This is an excellent collection of papers for professionals working together in secure mental health settings for women. The publication of the national strategy Women's Mental Health: Into the Mainstream (Department of Health, 2002) mapped out gender-specific service development for the next decade and beyond. However, the map had been drawn in the absence of specific evidence about treatment efficacy. There was little professional consensus on what type of service actually worked for which particular group of women; the policy implementation guidance recommended that women's mental health should become an integral element in the training of all staff and managers, within every organisation, but there was no research and little agreement about the types of training required. This book is therefore timely and a valuable resource in a relatively new but rapidly developing field.
The content addresses a range of clinical, political, social, training and management issues for women's secure services. The excellent introduction by the two editors, Nikki Jeffcote and Tessa Watson, lays out some of the key themes of the book, including the multidisciplinary nature of the work, the importance of care pathways into secure services and out of them again, and the impact of early experience and trauma on the development of adult therapeutic relationships. A feminist perspective underwrites many of the chapters. It defines the framework within which inequality and disempowerment are addressed; this may not appeal to all readers.
The first section comprises six chapters on ‘theory building’, the second is focused on ‘practice’ and the third is a collection of four practical papers on training and ‘service development’.
Needs and risk assessment are both addressed in the first section. The chapter by Nikki Jeffcote and Ray Travers on ‘thinking about the needs of women in secure settings’ helpfully reviews current approaches and the salience of relational issues, making the important link with Bowlby's attachment theory. This is an illuminating description of an overarching theoretical model of care. It is complemented well by Les Petrie's extremely useful and practical chapter in the third section on ‘ men, women and good practice.’ It also provides an appropriate springboard for Gwen Adshead's provocative piece on ‘more alike than different: gender and forensic mental health’, which draws out the dialectic with characteristic authority; it is refreshing to see the inclusion of an alternative view of gender sensitivity. Tony Maden's chapter on ‘ risk assessment’ addresses the unresolved difficulty of applying the existing risk assessment tools to women when they have all been standardised on male populations. There are no easy solutions here, but his guidance on the use of good holistic clinical risk assessment complemented by some of the existing instruments is helpful.
The ‘practice’ section includes a series of illuminating case examples to illustrate particular treatment approaches. Countertransference difficulties experienced by staff are described by Anne Aiyegbusi, in her chapter ‘Thinking under fire’. She makes an effective case for clinical supervision for nursing staff, but perhaps misses the opportunity to highlight the need for multidisciplinary reflective practice. There is also a good definitive chapter on the Gender Training Initiative by Sara Scott and Jennie Williams, necessary reading for all staff working in secure services.
I enjoyed this book immensely; it is rich reading and should be accessible on the bookshelves of women's service resource rooms.
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