NHS mental health trusts in London have been allowing male offenders to self-identify as women and access female-only wards, according to newly released internal documents. The policy has sparked strong criticism from women’s rights advocates who argue that the safety and dignity of vulnerable female patients are being compromised.
The documents, obtained through Freedom of Information (FoI) requests, show that mental health trusts are adhering to NHS guidelines that prioritize gender identity over biological sex. These guidelines state that transgender individuals should be accommodated in line with their self-identified gender, regardless of physical appearance or anatomy.
Some NHS staff have raised alarms about the risks involved. For example, the South West London and St George’s Mental Health NHS Trust suggested that in certain situations—for example, when a transgender patient is acutely unwell or in a manic state—it may be safer to place them in wards that match their biological sex. One case cited involved a transgender patient with bipolar disorder who disrobed in front of women on a ward, causing distress.
The policy documents explain that during such episodes, placing the patient in a ward matching their birth sex might help protect other patients. Once the individual regains mental capacity, they may then be transferred to a ward aligned with their gender identity.
Under the NHS’s 2019 guidance, transgender patients should be housed according to their lived gender. This includes access to toilets and bathing facilities, except in situations involving open showers and pre-operative individuals. West London NHS Trust, which oversees the high-security Broadmoor Hospital, follows this guidance closely, requiring that trans patients be placed in wards based on their presenting gender.
However, the documents also acknowledge that there are lawful exceptions. Patients, including transgender individuals, can be excluded from certain wards if doing so serves a legitimate goal—such as reducing harm to others.
Central and North West London NHS Foundation Trust also admitted that placing a pre-operative, sexually disinhibited transgender patient in a female ward could cause significant distress. In such rare cases, they recommend moving the individual to a private room and offering access to separate bathroom facilities, like disabled toilets, if needed.
Despite these caveats, the trust emphasized its commitment to respecting individuals’ rights to self-identify, noting that transgender women are permitted to use women’s toilets.
The ongoing controversy comes in the wake of a Supreme Court ruling that reaffirmed the legal basis for single-sex spaces being determined by biological sex. This decision is now prompting the NHS to review its own accommodation policies.
Helen Joyce, director of advocacy at the human rights group Sex Matters, criticized the current practice. “It’s deeply disturbing that the safety and welfare of some of the most vulnerable women in London are being compromised,” she said. “The Supreme Court judgment was crystal clear—single-sex services must be based on biological sex. NHS trusts must stop using ‘case-by-case’ policies that endanger female patients.”
A campaigner who helped compile the FoI data echoed this concern, telling The Times: “It’s scary to think that the gender identity of violent criminals can override the safety and dignity of women. NHS trusts are playing Russian roulette with women’s safety.”
An NHS spokesperson confirmed that the organization is reassessing its policies in light of the Supreme Court’s decision. “We recognize the need for revised guidance and are working closely with the Government. We will update our policies as soon as the Equality and Human Rights Commission issues its statutory guidance,” the spokesperson said.
As the debate continues, campaigners are urging the NHS to make swift and firm changes. They argue that maintaining biological sex-based wards is critical for safeguarding vulnerable women in mental health care.
