S1: From the newsrooms of the Sydney Morning Herald and The Age.
S1: This is the morning edition. I'm Samantha Cylinder Morris. It's Wednesday,
S1: April 23rd. It wasn't uncommon in the 19th century for
S1: women to be given the diagnosis of hysteria and admitted
S1: to mental health asylums if they didn't do what their
S1: husband said, or if they swore or had sex outside
S1: of marriage. But did you know that women are still
S1: being involuntarily sectioned in Australia today? Investigative reporter Ayesha Dow
S1: on what has led many women to end up in
S1: this terrifying situation, against their will and the consequences of
S1: being disbelieved and often misdiagnosed. So, Ayesha, you and our
S1: colleague Kate Aubusson, you've spoken to many Australian women who
S1: have been misdiagnosed with a mental illness. So let's just
S1: start with what broadly are the sort of cases that
S1: we're talking about. And are we actually talking about a few, frankly,
S1: terrifying one offs, or is this sort of widespread?
S2: Yeah. Look, I'm going to be really frank and say
S2: that I didn't expect that we would make some of
S2: the findings that we made as part of this investigation.
S2: We knew a lot going into this medical misogyny investigation
S2: about the sort of barriers you can face in the
S2: healthcare system or women in particular. We knew it was
S2: common for women to report having their pain dismissed, or
S2: that many face long delays getting a diagnosis, for example.
S2: But I, I didn't expect to discover not just one,
S2: but a few cases of women being reportedly placed in
S2: mental health wards when they weren't mentally ill. In fact,
S2: we heard about nine or so of these cases. I
S2: found this really shocking, as I'm sure many of our
S2: readers would too.
S1: Okay. So tell me about this. How are these women
S1: being wrongfully detained in public mental health facilities.
S2: Yeah. So it's going to be different, I guess, for
S2: each of those nine cases. But this investigation came about
S2: when we heard from one particular woman. So we're calling
S2: her Carol. That's not her real name. She told us
S2: that she was locked up in a mental health ward
S2: for 44 hours in 2019, when her husband allegedly falsely
S2: claimed she was suicidal. Now, Carol has consistently maintained at
S2: the time for years later, including up until this day
S2: that she was not suicidal at all. So there was
S2: a domestic dispute at the home on this day in 2019.
S2: Police were called, ambulance were called. The paramedics who attended
S2: the case, we got their notes afterwards and their notes
S2: said that they found that Carol did not present with
S2: any symptoms of acute psychosis or being an immediate risk
S2: to herself or others. They also found that, you know,
S2: she was sitting calmly in the lounge room, fully engaging
S2: in conversation. But the police heard something else that, you know,
S2: clearly worried them. They heard an allegation that Carol had
S2: apparently made in front of one of her children's psychologists,
S2: that she was going to jump off a cliff. Carol
S2: has always argued those comments were misrepresented. She said that
S2: she made an off hand remark about how she could
S2: drive off a cliff, and her husband wouldn't care less
S2: because of frustrations with feeling underappreciated and unsupported with parenting,
S2: but had not made a suicide threat. So that was
S2: one of the key things that came up in this
S2: case that was contested. It seems like the hospital put
S2: some weight in this allegation that she had been suicidal. Where? Carol,
S2: you know, consistently maintained that that comment was taken out
S2: of context.
S1: And I want to ask you about a particular woman
S1: who was involuntarily detained and sent to a mental health
S1: ward after she told police that she was being stalked.
S1: So what happened there?
S2: Yeah, this is an absolutely shocking case. It involves a
S2: woman who was worried about being watched and hearing noises
S2: in her roof. According to two doctors who are familiar
S2: with the case, the woman went to report her concerns
S2: to police about hearing these noises. But police didn't believe her.
S2: They thought she was delusional. As a result, she was
S2: forcibly admitted to a mental health ward for multiple days
S2: until it became apparent that she was actually competent and
S2: she was released. The doctors who are familiar with this
S2: case say the woman wasn't delusional at all. And down
S2: the track, her stalking complaint was validated when food and
S2: cameras were found in the roof of her home.
S1: I mean, that is just absolutely shocking. And you actually
S1: spoke to this woman's GP and a psychiatrist who specializes
S1: in trauma and family violence. So were they shocked at
S1: what happened there?
