Background The developmentof single-sexmedium secure units for womenhasbeen driven byconcern about thevulnerabilityofwomento sexual abuse and exploitation inmixed-sex secure settings.Less is known abouthowwomen

Declaration of interest None. It is recognised that women patients in mixed-sex psychiatric settings are vulnerable to threats, harassment and abuse by male patients (Barlow & Wolfson, 1987; Department of Health & Home Office, 1992; Department of Health, 1994; Thomas et al, 1995). This has led to UK governmental policy initiatives to increase the provision of single-sex units and wards for psychiatric patients (Department of Health, 1997, 2002, 2003). Women in secure forensic facilities may be particularly vulnerable because so many of them have histories of physical and sexual abuse (Bland et al, 1999; Coid et al, 2000). However, there is little information as to whether women patients consider gender segregation to be either desirable or likely to contribute to their sense of safety (Cleary & Warren, 1998; Parry-Cooke, 2000). The aims of our study were to assess, first, the extent to which women patients in single-sex and mixed-sex medium secure settings consider themselves to be safe, and second, the extent to which the patients’ perceptions of their safety are reflected in the views of staff working within those units.