The mental health field is viewed by some as reluctant to tackle the problem of abuse. While 'adult protection' offers one way forward, the authors of this paper caution against over‐enthusiastic borrowing from this paradigm. Instead they argue that mental health services will only become intolerant of abuse when there is widespread acceptance of the role of power abuse in psychological distress and disturbance.
The provision of mental health services to women has come sharply into focus for providers of secure psychiatric services in the UK. Women's services are being developed in response to the known risks of mixed-sex provision, and a growing appreciation of the ways that women in secure services can be further disadvantaged by their minority status. Our intention here is to present evidence and reflections to help inform this development. The evidence is drawn from our recent work in this field, which includes carrying out a review of local mental health services for 'difficult' women, and developing and piloting a national training programme for staff working with women in secure services. The reflections we offer are informed by the conviction that taking social inequalities into account is central to making sense of women's mental health difficulties, and improving service responses to women's needs. While there are signs that many mental health workers in secure services are beginning to share these convictions, the challenge now is to provide the necessary authorization, training and support that will enable them to translate these understandings into empowerment practice with women.
This is an edited version of a conversation that took place between myself and four other clinical psychologists who had been actively involved in developing better services for women living in Ashworth and Rampton hospitals - two of the three high security psychiatric hospitals in England. There have been long-standing concerns about the quality of the services provided by these Special Hospitals,1 and a public inquiry2 in 1992 identified services to women as a particular cause for concern. This inquiry was followed by a period of optimism during which time these psychologists had worked hard to improve services to women in the Special Hospitals. We met in late 1996 to talk about their frustrations and disappointments, to learn from their experiences, and to remember the women who live in these hospitals. This was not an easy conversation, and it was also limited by a pending tribunal and the ever present threat of legal action. The Special Hospitals have continued to feature in news headlines, and their future is being publicly debated. We want this debate to be informed by an understanding of the ways in which Special Hospitals continue to fail women. There is nothing to suggest that they provide women with what they need, or that they are likely to do so in the future. The development of better community mental health services is the only way forward.
