title: Pathways of care of women in secure hospitals: which women go where and why.
abstract: BACKGROUND
  Care pathways for women needing expensive, secure hospital care are poorly understood.
  
  
  OBJECTIVE
  To characterise women in low and medium security hospitals in England and Wales and to compare populations by security and service provider type.
  
  
  METHODS
  Census data from all specialist commissioning areas. Sociodemographic, clinical, medico-legal, criminological and placement needs data were requested on all women in low and medium secure hospital beds. Parametric tests were used for continuous data and chi-square or Fisher's exact tests for categorical data. Thematic analysis was used for free text data.
  
  
  RESULTS
  The independent sector is the main service provider. A third of all women (n = 1149) were placed outside their home region despite spare local National Health Service (NHS) capacity. The independent sector provides for women with relatively rare disorders, including intellectual disability. The NHS admits most serious offenders. One in 20 are detained because of self-harm alone.
  
  
  CONCLUSIONS
  Patient-specific factors (notably the diagnosis of personality disorder) and organisational inadequacy (commissioner and service provider) contribute to placements that compromise rehabilitation. Responses should include local solutions for women whose main risk is self-harm and a national approach to women with highly specialist needs.
authors.affiliation: Annie Bartlett, MRCPsych, PhD, Nadia Somers, MSc, Matthew Fiander, PhD, Department of Population, Health Sciences and Education, St George's, University of London, London; Mari Anne Harty, FRCPsych, PhD, Shaftesbury Clinic, Springfield University Hospital, London, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Bartlett
authors.affiliation: Annie Bartlett, MRCPsych, PhD, Nadia Somers, MSc, Matthew Fiander, PhD, Department of Population, Health Sciences and Education, St George's, University of London, London; Mari Anne Harty, FRCPsych, PhD, Shaftesbury Clinic, Springfield University Hospital, London, UK.
authors.forename: Nadia
authors.initials: N
authors.lastname: Somers
authors.affiliation: Annie Bartlett, MRCPsych, PhD, Nadia Somers, MSc, Matthew Fiander, PhD, Department of Population, Health Sciences and Education, St George's, University of London, London; Mari Anne Harty, FRCPsych, PhD, Shaftesbury Clinic, Springfield University Hospital, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fiander
authors.affiliation: Annie Bartlett, MRCPsych, PhD, Nadia Somers, MSc, Matthew Fiander, PhD, Department of Population, Health Sciences and Education, St George's, University of London, London; Mari Anne Harty, FRCPsych, PhD, Shaftesbury Clinic, Springfield University Hospital, London, UK.
authors.forename: Mari Anne
authors.initials: MA
authors.lastname: Harty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D016304:Hospitals, Private / Q000458:organization & administration; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D013222:State Medicine / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014852:Wales; D016387:Women's Health; D055815:Young Adult