Psychiatrist’s fight for women-only wards: ‘I started to think it would never happen’

The story behind Australia’s first women-only private mental health hospital is about safety.

Founder Professor Jayashri Kulkarni, a long-serving public psychiatrist, had witnessed firsthand the end of the asylum era, deinstitutionalisation and the dark consequences for women in the remaining acute wards.

“There was no separation between men and women, and unsurprisingly, horribly, this led to lots of assaults on women,” she tells AusDoc.

“Physical, sexual, emotional harassment, stalking.

“Personally, I was involved in cases where women had been raped in inpatient units.

“These women often had a horrible background story of violence against them, and here they were in hospital, experiencing more violence and re-traumatisation.

“It made the job of trying to treat them much more difficult.”

In her view, the “literally concrete” solution to end the assaults was to build separate units for men and women.

But it took decades of her campaigning before Cabrini Women’s Mental Health, where Professor Kulkarni is medical director, finally opened in Melbourne five years ago.

“Over the years, I kept raising this issue, and people would nod their heads and say, ‘It’s true, this is a difficulty, but there’s nothing we can do.’”

In 2010, Victoria’s Alfred Hospital received $320,000 to build an eight-bed women’s unit.

Professor Kulkarni co-authored a paper on the outcomes.

“Not surprisingly, the women in that ward were much happier, much safer, and there were no assaults in that area,” she says.

In response, the Victorian Government granted all public facilities permission to ring-fence several beds for women.

But this solution was short-lived.

“There is always pressure on mental health beds … and people started to do things like fill the empty beds in the women-only area with men, even if there were two other women there already,” Professor Kulkarni says.

“The system started to crumble from the inside.”

The Victorian Mental Health Complaints Commissioner then invited Professor Kulkarni to take part in a review of Victorian hospitals where assaults had happened.

“In one hospital, the lock to the women’s-only area had broken and staff said they didn’t ask for it to be fixed because they were putting men in there anyway,” Professor Kulkarni says.

It also revealed that women’s units were often far away from the nursing stations for privacy, but this had made them more dangerous for assaults.

“The idea had been good, but it had fallen apart.”

The review report was tabled in Parliament. Nothing happened.

Professor Kulkarni kept campaigning, but faced constant pushback: bed shortages; the question of where transgender patients would be placed; whether staff would want to work on male-only wards; not enough money.

In 2019, she took the issue to the Royal Commission into Victoria’s Mental Health System, but its interim report was largely silent on the concerns for women’s safety.

“Everybody agreed this was unacceptable, but nothing changed,” she says.

“I had been to so many safety committees saying the same thing that I started to think this was never going to happen.”

What changed? A chance conversation.

Professor Kulkarni, in her capacity as professor of psychiatry at Monash University in Melbourne, had visited private health service Cabrini Health to discuss psychiatry research with the CEO, Sue Williams.

“I found myself talking on my favourite hobby horse … and she said, ‘It’s funny you should say that because I’ve been thinking about what we should do for psychiatry and mental health beds.’

“I got two minutes into my pitch about women’s mental health and she said, ‘Okay, let’s do it.’

“I couldn’t believe it, but that was the way it went.”

Ms Williams offered Professor Kulkarni an old rehabilitation hospital in Elsternwick, Melbourne, and tasked her with opening the facility by mid-2021.

Now, the 30-bed unit provides inpatient stays for up to 14 days and a 10-week community program, a model designed to end the cycle of repeat hospital admissions.

“The whole program is built on dealing with and helping people through trauma … and the biological aspects that are different for women, the hormone-related issues,” Professor Kulkarni says.

This includes treating patients with menopausal, perimenopausal or premenstrual depression.

Notably, the diagnosis of borderline personality disorder is never used.

“That term is an anathema to me,” Professor Kulkarni says.

“I’ve been campaigning for a long time to get rid of it because how dare we label these women as personality disordered when in fact, if you bothered to go and take their story, there is a horrible, early-life trauma story that has never been recognised or dealt with.

“It is often that story that her subsequent behaviours, self-harm in particular, stem from.”

The admissions process can last more than two hours to take this detailed history, she says.

Allied health practitioners trained in trauma therapy support the therapeutic program.

Four psychiatrists are now on board, although recruitment was challenging at first.

“I could not believe it was so difficult because I thought, ‘This is a nice place, it looks beautiful, the staff are lovely, it’s a different, caring environment,” Professor Kulkarni says.

“There isn’t a custodial feel at all, yet I still couldn’t get a psychiatrist.”

As a solution, she approached some GPs, whom she says jumped at the opportunity.

“In the facility, the GPs admit patients.

“They love it because they get to be the consultant with a big team of allied health and nursing staff who carry out the program.

“There’s no difference between a psychiatrist admitting a patient and a GP, except for the remuneration, which I’m annoyed about.

“That’s my next battle.”

Professor Kulkarni says she always wanted the set-up at Cabrini to be exportable, and once established, she took it to the public system.

She convinced the Victorian Government to run a tender for a public unit, which opened in 2022 through a partnership between Ramsay Health Care and Alfred Health, using the Cabrini model.

“I’m thrilled because now there are units in Perth and one is being opened in Queensland,” Professor Kulkarni says.

“The idea of women’s mental health needing a separate understanding and attention paid to safety and privacy is catching on.”

This month, Cabrini Women’s Mental Health published data from its first three years showing that 95% of 972 patients surveyed had felt safe in the hospital’s care.

Professor Kulkarni finally has a sense of justice being delivered.

“I think we should all have a sense of guilt and shame that we have, as a group, allowed this to happen,” she says.

“It is our fault when a woman comes into a care facility and is assaulted.

“That is unbelievable, and what kept spurring me on.”