The authenticity and sustainability of trauma-informed approaches in health care systems is complex and hard won. It must encompass and accommodate a multiplicity of interpersonal relationships, with differing and often polarised perceptions, practices and priorities through organisational layers. This chapter sets out the philosophical understanding and challenges that arise in implementing trauma-informed care in a women’s secure psychiatric ward. Using a series of vignettes the chapter outlines some of the key features and strategies that can be used to achieve a compassionate focused and psychologically safe care dynamic in an otherwise restrictive and controlled environment.