Are women really difficult? Challenges and solutions in the care of women in secure services

Concern about the approach to the care of women in secure hospitals led to radical Department of Health Guidance in 2002 and 2003. This paper explores the views and experience of senior clinicians and managers involved in delivering care through semi-structured interviews. The gendered nature of the therapeutic challenge and the complexity of the women in their care are both articulated as well as the extent to which respondents see themselves as having addressed clinical practice guidance. Service delivery is substantially informed by the ideas of relational security, attachment theory and the recovery model. Traditional concepts of security were considered unhelpful in the care of women. Reliance on respondents' views as to the quality of care offered must remain limited in view of the continuing absence of corresponding clinical outcome data. However, their responses should inform amendments to current service organisation.