S2: Yeah, I think the answer to that is sort of
S2: yes and no. I think they were both incredibly outraged
S2: that this could happen. They were really outraged about this
S2: particular case where a perfectly healthy and sane woman could
S2: spend multiple days in a mental health ward, but they
S2: both have had quite a bit of experience seeing women
S2: misdiagnosed with mental health issues. Um, so perhaps in light
S2: of that, they weren't as surprised as you might expect.
S2: So we spoke to Doctor Karen Williams. She's a consultant psychiatrist.
S2: She's based in New South Wales, and she specialises in
S2: trauma and family violence. And she said to me, this
S2: is not a one off story. So she's actually heard
S2: of other similar cases like this, where women have been
S2: involuntarily admitted to mental health wards when, in her view,
S2: that's not appropriate. But she also told me many stories
S2: about women who had been told that they needed psychiatric
S2: help when they didn't need psychiatric help at all. So
S2: she is often treating women who've been referred on by
S2: their GP's for mental health support. But then she discovers
S2: that their symptoms aren't psychiatric. Perhaps they have thyroid issues,
S2: perhaps they have endometriosis, maybe they have polycystic ovary syndrome
S2: or chronic pain. And yet these symptoms have kind of
S2: quickly been dismissed as something that's all in their head.
S2: And off they go for mental health support when really
S2: they needed treatment by that doctor.
S1: I mean, it really does leave you sort of with
S1: your jaw dropped, which makes me want to ask. I mean,
S1: how easy is it or not to be involuntarily detained
S1: in a psychiatric facility. I mean, I think this would
S1: be a nightmare scenario for most of us. So tell
S1: us about this.
S2: Yeah, it's a really good question. And I think many
S2: people who would have had an interaction with the mental
S2: health system know it's actually it actually can be really
S2: hard to get into a mental health unit, even if
S2: you desperately need it. In my previous job as a
S2: health journalist, I'd often report on severely ill people who
S2: were having acute mental health episodes, and they were, you know,
S2: left to languish in Ed for days because there were
S2: there was no mental health bed available to them. And
S2: I guess that's one of the reasons why I found
S2: these stories so unbelievable, in a way, to begin with,
S2: because we know that there's a huge shortage of mental
S2: health beds. It doesn't seem to make sense that they're
S2: going to people that don't need them. Uh, however, we
S2: did speak to Matthew Large. He's a conjoint professor of
S2: psychiatry at the University of New South Wales. And he
S2: said these false positives. So these instances where someone is
S2: scheduled under the Mental Health Act when they don't need
S2: to be scheduled, he said they do happen and they
S2: do happen to both men and women. And he said
S2: that they happen because the health system is quite risk
S2: averse when it comes to the perceived threat of suicide.
S2: He said he'll sometimes hear doctors say things like, you know,
S2: I don't care. They're mentally ill or not. I don't
S2: want them to kill themselves. If that means they're in
S2: hospital for a day, that's the cost. And I guess
S2: you can kind of understand that perspective. But when I
S2: was speaking to Carol, one of the women who was
S2: involuntarily detained, she talked about the long term impact of
S2: that detention on her. She developed PTSD as a result
S2: of the time she spent in hospital. And she was
S2: sort of urging people to, when they're weighing up these things,
S2: to consider the cost of detaining someone when they don't
S2: need to be detained.
S1: We'll be right back. I wanted to ask you about
S1: something that the lawyer that you spoke to, Joanna moy.
S1: She represented a number of the women who have been
S1: wrongfully detained in public mental health facilities, because it seems
S1: like she has said that a number of the women,
S1: they were very educated, and they actually found it very
S1: difficult to budge the perceptions of those that were treating them,
S1: that they that they were mentally well, no matter how
S1: articulate they were. Is that right?
