It’s hard to imagine a more vulnerable group of women than inpatients in a mental hospital. It’s even harder to understand why some NHS trusts would force them to share female wards with men who identify as women. Yet an audit by a women’s organization, reported in The Times, has discovered that the policy is in operation in several mental hospitals in London, allowing men who have committed violent offenses to choose where they are accommodated.

Central and North Western London NHS Trust, responding to an FoI request, said it “respects an individual’s right to self-identify as male or female”. It added that “transgender” women have the right to access women’s support groups and toilets, a policy that appears to be in defiance of the landmark Supreme Court ruling in April that “woman” in the 2010 Equality Act refers to biological sex.

The same trust acknowledges that problems might arise, including female patients being flashed by “a sexually disinhibited pre-operative transsexual individual”. The risk of such an event occurring on a hospital ward — the criminal offense of indecent exposure, to be clear — is not limited to a single hospital. Another NHS trust, South West London and St George’s, says such patients might need to be admitted to a male ward “while they are acutely unwell and at risk of ‘outing’ themselves”. It implies an alarming readiness on the part of staff to collude in deceiving mentally fragile female patients.

The trusts acknowledge that some trans-identified patients may pose a “risk to a particular gender” — they mean women but are too mealy-mouthed to say so — and behave in a manner that’s “very distressing for other patients on a single-sex ward”. It’s no longer a single-sex ward, critics might point out, if men are allowed on it. But the wishes of violent criminals matter more than the welfare of female patients, who are unlikely to get better in an environment where they’re being told not to trust the evidence of their own eyes.

West London NHS Trust appears to be ignoring the judgment, sticking to out-of-date guidance issued by the NHS in 2019 while it waits for the Equality and Human Rights Commission to issue a final updated version. Until then, it expects staff to “use names, titles and hospital accommodation that the service user regards as appropriate”. The trust runs Broadmoor Hospital, which houses some of the country’s most notorious killers, and the public might be surprised to learn that it allows them to impose their preferred pronouns on staff and other inmates.

The “waiting for guidance” excuse is popular across the board. Last month the Daily Mail revealed that NHS trusts and local authorities up and down the country are still allowing biological males to use women’s toilets. Salford City Council responded to the Supreme Court judgment by talking about having a “zero-tolerance approach to transphobia” and said it was awaiting further guidance.

They’ve now got all the guidance they need, like the other public bodies grasping this pathetic fig leaf. The EHRC’s interim guidance is clear that “trans women (biological men) should not be permitted to use the women’s facilities and trans men (biological women) should not be permitted to use the men’s facilities”. There’s no ambiguity about that, but no announcement either from Salford or St. George’s about a change in policy.

Many publicly-funded organizations have been following guidance that misstated the law. They no longer have any excuse and the revelations about mental hospitals continuing to indulge trans-identified males reveal a ghastly truth. There is simply no cohort of women, no matter how fragile, whose feelings can’t be disregarded if a “trans woman” might be inconvenienced.

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Joan Smith is a novelist and columnist. She was previously Chair of the Mayor of London’s Violence Against Women and Girls Board, and is on the advisory group for Sex Matters. Her book Unfortunately, She Was A Nymphomaniac: A New History of Rome’s Imperial Women was published in November 2024.

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