Women who challenge - Nacro

Women who challenge: women offenders and mental health issuesservice provision at a medium-secure level,where female patients have frequently foundthemselves in an extremely vulnerable positionon their own, or as one of a very small numberof women, in units populated predominantly bymen. The men held in medium secure units haveoften been perpetrators of violent or sexualoffences, while the women have frequently beenvictims of physical or sexual abuse and this hasmade for a wholly unsatisfactory environment.The limited resources available at this level ofsecurity also have a bearing on the size of thepopulation in the secure system in that, if nosuitable beds are available, offenders may wellend up with a custodial sentence rather than ahospital disposal, as shown above by Allen’sresearch 80 . It can also be the case – and this mayapply particularly to women – that offenders aresometimes excluded from low secure places,which would be appropriate to their condition,because they are offenders and clinicians areconcerned that they may have a disruptiveinfluence.The Government is now committed to theelimination of mixed sex accommodation and isworking towards three main objectives in thiscontext 81 :• ensuring that appropriate organisationalarrangements are in place to secure goodstandards of privacy and dignity for hospitalpatients• achieving fully the Patient’s Charter standardfor segregated sleeping, washing and toiletfacilities across the NHS• providing safe facilities for patients inhospital who are mentally ill, which safeguardtheir privacy and dignity.This is a welcome step towards providingvulnerable women with an environment inwhich they can feel safe. It does not, however,resolve the issue of providing adequate accessto services at a medium secure level. Thedevelopment of women-only units may notnecessarily be the complete solution it seemsand there are consequences of such a move,both foreseen and unforeseen, that need to bemonitored and reviewed. Because of the smallnumbers of women involved, the number ofwomen-only units required would still be small,even if limited in size. This could have thedrawback that women would end up beingdetained even further away from home thanmight otherwise be the case. Also, while thearguments for segregated sleeping, washing andtoilet facilities are now undisputed, the positionin relation to separate social, educational andother facilities is less clear-cut. While somefemale patients would undoubtedly prefer awholly separate living environment, this doesnot apply to all. Some prefer to haveopportunities to mix and this may also betherapeutically advisable given that whenpatients leave hospital they won’t be insegregated environments. The solution may bethe further development of sites containingseparate single sex units, as well as facilitieswhich allow opportunities for mixed social andother activities.80 Allen H (1987) op cit81 Department of Health (1997) The Patient’s Charter: Privacy and dignityand the provision of single sex hospital accommodation NHS CircularEL(97)3 London: Department of Healthpage 29