S2: Yeah, absolutely. Um, Carol told us that there comes a
S2: point where people just stop listening to you. She did
S2: a bit of research after this happened to her, and
S2: she came across something called Diagnosis Momentum. And that's as
S2: soon as the patients labelled with something, it's very difficult
S2: to have that removed. And the health service noted that
S2: she had presented as teary and agitated, and became more
S2: distressed and angry during the initial assessment. But Carol's psychiatrist,
S2: Doctor Judith Craig argues those observations aren't necessarily in themselves
S2: are sufficient justification for keeping someone. So, she says, if
S2: you've just been assaulted by someone and sort of dragged
S2: off by police, you know, you might actually be teary
S2: and agitated, but it would be within that context. She
S2: said a lot of people who obviously present to her
S2: rooms are very tearful when they're telling you about something,
S2: but that's not an indication for keeping them. So yeah,
S2: we did hear a little bit from patients and, and
S2: people that had worked with them that there was a
S2: sense that no matter, you know, what these people said
S2: once they'd sort of attracted that label, it was very
S2: difficult to budge. In one of the cases that Sydney
S2: family law solicitor Joanna moy saw recently there had been
S2: a woman who she said was involuntarily detained in a
S2: mental health ward, basically because she had different political views
S2: from her husband. She was a supporter of Donald Trump
S2: and she was anti-vaccination, apparently. So Joanna said that was
S2: apparently enough to have this woman locked away.
S1: And it's hard not to hear these instances and really
S1: be reminded of all those women that we used to
S1: hear about, you know, from the 19th century. They were
S1: branded hysterical and they were institutionalized. And I think back then,
S1: it was because they were socially inconvenient in a number
S1: of ways. So I guess tell me a bit about
S1: what they used to be locked up for back then.
S1: These women. And do the experts see any parallel between
S1: those women in the 19th century and the women now?
S2: Yeah. When I first heard about these stories, I couldn't
S2: help thinking about a television show I'd recently watched. It's
S2: based around the goings on of a group of women
S2: who lived in a brothel in 18th century London. And
S2: there's an there's an episode of that series, harlots, where
S2: one of the the older women in the series, a
S2: brothel madame, she gets admitted to an asylum by her son,
S2: even though she's not insane.
S3: I'm not leaving this in my house. Yeah.
S2: And they depict her sort of running around saying, look,
S2: I'm not crazy. I don't I shouldn't be here. And
S2: of course, you know, no one pays her any attention.
S4: I'm as sane as you please.
S2: So that's obviously a fictional story, but it's based on
S2: real life events in previous centuries. This actually did happen.
S2: And it happened quite commonly. So healthy and sane women
S2: were admitted to asylums or madhouses by their relatives. We
S2: know that there were women who were admitted to psychiatric
S2: institutions because they didn't do what their husbands said, or
S2: they broke social norms by having sex outside of marriage
S2: or drinking or swearing. Um, and sometimes this wasn't actually happening.
S2: You know, very long ago, even as recently as 1970,
S2: a woman named Carmella was hospitalized because her husband said
S2: she was unbearable, that she could not cope with the family,
S2: that she was crying, had affairs with two men, and
S2: she didn't like him. Yeah, so I guess it's hard
S2: not to see the shadow of this history in these
S2: cases that have come up in our reporting. And one
S2: of the experts we spoke to for this story agreed.
S2: Jane Asher, she's a professor of women's health psychology at
S2: Western Sydney University. She said she felt like these modern
S2: cases we reported on were a modern iteration of what
S2: we have seen in the past, where difficult women were
S2: considered mad and locked away.
S1: And you've written that women who are victims of family
S1: violence are particularly at risk of receiving an incorrect mental
S1: health diagnosis. So why?
S2: Yeah. That's right. You know, quite a few of the
S2: most disturbing cases that we examined as part of this
S2: investigation were cases where women had allegedly been the victim
S2: of abusive, of an abusive partner. And I guess you
S2: have to consider that these women, they might be being
S2: told by an abusive partner, you know, you're you're crazy.
S2: They might even start to believe that themselves. Or perhaps
S2: their abuser is telling the authorities that their victim is
S2: mentally ill and shouldn't be believed. Their story shouldn't be believed.
S2: We spoke to Victorian psychiatrist Professor Manjula O'Connor, and she
S2: told me that she had seen multiple cases of family
S2: violence victims being misdiagnosed with chronic mental health conditions, such
S2: as schizophrenia and borderline personality disorder. And she put this
S2: trend down to a lack of awareness about how trauma
S2: can manifest in people.
S1: And I guess tell us about what the repercussions of
S1: these misdiagnoses are for these women. I mean, I can
S1: only imagine that this would be devastating, but what is
S1: it actually like for them when this happens?
