The system wasn’t built for her: an integrative review of women’s experiences in psychiatric and forensic units

Introduction: Many studies report that women's access to safe and equitable care remains limited due to interpersonal and systemic barriers. In mental health care contexts, including psychiatric hospitalization, these inequities are reinforced by the gendered stigmatization of mental health disorders, which influences both diagnosis and clinical interventions. Objective: The aim of this integrative review is to explore women's experiences in psychiatric and forensic units. The research questions are: (1) What are the gender-based violence experiences reported by women during psychiatric hospitalization? and (2) What current or potential individual, interpersonal, and systemic initiatives exist to prevent or address gender-based violence? Methods: An integrative literature review was conducted employing an intersectional approach and lived experience knowledge. Searches across six databases, supplemented by manual searches in the grey literature and reference lists, yielded 54 articles. Thematic analysis was used to analyze data. Results: The identified themes are: (1) when men are the norm: the making of women's subordination, (2) the cycle of harm: trauma, systems, and retraumatization, (3) institutional disregard of women's bodies: reproductive care and maternal role, (4) layered harms: when intersecting identities meet institutional violence and (5) paths forward: initiatives to counter institutional gender violence. The results indicate the existence of hospitalization experiences specific to women that include gender-specific violence and coercion, with experiences in forensic psychiatry care displaying additional specificities related to the legal context and length of the hospitalization. Conclusion: The results suggest that gendered power dynamics are transferred to the context of psychiatric and forensic hospitalization. Current clinical practices and training do not consider the specific needs of women in these settings. This review underscores the importance of recognizing and addressing the specific needs of women during psychiatric hospitalizations.