Patients’ experiences of sexual violence in psychiatric in-patient care: systematic review and synthesis of qualitative studies

BACKGROUND: Sexual violence in psychiatric in-patient care has received increasing attention following persistent evidence of sexual violence and harassment on wards. However, patients' subjective experiences remain under-examined, limiting the evidence base to inform safeguarding, gender-sensitive design and trauma-informed practice. AIMS: To synthesise qualitative evidence on patients' experiences of sexual violence and perceived risk within psychiatric in-patient settings. METHOD: We conducted a systematic review and qualitative synthesis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PROSPERO registration no. CRD42024595945). MEDLINE, Embase and PsycINFO were searched from inception to October 2024, supplemented by reference list screening and citation tracking. Inclusion criteria were peer-reviewed qualitative studies reporting patients' first-hand accounts of sexual violence or perceived sexual safety in psychiatric in-patient care. The quality of the included studies was assessed using the Critical Appraisal Skills Programme checklist, and data were analysed by thematic synthesis. RESULTS: Six studies published between 1998 and 2025 met the inclusion criteria, with most focusing on female patients in mixed-gender wards. Three overarching themes were developed: (a) 'a culture of permissiveness and dismissal' - patients downplayed harassment and abuse and staff routinely dismissed concerns; (b) 'everyday fear, hypervigilance and resistance' - the constant threat of harm generated chronic distress, with safeguarding responsibility shifted onto the patients; and (c) 'gendered power dynamics in open or mixed-gender spaces' - open ward layouts, inadequate boundaries and legal detention compounded vulnerability to harm. CONCLUSIONS: Sexual violence in psychiatric in-patient care is enabled by ward cultures that normalise harm, weak safeguarding and gendered power imbalances. Urgent action is needed to implement trauma-informed, gender-sensitive practices and secure spatial boundaries and consistent incident responses, alongside policies that enable safe disclosure and accountability.