Effective therapeutic milieus in secure services for women: the service user perspective

J Ment Health. 2012 Dec;21(6):567-78. doi: 10.3109/09638237.2012.734649.


Background: Women in secure setting represent a group for whom gender sensitive treatments are only emergent. Service users are viewed as participants in treatment developments. However, the opinions of forensic patients have, in contrast to other service users, been under researched.

Aims: To identify service users' views of the constituents of an effective therapeutic milieu for women in secure settings and to help identify the extent to which services need to be specifically tailored for women.

Method: A qualitative service user-led participatory research approach was used. Two focus groups with service users from low and medium secure settings discussed the ingredients of an effective therapeutic milieu based on their experience of gender-specific treatment. Group transcripts were subjected to thematic analysis.

Results: Themes identified covered interpersonal relationships; treatment programming; service user empowerment; the ward as a place of safety; and hope for the future. Participants did not highlight gender-specific issues despite this being implicit in focus group questions.

Conclusions: Findings echo themes from other psychiatric settings and provide a much needed consensus between service providers and users on which to base healthcare planning. The elucidation of gender-specific factors in effective therapeutic milieus requires more focussed research.

MeSH terms

  • Adult
  • Attitude to Health*
  • Borderline Personality Disorder / psychology
  • Borderline Personality Disorder / therapy*
  • Female
  • Focus Groups
  • Forensic Psychiatry / methods*
  • Forensic Psychiatry / statistics & numerical data
  • Hospitals, Psychiatric
  • Humans
  • Inpatients / psychology*
  • Inpatients / statistics & numerical data
  • Interpersonal Relations
  • Mental Health Services
  • Middle Aged
  • Patient Participation / methods
  • Patient Participation / psychology
  • Patient Participation / statistics & numerical data
  • Patient Safety
  • Patient Satisfaction / statistics & numerical data*
  • Power, Psychological
  • Psychotherapy / methods*
  • Psychotherapy / statistics & numerical data
  • Treatment Outcome
  • United Kingdom
  • Women's Health / statistics & numerical data