Everything was so hard. I felt like I had been cut off at the knees.
Across Australia, one in four women carry the weight of severe mental illness, often for years before receiving an accurate diagnosis — their symptoms shaped by hormonal tides that medicine has long struggled to read. The places meant to offer refuge can themselves become sites of harm: in mixed-gender psychiatric wards, sexual assault occurs at six times the rate of single-gender settings, a disparity that reveals how the architecture of care has failed to account for the vulnerability of those it is meant to protect. A growing chorus of clinicians and policymakers is now asking what has always been a moral question dressed in clinical language — whether a system can truly heal what it continues to wound.
- Women with complex, overlapping mental health conditions are routinely misdiagnosed for years, their suffering compounded by a system not designed to recognize the hormonal dimensions of their distress.
- Mixed-gender psychiatric wards are generating new trauma inside the very spaces meant to treat it, with sexual assault rates six times higher than in single-gender facilities — a figure psychiatrists call a damning indictment of current practice.
- Clinicians who have witnessed abuse firsthand are pushing for structural reform, arguing that the physical environment of care is not a secondary concern but a clinical one with direct consequences for patient outcomes.
- The federal government has committed $283.2 million to mental health infrastructure, and peak psychiatric bodies are now calling for women-only wards — with separate bedrooms, bathrooms, and communal spaces — to be built into all future facility design.
- For patients in the public system, choice rarely exists: when acute care is needed, mixed-gender wards are often the only option, leaving the obligation to ensure safety largely unfulfilled in practice.
Tanya sits in a Melbourne women's health hospital, working through a coloring design with quiet focus. It looks meditative — and it is, in a way — but it is also part of the structured psychiatric program that helped her rebuild a life that had become unlivable. Two years ago, she was a working mother who could barely leave her bed. After months of struggling in silence, she was referred to a women's mental health program, where she discovered art, began journaling, and slowly learned to name what she was feeling.
What doctors eventually found was a constellation of diagnoses — complex PTSD, ADHD, anxiety, and depression — that had never been identified, even as the symptoms accumulated for years. Part of the delay was that her decline coincided with hormonal changes she didn't fully understand. Her story is not unusual. One in four Australian women experience severe mental health challenges at some point in their lives, and their symptoms frequently resist neat categorization, flaring during hormonal shifts that clinicians often fail to connect to mental health.
Professor Jayashri Kulkarni, founding medical director of Cabrini Women's Mental Health in Melbourne, has spent years documenting this pattern. She has also spent years witnessing something more alarming: women admitted to mixed-gender psychiatric wards being traumatized, harassed, and in the worst cases, raped by male co-patients. A 2026 report she co-authored confirmed that women with histories of violence experience further distress in co-gendered facilities — meaning hospitalization itself can become a source of new trauma.
The data is stark. The Royal Australian and New Zealand College of Psychiatrists reports that sexual assault in mixed-gender wards occurs at six times the rate of single-gender settings. The college's president-elect describes this as a 'terrible indictment' of the system, noting that many inpatient units are frightening environments, made more volatile by the increasing complexity of patients admitted. Yet for most people seeking public care, mixed-gender wards are the only option available.
The federal government has allocated $283.2 million over four years to strengthen mental health and suicide prevention services, and the RANZCP is calling for all future facilities to be designed with secure, women-only spaces. Where existing facilities stand, retrofitting should be attempted. The pressure is real: mental illness costs the Australian economy an estimated $56 billion annually, and rising living costs are pushing more people toward crisis.
Tanya is now studying for a new career in health and leisure. 'It is hard for me to ever say that I feel proud of myself,' she says, 'but I have worked really hard to connect with and understand mental health and mental wellbeing.' Her recovery is a reminder of what becomes possible when care is designed with women's safety and complexity genuinely in mind.
Tanya sits in a bright room at a Melbourne women's health hospital, working through a coloring design with quiet focus. The activity looks simple, almost meditative—but it is part of a structured psychiatric treatment program that allowed her to rebuild a life that had become unlivable.
Two years ago, Tanya was a full-time working mother with teenagers. She could barely leave her bed. The weight of daily tasks—work, parenting, the ordinary machinery of living—had become impossible to bear. After months of struggling in silence, she saw her GP and was referred to a women's mental health program. There, during therapy sessions, she discovered art. She began journaling. She learned to name what she was feeling. Over six months of outpatient care, something shifted. She felt better. She understood herself differently.
Tanya's story is not unusual. One in four Australian women experience severe mental health challenges at some point in their lives, according to the 2025 Women's Mental Health Research Report. What makes her case instructive is what doctors eventually found: complex post-traumatic stress disorder, attention deficit hyperactivity disorder, anxiety, and depression—a constellation of diagnoses that had never been named before, even as the symptoms had been accumulating for years. Part of the delay was that her mental health decline coincided with hormonal changes she didn't fully understand. The causes were overlapping, unclear. "Everything was so hard," she recalls. "I felt like I had been cut off at the knees."
