Should women be a special case when it comes to services for psychosis?

Women with psychosis are distinctly different from men with the same condition. In a number of areas the distinctions are quite noticeable, in terms of mood symptoms, physical health issues, post-traumatic issues and social loss, for example. The question is: what represents best care for women, and is care best done in specialist units? Care programmes for women need to manage both complex affective disorders and schizophrenia. This might involve deploying staff with specialist technical expertise, such as a specialist pharmacist, for example. Psychologists and nurse therapists would need a broader range of background experience and training. The therapeutic milieu needs to be as homely as possible. A supportive structure needs to be established that minimises 'the critical voice'. Some traditional care models are based on setting clinical targets for patients to work towards. For many patients this can be very helpful, but for some this inadvertently creates a feeling of being judged as not good enough, and the care system then becomes seen as a critical voice. There needs to be a confident understanding of 'boundary management' within the service - the skill of using clinical relationships to help people to better understand how to manage themselves and keep themselves safe. A particularly effective approach is to engage people as much as possible in doing things, allowing the natural effect of a programme of activities to generate a structure. This has the added benefit of developing self-esteem. Occupational therapy and work therapy input therefore plays a major role. Activities have to be those that women want to do. The service needs space for individuals to be intensively supported through distressing periods, where individuals can safely withdraw for a while, start to be in community with others and direct their own affairs, space where there is no exposure to sexual pressures, male banter and innuendo (which some women find oppressive, but keep silent about). Finally, a care system is needed that is particularly suited to having to deal with multiple, co-existing dimensions of concern. Each area needs specialist attention in its own right, and each dimension can cross interact with others to compound the complexity of the individual patient's predicament. To handle the seriousness and the multiplicity of the issues emerging as significant for women requires a degree of focus and cohesion of the care team that suggests the need for a specialist approach. Moreover, other than for peri-natal psychosis, the whole area of psychosis specifically in women is relatively under researched. One advantage of a service that specialises in this area would be its capacity to begin formal further research in this area.