Background Service evaluations of medium secure hospital facilities for women are underrepresented in the extant literature. Hypothesis That positive changes in symptoms, personality traits and service need would be evident between admission and discharge among women in a medium security hospital service. Methods A pre‐test/post‐test design was used, with comparisons made between admission and pre‐discharge points on a variety of measures of psychiatric symptoms and personality traits. Results There were significant improvements in mood according to Beck Depression Inventory scores, mood and other symptoms of mental disorder and distress as measured by the Brief Psychiatric Rating Scale and the Modified Post Traumatic Stress Disorder Symptom Scale, personality traits recorded using the Millon Clinical Multiaxial Inventory III and service need as measured by the Camberwell Assessment of Need, Forensic Version. Conclusions/implications for practice Significant positive change during treatment, in all clinical areas, is encouraging given poor outcomes for women reported in other research. Findings cannot, however, be unequivocally attributed to the treatments given. Further work is needed to improve early engagement and tailor treatment more specifically to the needs of a heterogeneous population. Copyright © 2014 John Wiley & Sons, Ltd.