The future of Britain's high security hospitals

The culture and values won't change until the Prison Officers' Association is ousted

Until a decade or so ago, the vast majority of mentally disordered offenders who posed a threat to public safety in Britain were consigned to one of the country's three “special hospitals”, Broadmoor, Rampton, and Ashworth (previously Moss Side and Park Lane). This is no longer the case. Most patients on whom a crown court judge has imposed a restriction order (under section 37/41 of the Mental Health Act 1983) are now cared for in regional secure units, general NHS psychiatric inpatient acute units, and independent sector hospitals. These institutions operate far more liberal regimes but with no less safety and without the problems that have dogged the special hospitals. Now that their role is much diminished, do these troubled hospitals have any role in the future of forensic mental health care? And if they do, how can they become clinically excellent institutions?

The special hospitals were run directly by the Home Office and staffed like prisons until 1948. They were then transferred to the Ministry of Health but did not join the new NHS, being managed directly by civil servants. After increasing concern in the late 1980s about standards of care and security, the Special Hospitals Service Authority was established in 1989 to oversee the service at arm's length from the Department of Health. The undersecretary responsible for the service at that time, Cliff Graham, made no secret of his disquiet about the proposed continuation of a centralised management structure, but he felt it was a reasonable interim solution while the hospitals prepared themselves for greater self governance. One of the authority's main problems was to establish management control over a large group of staff that Mr Graham and others perceived to have a damaging influence on standards of care through their rigid, authoritarian, and denigrating attitudes to patients. …