Sir: Hassell and Bartlett (Psychiatric Bulletin, September 2001, 25, 340-342) provide a welcome snapshot of women in medium security. They report large increases in numbers of women in such conditions, of whom almost all those detained in NHS facilities are in mixed gender units. They find that women are more often in private sector units than men, and comment that some units no longer accept women because the environment is considered unsuitable.

Service planners have woken up to the fact that mixed gender wards do not work. This is not a surprise, given the historical lessons that prison development has taught us. In the early 19th century women comprised around 20% of the prison population. High profile campaigning led to formal recognition of the problems they faced when regularly outnumbered by men in gaols. The Gaol Act, passed in 1823, led to gradual separation of penal facilities and presently there are 10 establishments in England (none in Wales) that care for women only (Home Office, 1997).

The National Service Framework (Department of Health, 1999) gives a clear commitment to ending mixed gender hospital accommodation, and makes it clear that “as part of the strategy to provide safe services NHS trusts need to… recognise that the needs of male and female patients may be different”. The experience of the prison service (Reference MouldenMoulden, 2000) makes a bold case for small, locally determined units that could clearly meet the required objectives, with the added benefit of minimum disruption to local services and social networks.