Jayashri Kulkarni, a professor of psychiatry at The Alfred and Monash University and founding medical director of Cabrini Women's Mental Health in Melbourne, has spent years studying this pattern. Women's symptoms often do not fit neatly into a single diagnosis. They can flare during hormonal shifts, particularly around menopause, yet this connection is frequently missed. Kulkarni has treated women successfully for what turned out to be menopause-related depression—after they had been misdiagnosed for months or years. The complexity of women's mental health, she argues, demands a different approach to care and a different physical environment in which to receive it.
That environment matters more than many people realize. After working in both public and private mixed-gender psychiatric wards, Kulkarni became an advocate for women-only hospital spaces. The risks in co-gendered wards are substantial. She has witnessed women traumatized, abused, and in the worst cases, raped by male co-patients. A January 2026 report she co-authored in the journal Australian Psychiatry documented that women with histories of violence and trauma experience further distress when admitted to mixed-gender mental health facilities. For these patients, hospitalization itself can become a source of new trauma.
The data supports her concern. According to the Royal Australian and New Zealand College of Psychiatrists, sexual assault in mixed-gender psychiatric wards occurs at six times the rate of single-gender settings. Dr. Angelo Virgona, president-elect of the college, describes this as "a terrible indictment" of the system. He notes that the atmosphere in some inpatient units is "very distressing, very harrowing, and frightening," driven partly by the increasing acuity of patients admitted—many struggling with substance use or drug-induced psychosis alongside their primary mental health conditions. Yet many people seeking treatment through the public system have no choice but to be admitted to mixed-gender wards. "Often, that is all that is available," Virgona says. When someone is acutely unwell and needs inpatient care, services are obligated to try to make those mixed-gender environments as safe as possible. The obligation, however, does not always translate into practice.
The federal government has allocated $283.2 million over four years beginning in 2025-26 to strengthen Australia's mental health and suicide prevention system. Mental illness costs the Australian economy an estimated $56 billion annually. The pressure on services is mounting as the cost of living rises, pushing more people toward depression and anxiety. Amid this strain, the RANZCP is calling for future mental health facility design to prioritize secure, women-only spaces—separate bedrooms, bathrooms, communal areas. Where new facilities are being built, they should have a single-gender orientation. Where facilities already exist, retrofitting should be attempted wherever possible.
Tanya is now studying for a new career in health and leisure. She has moved forward. "It is hard for me to ever say that I feel proud of myself," she says. "But I have worked really hard with support from the program to connect with and understand mental health and mental wellbeing." Her recovery is real. It is also a reminder of what becomes possible when women receive care designed with their safety and complexity in mind.
Notable Quotes
There are many risk factors in co-gendered wards. I have been involved with situations where women have been traumatised or abused, or even raped by co-patients.— Jayashri Kulkarni, professor of psychiatry and founding medical director of Cabrini Women's Mental Health
The atmosphere in some inpatient units is very distressing, very harrowing, and frightening. Often, mixed-gender wards are all that is available.— Dr. Angelo Virgona, president-elect of the Royal Australian and New Zealand College of Psychiatrists
The Hearth Conversation Another angle on the story
Why does Tanya's story matter now, in 2026? Isn't mental health care already well-established in Australia?
It matters because Tanya went years without a diagnosis, even though her symptoms were severe enough to keep her in bed. The system didn't fail her completely—eventually she got help—but the delay cost her time, work, stability. And she was lucky enough to access a women-only program. Most women don't have that option.
What's the difference between a women-only program and a mixed ward?
Safety, primarily. In mixed wards, women report sexual harassment and assault at six times the rate of single-gender settings. But it's also about being understood. Women's mental health often involves hormonal factors that male clinicians might miss. A woman in menopause presenting with depression might be misdiagnosed for years if no one is asking the right questions.
Kulkarni mentions women being raped by co-patients. How does that happen in a hospital?
It happens because acute psychiatric wards are chaotic. Patients are in crisis, sometimes on substances, sometimes experiencing psychosis. The environment is distressing even without assault. Add mixed-gender housing, limited supervision, and you create conditions where vulnerable people can be harmed by other vulnerable people. The system knows this. It's documented. But alternatives are expensive and rare.
So the solution is just to build more women-only wards?
That's part of it. But it's also about training clinicians to recognize patterns they've been missing—like how hormonal changes can trigger or worsen mental illness. And it's about funding. The federal government allocated $283 million, which sounds substantial until you realize mental illness costs the economy $56 billion annually. The investment is real but still inadequate.
What happens to women who can't access a women-only program?
They stay in mixed wards. They manage their acute crisis in an environment that may re-traumatize them. Some recover anyway. Some don't. Some leave the hospital worse than they arrived. That's the indictment Virgona was describing—that we know this happens and we continue to allow it because we haven't prioritized alternatives.
Does Tanya's recovery suggest that women-only care is a cure?
No. It suggests that when women receive care designed with their safety and complexity in mind, they have a better chance of healing. Tanya still had to do the work—the art therapy, the journaling, the hard internal reckoning. But she could do that work without fear. That matters.