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Not all women fancy single-sex wards

National High Secure Women’s Services, Nottinghamshire Healthcare NHS Trust, Rampton Hospital, Retford, East Notts DN22 0PD, UK.

P. Holdsworth

Nottingham City Primary Care Trust, Nottingham, UK

D. Edge

Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK

Correspondence: E-mail: raymond.travers{at}nottshc.nhs.uk

Declaration of interest

None. This is not a representative view of Nottinghamshire Healthcare NHS Trust, Nottingham City Primary Care Trust or The University of Manchester.

Psychiatric hospitals operate at three levels (Stokes, 1994) – ‘what we say we do’, ‘what we really believe we are doing’ and ‘what is actually going on’. Most are unconscious of this third level. Mezey et al (2005) rightly remind us that the further development of single-sex secure units for women may not be justified on the grounds of safety alone, but such a narrow focus has never been the principal driving force for developing gender-sensitive and single-sex secure units, which has massive ramifications for the wider hospital organisation.

Ramsay et al (2001) broadly described the issues relating to women and psychiatry and Kennedy (2001) argued for a proper focus on the needs of male patients. Both perspectives reinforce the need for gender-informed practice. While developing different services for male and female forensic patients, it is worth considering that one tenet of feminism is that no person should be discriminated against on the grounds of gender. Although men and women are not the same, Adshead (2004) argues that, in terms of human needs and human rights, male and female patients are more alike than they are different and that differences should not be the basis for abusive or discriminatory practice.

Although not emphasised sufficiently in the literature, particular issues are commonly encountered by both male and female in-patient forensic populations. These include the emotional and behavioural impact of bringing together a number of patients who have high levels of comorbidity, personality disorder and complex post-traumatic stress syndromes (Bercu, 2001). However, models of care for male patients (the majority population in mixed forensic units) fail to address the relational and other specific needs of women, their marginalisation and the impact of their experience of victimisation. Gender-informed forensic services therefore need to be equipped and enabled to provide appropriate levels of care and interventions, in suitable accommodation, for individuals with severe, complex clinical presentations and who present significant risks to themselves and others.

Our position is not that gender adequately differentiates between men’s and women’s needs but that in the absence of more sophisticated frameworks, their needs are such that, for the foreseeable future, service planning must be based on the assumption that women forensic patients are sufficiently different from their male counterparts that their needs should be provided for separately.

REFERENCES

Adshead, G. (2004) More alike than different. In Working Therapeutically with Women in Secure Mental Health Settings (eds N. Jeffcote & T.Watson). London: Jessica Kingsley.

Bercu, S. (2001) Experience of a women’s psychiatric ward in London (abstract). Abstracts of the 26th International Congress on Law and Mental Health. Canada: Cheneliere/McGraw-Hill. http://www.ialmh.org/Montreal2001/Sessions/womens_corrections.htm

Kennedy, H. (2001) Do men need special services? Advances in Psychiatric Treatment, 7, 93 –99.[Free Full Text]

Mezey, G., Hassell, Y. & Bartlett, A. (2005) Safety of women in mixed-sex and single-sex medium secure units: staff and patient perceptions. British Journal of Psychiatry, 187, 579 –582.[Abstract/Free Full Text]

Ramsay, R., Welch, C. & Youard, E. (2001) Needs of women patients with mental illness. Advances in Psychiatric Treatment, 7, 85 –92.[Free Full Text]

Stokes, J. (1994) Institutional chaos and personal stress. In The Unconscious at Work (eds A. Obholzer & V. Z. Roberts). London: Routledge.

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Travers, R. F. Articles by Edge, D. Search for Related Content PubMed PubMed Citation Articles by Travers, R. F. Articles by Edge, D.