Hannah Moore, Vice-Chair, Expert by Experience group, Equally Well UK

Having a cervical smear test isn’t pleasant for anyone. But for someone with a mental illness or someone who has experienced trauma in their life it can make it 100 times worse. I know this myself as I have a mental illness and have CPTSD (complex post-traumatic stress disorder) from trauma. Cervical screening isn’t just a traumatic experience when you have one it can also be very nerve-racking waiting for the results and the build up to having your test. People can have feelings of shame, embarrassment, anxiety, even have panic attacks and disassociation. With smear tests your mind understands why these are necessary but often your body can not differentiate between the exam and the trauma that you experienced, so the smear test can feel both painful and a violation of the body.

I was told loudly in a waiting room full of people that I’m overdue a smear test and asked for the reason why I hadn’t book one already. This is not encouraging someone to have a test done, it just makes them feel embarrassed and even more traumatised.

Here are a few suggestions of what health care professionals can do to make having a smear test less daunting for people living with severe mental illness, and especially for those who have experienced trauma:

  • Healthcare providers have a responsibility to think about the needs of a whole range of patients, not just patients who don’t have a mental illness or who haven’t suffered trauma.
  • Professionals need to educate themselves in trauma informed care.
  • Talk to the person privately about having a cervical smear test. Don’t do what they did to me and do it in a room full of people waiting to see the doctor, this will only put someone off having one.
  • Make sure the person has a choice of what gender does their smear test. Most tests are done by females, but someone could have been abused by a woman and prefer a man. Not many people think of this.
  • Explain how important it is to have a cervical smear test and go through with them what will be done so they are prepared and can ask any questions.
  • Speak to the person after to see if they are ok. The test could trigger past trauma and they may need an extra follow up. Maybe ask if they would like you to call someone for them if they have come alone.

There are also plenty of things that you can do to help yourself cope with and manage your smear test.

  • Tell the person who is doing your smear test to stop if you feel uncomfortable. This is your right, no one should carry on if you ask them to stop the test. Also mention that you may stop them before they do the test if you feel uncomfortable.
  • Communicate with your body about what is going to happen before going for the test, as this helps the body to feel safer and if you notice your body going into a fight, flight freeze response, it is ok to ask the professional to stop and try again another day. It is best not to force your body to go through it in silence while you’re feeling uncomfortable and scared.
  • Maybe explain (if you feel comfortable) to the person doing your test that you have a mental illness and/or have suffered trauma so the test may be difficult for you. This should hopefully make them more understanding, I know it did when I went for mine.
  • Look after yourself following the test. Maybe have a nice bath or shower, meet a family member or friend for a chat or chill out and watch TV or read a book. Don’t do anything that’s going to upset you more.
  • Remind yourself that you don’t need to be embarrassed about the test. The people who do the tests do them all the time, so they have seen it all already!

Cervical screening Is extremely important for woman because if problems go unnoticed, they can become life threating, (most times not but this can happen). This could be one contributory factor to the mortality gap between people living with a mental illness and those that don’t – remember, people living with a mental illness die 15 to 20 years earlier from physical health problems than average.*

Supporting people with a mental illness to attend cervical screening tests should be a priority for healthcare professionals, including the persons mental health team. They should be encouraged to attend these appointments, maybe even with someone from their support system such as a community psychiatric nurse or support worker or if they don’t feel comfortable with this then maybe a close friend.

Don’t put off your smear test! If you go for yours, I’ll go for mine! 🙂

Hannah Moore

*read more about health inequalities in this blog: Counting the cost of health inequality, by Andy Bell.