‘Very Difficult People?’ Women with
Learning Disabilities in Secure
Services
Rebecca Fish
Background to study
• Calderstones Partnership NHS Foundation
Trust
• Low and medium secure units + rehabilitation
service for people with learning disabilities
• 22% service users (only 37 women)
• Single sex flats of 3-5 women
Woodview
Medium
Secure
Unit
Reception
Background to study
• The Reed Report: A Review of Health and Social Services for
Mentally Disordered Offenders and Others Requiring Similar
Services (1992): ‘In male dominated environments, women’s
needs including their more personal female needs are liable to
be overlooked. They are sometimes subject to sexual
harassment and other demeaning behaviour… Services need to
be responsive and proactive in order to counteract these
problems, in order that women receive appropriate care,
treatment, accommodation and rehabilitation with proper
attention to their personal dignity’
Background
• ‘Research on offenders with learning disabilities seldom
includes women and when women participants are
included, the findings tend to be presented in a non-gender
specific manner.’ (Hayes, 2007:190)
• There is a ‘significant need for women with intellectual
disabilities to be heard and ... the meaning that they
ascribe to their lived experiences acknowledged’ (Taggart
et al, 2008: 205).
• The Corston Report, a review of women with particular
vulnerabilities in the criminal justice system (2007:2):
‘women have been marginalised within a system largely
designed for men for far too long’ and there is a need for a
‘champion; to ensure that their needs are properly
recognised and met.’
Women in Secure Hospitals
• women service users are perceived by staff to be the most
difficult to deal with.
• Women in secure hospitals:
– are more likely to be classified as having a personality disorder,
– are more likely to have experienced sexual and/or physical
abuse and
– are more likely to stay longer than men in secure care (Stafford,
1999)
– are involved in more incidents of aggression than men (Sequeira
and Halstead, 2001; Alexander et al, 2005)
– are more likely to self-harm (Maden, 1996),
– are construed by staff as more ‘volatile’ than men (Crawford,
2001)
Staff Quotes
• ‘I think that being in a minority affects the service
that the women are given, and I think as well that
even though they might not be aware of it
they’re living with quite a few sex offenders and
quite a few of the women will have suffered
sexual abuse in the past. So it’s psychologically
not very good for them.’
• ‘Because the women, and I don’t mean to be
horrible to them, but they’re very difficult
people, they’re very very complex, very damaged
people. And they burn out the staff.’
Women with learning disabilities
(Traustadottir and Johnson, 2000)
• Women with learning disabilities and their
experiences remain marginal in the discussions of
feminists, both non-disabled and feminists with
physical and sensory impairments.
• Medical discourse constituted people with
learning disabilities as sick and in need of medical
attention.
• Issues about gender and learning disabilities
neglected within the disability movement.
• Problems with attitudinal barriers and
• Theorising from personal experience problematic.
Women in Secure Hospitals (Warner,
1996)
• Women’s behaviour is more likely than men’s to
be viewed as pathological:
– ‘Turning rage and depression inwards may have less to
do with women’s biological inadequacies and more to
do with their social manipulation and subjugation.
We should be careful not to pathologise individuals
for what might be better understood as being the
result of social inequality and restricted choice.’
(p267)
– Because systems focus on which symptoms are
present, rather than the contexts in which they arise,
the social constitution of mental disorder is seldom
explored.
Research Objectives
• Ethnographic study – participant observation and staff
and service user interviews
• WAG – Women’s Action Group as consultants
• Inclusive research –
– Research must address issues which really matter to
people with learning disabilities, and which ultimately
leads to improved lives for them
– Research must access and represent their views and
experiences
– People with learning disabilities need to be treated with
respect by the research community (Walmesley and
Johnson, 2003)
Research Questions
• How do women service users see their future? What would they
consider good outcomes from using the service?
• What could help women to achieve their preferred outcomes?
• How do women service users and staff feel the service is
implementing the 4 guiding principles of the Department of Health
strategy Valuing People Now (2009):
–
–
–
–
rights,
independent living,
control and
inclusion?
• How do women experience enhanced observations and physical
intervention? – This will result in development of a PROM
• What are the support needs of staff working with women on the
unit, including training and resource needs?
Service User Quote - Physical
Intervention as retraumatisation
• Researcher: So does it matter to you who
restrains you?
• Service User: Yeah, if it’s men I go ballistic.
• Researcher: Why is that?
• Service User: I don’t know. ‘Cause I were
raped by me dad and I don’t feel that, it’s like
men shouldn’t restrain me. There were men
on me foot and even on me hand.
Service User Quote – Self Harm and
the service response
• ‘No-one accepts it, they don’t like it. They feel
they have to stop me. They have to be seen to
be doing something. Nobody’s bad for cutting
up, you shouldn’t be punished either for
cutting up, I don’t think. You do it to yourself
don’t you? Not others. Other people
regularly attack all the time don’t they and
they get things in their room, it’s all wrong.
They don’t want to understand.’
Service User Quote – Enhanced
Observation
• ‘They don’t come to your house do they and sit
and watch you? I’ve no privacy and that’s
difficult. It’s frustrating for me, you wouldn’t like
it. I’ve had to lock myself in somewhere before
now, because everywhere I go there’s staff.’
• “…they check your pockets, check your socks,
totally degrading, things like that, open your
mouth, make sure you’re taking your tablets
when you’re on medication and that really
irritated me.”
Thanks for listening
R.Fish1@lancaster.ac.uk