Mixed or single gender psychiatric wards? A multi-stakeholder study of gender differences and preferences

Abstract Background Whether psychiatric wards should be mixed- or single-gender remains unresolved, reflecting a tension between the normalization paradigm that emphasizes social integration, and the protection paradigm that prioritizes safety, mainly for women. Previous research has yielded mixed findings and has rarely integrated multiple stakeholder perspectives. Methods This cross-sectional study examined the preferences of 233 participants. It included four stakeholder groups: current ( n = 74) and former inpatients (60), family members (37), and staff members (62) from two mental health centers in Israel. Data were collected using structured questionnaires and analyzed using chi-square tests and regression analyses to examine relationships between demographic variables, experience and seniority, and preferences. Results Significant gender differences were found among all patients. Men showed greater preference for mixed wards, whereas women preferred single-gender wards. The responses of family members varied according to the patient’s gender, such that there was stronger support for single-gender wards for female patients. Staff showed no clear preference, although a marginal trend indicating that previous experience in mixed-gender wards was associated with a lower preference for single-gender wards, while greater seniority was marginally associated with a higher preference for these (single-gender) wards. Conclusions The findings highlight the complexity of ward gender composition preferences and the absence of a consensual model. Both normalization and protection considerations are valid and support a flexible, patient-centered approach that allows choice. This is particularly so where safety concerns are salient – among women, mainly with trauma background, but also when the person has significant impairment in judgment and reality testing.