Female forensic mental health patients are a highly selected group who present exceptional clinical and behavioral challenges along with highly complex treatment needs. St. Andrew's Healthcare Women's Service offers a ‘best practice’ psychosocial treatment program in conditions of medium security. The outcomes of 60 women residents between 2003 to 2008 are described in terms of risk, behavior, symptomatology, and social functioning using HoNOS-secure. The instrument was sensitive to change in this population, including the security scale, which captured highly significant clinical improvements. Some of the challenges associated with measuring outcomes for this group are discussed. The needs of women in secure services can be effectively addressed, enabling movement to less secure settings and further improvement.