illness in girls
and women
4. Support safe, respectful, appropriate,
gender sensitive comprehensive mental
health and physical health services for
girls and women across the life cycle
irrespective of the economic and social
status, race, nationality or ethnocultural
background

13. 5. Support timely access to adequately
skilled mental health professionals who
provide quality of care consistent with best
current knowledge and availability of
appropriate therapy, technology or drugs
and who take women’s special needs into
consideration
6.Support the development and use of
culturally appropriate diagnostic systems
that consider the sociocultural context of
women’s lives, and biological differences
when they are salient

14. 7.Support the provision of accurate
information and respect choices in
treatment decision making by girls and
women whenever possible
8.Support the provision of mental health
care for girls and women that is free from
breaches in fiduciary responsibility
9.Support increased attention to research on
girls’ and women’s mental health including
those factors which enhance or inhibit the
development of resiliency

15. 10. Support the provision of core training and
education about gender issues for
health, and mental health, professionals
11. Support gender equality in practice and
promotion within mental health services
and organizations including equal
opportunities for advancement and
eradication of gender harassment,
intimidation or unjustified discrimination
on the basis of sex.

16. UNITED NATION’S INSTRUMENTS
RELEVANT TO M.H
• Protection of Persons with Mental Illness
• Protection and Promotion of Rights and
Dignity of Persons with Disabilities
• Declaration of Human Rights
• Economic, Social, Cultural Rights
• Civil and Political Rights
• Against Torture, Cruelty, Degrading
Treatment

17. INTERNATIONAL ORGANIZATION &
REGIONAL INSTRUMENTS
• WPA – Declaration of Madrid and following…
- Consensus Statements – on Women’s
Mental Health & VAW
• African Charter on Human Rights
• Interamerican Convention on Human Rights
• European Convention on Human Rights
• Council of Europe Recommendations on
Psychiatry and Human Rights

18. PROTECTION OF PERSONS WITH
MENTAL ILLNESS
and
THE IMPROVEMENT OF MENTAL
HEALTH CARE
http://www.un-document.net/a46r119.htm
Office of UN High Commissioner for Human Rights
Dec. 1991, Adopted by General Assembly

19. • 1.1 right to best available care
• 1.2 treated with humanity and respect *
• 1.3 protection from exploitation, abuse and
degrading treatment *
• 4.3 family, professional, moral or cultural
conflicts never a determining factor in
diagnosis

20. • 8.1 right to received care appropriate to
health needs
• 8.2 protection from harm
• 9.3 in accordance with applicable standards
of ethics
• 9.4 directed towards enhancing personal
autonomy

21. • 11.1 no treatment without informed consent
• 11.4 right to refuse treatment
• 11.12 sterilization never carried out as
treatment
• 13.2 living conditions close to those of normal
life
• 13.4 labour of patient never be exploited
• 19.1 entitled to access to own health and
personal records
• 20.2 right to receive best available care

22. UN CONVENTION ON THE RIGHTS OF
PERSONS WITH DISABILITIES
ADOPTED 2006, FORCE 2008
• Sets out legal obligations on states to
promote and protect the rights of persons
with disabilities
• Article 1: Includes those with long term
physical, mental, intellectual or sensory
impairments which in interaction with
various barriers may hinder full and
effective participation in society on an
equal basis with others

23. GENERAL PRINCIPLES
• Respect for inherent dignity , autonomy
and independence
• Nondiscrimination
• Full and effective participation in society
• Respect for differences and acceptance of
persons
• Equity between men and women
• Accessibility to health services
• ----
• ----

24. RIGHTS
• Freedom from exploitation, violence and
abuse
• Respect for privacy
• Right to health care
• Right to work
• Right to adequate standard of living

25. CONCLUSIONS
• There are special issues for women
psychiatric patients
• Power/autonomy/informed consent issues
• Respect/modesty issues
• Sexual abuse issues (staff and patients)
• Safety issues
• Access to appropriate/sensitive care
• Needs education, policy, more training