Mental Health Services for ‘Difficult’ Women: Reflections on Some Recent Developments

Abstract

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.

Gender politics and secure services for women: reflections on a study of staff understandings of challenging behaviour

“…Despite a considerable amount of recent policy concern with the position of women in psychiatric services, the findings of this research suggest that many front line staff are reluctant to highlight gender in their explanations of women's behaviour. This supports the assertion by Williams et al . (2001), who were involved in the National Gender Training Initiative (NGTI), that most critical theorizing about women's mental health has had minimal impact at the level of individuals' understandings of these important issues.…”

Taming The Shrew: Regulating Prisoners Through Women-Centered Mental Health Programming

“…Feminist informed mental health practitioners outside the correctional system have challenged the tendency to label post-traumatic stress responses as pathological and disordered (Henderson et al 1998;Ussher 2000;Warner 2001;Williams et al 2001;Rivera 2002) This research is particularly important because while it acknowledges the reality of the psychological distress and difficulties of women given personality disorder diagnoses, it simultaneously de-privileges psychiatric discourse, concretely deals with issues of power in the therapeutic relationship and within the context of service delivery, and explores the relationship between social inequalities and psychological distress. These models, variously called feminist (Ussher 2000;Rivera 2002), post-structural feminist (Warner 2001), gender-appropriate (Henderson et at.…”

“…This can be seen in the CSC's emphasis on women offenders as having personality disorders (Laishes 2002;McDonagh et al 2002a, b). The invocation of psychiatric ideologies, however, does not result in an approach that considers the impact of gender (or race or culture) on women's mental health (Williams et al 2001), but rather, perpetuates the invisibility of social and cultural influences upon women's behavior and sense of self.…”

“…These models, variously called feminist (Ussher 2000;Rivera 2002), post-structural feminist (Warner 2001), gender-appropriate (Henderson et at. 1998), and/ or woman-focused (Williams et al 2001), are designed for the same population with which the CSC is concerned, survivors of childhood trauma who are self-injurious, angry, and suicidal. Although some of the treatment strategies may also be similar (many draw on both cognitive behavioral techniques as well as psychodynamic approaches), the philosophical frameworks and policy implications are dramatically different.…”

Gendered experiences of physical restraint on locked wards for women

“…Women service users on Unit C were described as using 'relational aggression' , which was considered to be more difficult to deal with than the type of aggression shown by male service users on the unit (see also Wilcox, Finlay, and Edmonds 2006;Williams, Scott, and Waterhouse 2001). This perceived difficulty legitimated the use of restraint with women, some of whom had been given a Borderline Personality Disorder diagnosis, a distinctly gendered label signifying extreme difficulties with relationships (Becker 1997).…”