S2: Yeah, I agree, I think anyone who's spent time in a,
S2: you know, mental health ward in a public hospital can
S2: know that they they can be pretty hostile and scary places. Carol,
S2: one of the women we spoke to for the series,
S2: said she was incredibly scared. Uh, she later went on
S2: to develop PTSD as a result of her stay. She
S2: did say, and I think that this is reflected in
S2: the in the patient notes that other patients were fighting.
S2: She told me that her memories of this time were
S2: burnt into her memory. I think it was the sense
S2: of injustice that she shouldn't be there. I think that
S2: would have been incredibly scary, perhaps not knowing how long
S2: she was going to be there. So yeah, it sounded
S2: like it was a yeah, a pretty scary place to be.
S1: And are women actually more likely to be disbelieved or
S1: misdiagnosed with mental health issues?
S2: Yeah, this is really interesting. We do know that women
S2: are more likely to have mental health diagnosis, but what
S2: we know is that the studies have shown that women
S2: are much more likely than men to receive a mental
S2: health diagnosis, even after going to the doctors with similar symptoms.
S2: So it's more likely that those symptoms will be, I guess,
S2: attributed to a psychiatric cause. So, for example, a Spanish
S2: review from back in 2020 found women received a higher
S2: number of psychiatric diagnosis and prescriptions for mood altering drugs.
S2: And that's even after controlling for those higher rates of
S2: mental health conditions in the female population overall. So this
S2: research sort of reflects what we're hearing anecdotally from the
S2: 1800 people that responded to our medical misogyny survey that
S2: their their pain's kind of less likely to be taken seriously,
S2: to be believed to be treated. And that also when
S2: they go to the doctor with physical ailments and concerns
S2: that I guess they're more likely to have those symptoms
S2: very quickly written off as stress, anxiety or just, you know,
S2: a normal part of being a woman.
S1: And Asia, I guess. Just to wrap up, what sort
S1: of practical changes do you think would help stop women
S1: from being involuntarily sectioned or incorrectly diagnosed with mental illness?
S2: So we know that these cases are really complex, which
S2: means the causes and the solutions are, you know, complex too,
S2: in terms of the women that have been detained in
S2: mental health wards when they don't need to be detained.
S2: That could be influenced by, you know, understaffing and strain
S2: on hospitals, by insufficient training given to doctors by police,
S2: misunderstanding family violence situations and a culture that still persists
S2: in our society of misunderstanding women. One solution suggested by
S2: Matthew Large is better ongoing training for doctors on scheduling
S2: patients and recognizing misinformation that may be fed into patient
S2: notes as part of this investigation. This masthead is also
S2: backing calls for more funding for longer GP consults, so
S2: peak doctors groups have consistently warned that the current Medicare system,
S2: as it stands, incentivizes shorter appointments. So you'll get much
S2: higher rebates Overall, if you, you know, have lots of
S2: smaller GP appointments rather than taking your time with just
S2: a few GP appointments. So I think, you know, many
S2: of us would have had an experience at the GP
S2: where you feel like you can only raise one issue
S2: and that's not necessarily the GP's fault, it's just that
S2: we know that they're pressed for time and that the
S2: appointments only last for so long.
S1: Oh for sure. You're like apologetic aren't you? Yeah, exactly.
S5: Just like I'm so sorry.
S1: I've got a limb falling off. Do you mind.
S5: If I just. Yeah.
S2: So kind of what? You. As women, I think that's
S2: something that we can really understand. Like, we have a
S2: bit of a laundry list of things that we need
S2: to get through, and you kind of maybe pick the
S2: top 1 or 2. Most, most pressing. But what it
S2: means is, you know, a woman, they might mention their headaches,
S2: but they won't mention their period pain, they won't mention
S2: their sleeplessness. And if there was time to discuss all
S2: those things, then the GP, they would be able to
S2: make the connections between the three and give them, I guess,
S2: a better opportunity to come to the correct diagnosis.
S1: Well, thank you so much for your time.
S2: Thanks so much, Sam.
S1: Today's episode was produced by Josh Towers and Julia Carcasole.
S1: Our executive producer is Tammy Mills. Tom McKendrick is our
S1: head of audio. To listen to our episodes as soon
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S1: Links are in the show. Notes. I'm Samantha Selinger. Morris.
S1: Thanks for listening.