Psychiatric hospitals operate at three levels (Reference Stokes, Obholzer and RobertsStokes, 1994) – ‘what we say we do’, ‘what we really believe we are doing’ and ‘what is actually going on’. Most are unconscious of this third level. Mezey et al (Reference Mezey, Hassell and Bartlett2005) rightly remind us that the further development of single-sex secure units for women may not be justified on the grounds of safety alone, but such a narrow focus has never been the principal driving force for developing gender-sensitive and single-sex secure units, which has massive ramifications for the wider hospital organisation.

Ramsay et al (Reference Ramsay, Welch and Youard2001) broadly described the issues relating to women and psychiatry and Kennedy (Reference Kennedy2001) argued for a proper focus on the needs of male patients. Both perspectives reinforce the need for gender-informed practice. While developing different services for male and female forensic patients, it is worth considering that one tenet of feminism is that no person should be discriminated against on the grounds of gender. Although men and women are not the same, Adshead (Reference Adshead, Jeffcote and Watson2004) argues that, in terms of human needs and human rights, male and female patients are more alike than they are different and that differences should not be the basis for abusive or discriminatory practice.

Although not emphasised sufficiently in the literature, particular issues are commonly encountered by both male and female in-patient forensic populations. These include the emotional and behavioural impact of bringing together a number of patients who have high levels of comorbidity, personality disorder and complex post-traumatic stress syndromes (Reference BercuBercu, 2001). However, models of care for male patients (the majority population in mixed forensic units) fail to address the relational and other specific needs of women, their marginalisation and the impact of their experience of victimisation. Gender-informed forensic services therefore need to be equipped and enabled to provide appropriate levels of care and interventions, in suitable accommodation, for individuals with severe, complex clinical presentations and who present significant risks to themselves and others.

Our position is not that gender adequately differentiates between men's and women's needs but that in the absence of more sophisticated frameworks, their needs are such that, for the foreseeable future, service planning must be based on the assumption that women forensic patients are sufficiently different from their male counterparts that their needs should be provided for separately.