My cousin was raped – then harassed on a mixed sex mental health ward that was supposed to keep her safe

In February 2017, eight months before she died, Gaia was an inpatient at St Ann’s Hospital – which, like the community services that were failing us so utterly, is run by Dorset Healthcare. In a climate of savage government cuts and a severe bed shortage, unexpected deaths of Dorset service users were soaring and hundreds of patients were being forced as far as Manchester to find care.

While Gaia and I raised concerns about her being in a mixed ward, at least it wasn’t hundreds of miles away. There was nothing we could do except fight – and it was always a fight – to get some recognition of the fact Gaia was a rape survivor; that this trauma was at the root of her mental distress; and that she lived in fear of retaliation from the perpetrator or being abused by someone else.

When she was sexually harassed by a fellow inpatient in the one place she was meant to be safe, it took courage for her to report to staff after all her previous experiences being dismissed and disbelieved. In response, not only did they fail to make a safeguarding referral or log the incident in line with their own policy, they discharged her within 48 hours.

The inquest into Gaia’s death exposed more than 50 institutional failings and laid bare the wreckage left by a decade of austerity cuts. This, I was prepared for. What I was not prepared for was the avalanche of evidence of institutional misogyny in our mental health system.

Gaia’s medical records read like a police report. Notes about her “delusions” of assault and questioning the validity of her claim dated back to before the police investigation had even begun.

One psychiatrist, Dr Kannan, noted Gaia had lived in fear of the consequences of “not complying” with the perpetrator but failed to recognise this as a teenager being subjected to textbook coercive control. He intended, he wrote, to refer Gaia to Steps to Wellbeing – the cheapest, most generic short-term counselling available and pretty much all that they offer – but he forgot to do so.

Subsequently, we were repeatedly told Gaia did not “meet the threshold” for community mental healthcare. She would die not meeting their threshold.

Three weeks earlier, Gaia’s final mental health crisis saw her taken to hospital in a police car because there were no ambulances available. She was shouting and crying about the rape and was held in hospital for over 50 hours waiting for a mental health assessment.

She was terrified of being sent back to St Ann’s and agreed to take a sedative when nurses told her it would improve her chances of being allowed to go home. So Gaia was sedated and sleep deprived by the time she was assessed, so they could justify releasing her again with no support referral.

On the day she disappeared, Gaia had an appointment booked with her GP because despite everything, this was the only avenue left to her to access support. It was of course far too little and far too late.

There is growing awareness about how the legal system weaponises survivors’ trauma against them, contributing to a stunningly low rape conviction rate of 1.5 percent. Either you’re “too calm to be an abuse victim” or “too unstable to be a reliable witness,” one reason why those with mental health challenges are40 per cent less likely to have their case referred for prosecution. But this happens in the healthcare system, too.

Almost half of women who experience severe mental distress are survivors of sexual violence yet many trusts lack specific, trauma-informed policies and training for staff about survivors’ needs.

Gaia was one of the eight in 10 women and girls diagnosed with a mental illness after turning to the NHS for help coping with the trauma of rape. While much attention has been paid to how Gaia was failed by police, our experience with the NHS was no better.

Despite consistent pleas for support, in those two years Gaia spent less than 30 days under the care of community mental health services. She was repeatedly neglected until she spiralled into crisis, at which point she would be sectioned and sedated (“stabilised,” they called it), only to be discharged – yet again – with no follow up care.

Both a lack of funding and a lack of understanding mean that the impacts of sexual trauma are either ignored or pathologised as symptoms of a mental illness, both of which retraumatise the victim. This also makes many survivors afraid to turn to services in the first place and less likely to report abuse - putting everyone at risk.

Meanwhile, independent specialist Rape Crisis services with the expertise to lead service provision, education and culture change in the NHS are left fighting for their survival.

Fewer than 20 per cent are still fully funded and many have been forced to close their waiting lists, which runup to 18 months long.

Sexual trauma and the legacy it leaves requires specialist support underpinned by a trauma-informed and survivor-centred approach. Unfortunately, this is antithetical to what the NHS has become: an unconsciously and institutionally misogynistic bureaucracy of gatekeepers with one eye on the clock who prioritise cost-cutting over care.

The history of psychiatry is steeped in misogyny, white supremacy and ableism and it has long presented the prejudices of its practitioners as objective science. Tokenistic moves to address this with what they call “a patient-led approach” but is actually just a withdrawal of care, might improve the optics of austerity from a PR perspective but it doesn’t help anyone.

The state of our mental health system today reflects the ideology and priorities of neoliberalism, favouring incarceration and medication over the social support and specialist care that actually works long-term. As long as this culture holds sway lives like Gaia’s will be needlessly lost and both public health and public safety subordinated to someone else’s bottom line.

Marienna is a social justice advocate and writer. She led the Justice For Gaia campaign and now works with the Gemini Project. She is also writing The State of Britain Is Killing Us, collecting the stories of changemakers who lost loved ones in state custody or care