Sex differences in patients admitted to a regional secure unit

Evolution of secure services for women in England

Patients detained at high and medium security reveal significant gender differences in the presentation of psychopathology, mental disorder and social and offending profiles. However, secure mental health services in England, like prisons, generally fail to recognise the core importance of the differing biopsychosocial development in women and the impact of life experiences on women's subsequent biopsychosocial functioning. As a consequence, women are often inadequately provided for in services dictated by the identified needs, risks and responsiveness of men. The lack of clinically appropriate facilities for women may account for the increased frequency with which women are readmitted to medium security and for their longer admissions to both high and medium secure care. New tertiary services are developing as a result of the lessons learnt while providing gender-blind care. However, further development is required to ensure that women receive services of the same quality, range and nature of those received by men.

The changing climate for women patients in medium secure psychiatric units

Aims and Method

We conducted a telephone survey of medium secure units in England and Wales to determine the distribution of women patients.

Results

The survey identified 1836 medium secure beds, housing 342 women patients. Women in the NHS were housed primarily in mixed-gender units (170 women, 94%). Most NHS beds in single-gender units were for men (56 beds), whereas most private sector beds in single-gender units were for women (79 beds).

Clinical Implications

Increased awareness of the often inappropriateness of services for women in mixed-gender units has led to units deciding not to admit women patients and, inadvertently, more single-gender beds for men in NHS units than for women. The NHS units have to rely on private sector units to provide beds in single-gender units for women, perhaps at the expense of effective continuity of care.

Do women need special secure services?

Clinicians working with women patients in secure units will already know that they are the centre of a debate not of their own making, which is about the appropriate specification of services for women patients with security needs. This paper attempts to outline the relevant issues and proposed solutions.

Occupational Therapists' Perspectives of the Needs of Women in Medium Secure Units

The Department of Health and Home Office (1992) formally acknowledged women in forensic provision as being a vulnerable group, with neglected needs in terms of care and treatment. It also clearly identified a role for occupational therapy in meeting these needs through involvement in multi-agency cooperation. The aim of this investigation was to ascertain if, from an occupational therapy perspective, the needs of women in medium secure care were being met.

A postal questionnaire was administered to 62 therapists working in medium secure provision in England, with a response rate of 73%. The data generated identified occupational therapists' perceptions of female client needs and the intervention available to women in medium secure care and provided a snapshot of therapists' views in relation to current issues in secure care.

The findings demonstrated that occupational therapists working in medium secure care had a good understanding of female client needs and tailored their intervention to be as gender-sensitive as possible within the limitations imposed by the environment. The study also highlighted the requirement for further research to investigate the needs of women in forensic environments from their own perspectives.

Meeting the needs of women in secure mental health: a conceptual framework for nurses

Within the wards of Britain’s high and medium secure mental health services, the needs of the female population differ significantly from those of their male counterparts. Although much smaller in number, the vast majority of female patients formally detained in secure services are young, Caucasian women, who are less likely to be prone to criminality and have a propensity to suffer from psychological distress. Many have experienced extensive trauma and exhibit both internally and externally driven violence. Drawn from the women’s own narratives and analysed using a descriptive phenomenological approach, the findings provide the basic structure for a new ‘humanistic conceptual framework for care’ which could be used by mental health practitioners to both inform and structure the daily provision of care and to better understand the physical and mental health needs of this unique patient group within secure mental health services.

The journey from despair to hope: an exploration of the phenomenon of psychological distress in women residing in British secure mental health services

This paper reports the findings of a descriptive phenomenological study that aimed to elicit and describe the experience of psychological distress as expressed by a group of women compulsorily detained within secure mental health services in the U.K. A fundamental objective of the study was to contribute to the existing evidence base that supports the care and treatment needs of this severely traumatized and challenging patient group. We argue that service providers and clinical practitioners could be better informed about the unique care and treatment needs of this severely traumatized and challenging patient group when working with them. A descriptive phenomenological approach developed by Giorgi was used to elicit the lived experiences of 'psychological distress' from a sample of female patients resident within a high secure hospital and an independent medium secure hospital. The findings indicate that a treatment plan which includes a combination of prescribed medication, informal support networks, intensive individual therapy and active engagement in a therapeutic life skills programme can be extremely beneficial. Most notably in helping to reduce the frequency of both internally and externally directed violent behaviour in this vulnerable client group.