Sex and gender are often overlooked factors in the delivery of mental healthcare, resulting in a gender blindness that ignores the specific needs of women and, in some circumstances, men. A lack of gender-disaggregated data and balanced sex and gender representation in clinical research has led to knowledge gaps in women’s health overall. This article explores the influence of gender bias across a spectrum of conditions where disparities in diagnosis, treatment and research exist, including psychosis, mood disorders, neurodevelopmental disorders, eating disorders and substance use disorders. The influence of female reproductive hormones (oestrogen and progesterone) on symptom onset, presentation and treatment response is also discussed where clinically relevant. Gender-aware approaches to delivering mental healthcare are needed, including trauma-informed care, in order to deliver equitable and effective mental healthcare for all.

There has been a renewed focus on improving mental health outcomes and experiences for women with the publication of ‘Embedding Women’s Mental Health in Sharing the Vision’, but much needs to be done to translate this policy into tangible improvements in delivered care. Historical biases in medical education and practice, as well as in research, have led to serious deficiencies in how illnesses are diagnosed and managed in women. This is not solely observed in mental health, and andronormative perspectives and gender blindness are widespread throughout medicine. Trauma informed practices should be adopted in all healthcare settings that treat women. Consideration also needs to be given to reproductive life stage in psychotropic prescribing beyond concerns of the risk of teratogenicity. Medical education and training should play a central role in increasing gender awareness among healthcare professionals. Combining top-down policy initiatives with bottom-up education and training is required to meaningfully integrate gender awareness into mental healthcare and address historical shortcomings in care for women. Implementing gender-sensitive practices is an important step toward delivering more individualised, patient-centred mental health services.