Broadmoor Hospital

Broadmoor Hospital is a high-security psychiatric hospital at Crowthorne in the Borough of Bracknell Forest in Berkshire, England. It is the best known of the three high-security psychiatric hospitals in England, the other two being Ashworth and Rampton. Scotland has a similar institution at Carstairs, officially known as The State Hospital but often called Carstairs Hospital, which serves Scotland and Northern Ireland.

The Broadmoor complex houses about 260 patients, all of whom are men since the female service closed with most of the women moving to a new service in Southall in September 2007, a few moving to the national high secure service for women at Rampton and a few elsewhere. At any one time there are also approximately 36 patients on trial leave at other units. Most of the patients there suffer from severe mental illness; many also have personality disorders. Most have either been convicted of serious crimes, or been found unfit to plead in a trial for such crimes. The average (arithmetic mean) stay for the total population is about six years, but this figure is skewed by some patients who have stayed for over 30 years; most patients stay for considerably less than six years.

The catchment area for the hospital underwent some rationalisation of the London area in the early twenty-first century, and now serves all of the NHS Regions: London, Eastern, South East, South West.

One of the therapies available is the arts, and patients are encouraged to participate in the Koestler Awards Scheme.

History

The hospital was previously known as the Broadmoor Criminal Lunatic Asylum; the change of name reflects a change in attitude towards mental illness, criminals, and the word "asylum".

The hospital was built to a design by Sir Joshua Jebb, an Officer of the Corps of Royal Engineers, and covers 210,000 square metres (53 acres) within its secure perimeter. It received its first female patients on 27 May 1863, with the first male patients arriving on 27 February 1864. The original building plan of six blocks for men and two for women was completed in 1868. A further male block was built in 1902.

Due to overcrowding at Broadmoor, a branch asylum was constructed at Rampton Secure Hospital and opened in 1912. Rampton was closed as a branch asylum at the end of 1919 and reopened as an institution for mental defectives rather than lunatics. During World War I Broadmoor's block 1 was also used as a prisoner-of-war camp, called Crowthorne War Hospital, for mentally ill German soldiers.

After the escape and the murder of a local child in 1952 by John Straffen the hospital set up an alarm system, which is activated to alert people in the vicinity, including those in the surrounding towns of Sandhurst, Wokingham, Bracknell and Bagshot, when any potentially dangerous patient escapes. It is based on World War II air-raid sirens, and a two-tone alarm sounds across the whole area in the event of an escape. It is tested every Monday morning at 10 am for two minutes, after which a single tone 'all-clear' is sounded for a further two minutes. All schools in the area must keep procedures designed to ensure that in the event of a Broadmoor escape no child is ever out of the direct supervision of a member of staff. Sirens are located at Sandhurst School, Wellington College and other sites.

As well as providing patient care Broadmoor is a centre for training and research.

Following the Peter Fallon QC inquiry into Ashworth Special Hospital, which found, amongst other things, serious concerns about security and abuses that came about from poor management, it was decided to review the security at all three special hospitals. Until this time each special hospital was responsible for maintaining its own security policies.

This review was made the personal responsibility of Sir Alan Langlands who at the time was Chief Executive of the National Health Service (England). The report that came out of the review initiated a new partnership to be formed whereby the Department of Health sets out a policy of safety and security directions that all three special hospitals must adhere to. These directions are then updated or modified as needed.

This has resulted in upgraded physical security at Broadmoor from approximately category 'C' to category 'B' prison standards. Higher levels of security than this are then placed around certain buildings. New standards have also been formulated to increase procedural security and safety for the staff and other patients; these include procedures and equipment for reducing the amount of contraband smuggled into the hospital.

Before the Langlands report, it had been an anathema in modern psychiatry to think of enclosing the mentally ill behind razor wire. As this type of security measure had been seen as unnecessary, it was thought that it would only serve to reinforce the stigma against psychiatric patients if it were to be employed.

Misconceiving it as a prison

Because of the outside appearance of the buildings, especially its high walls and other visible security features, and the inaccurate news reporting it has in the past received, it is occasionally presumed by some members of the general public that Broadmoor Hospital is a prison. Many of its patients are indeed referred to it by the criminal justice system, and its original design brief incorporated an essence of addressing criminality in addition to mental illness; however, the layout inside and the daily routine are designed to assist the therapy practised there rather than to meet the criteria necessary for it to be run along the lines of a prison in its daily functions. Many staff were often members of the Prison Officers Association, as opposed to the health service unions like COHSE.

Jimmy Noak, Broadmoor's director of nursing, in response to claims that criminals were being given unfairly pleasant treatment in the facility, commented, "It's not fair, but what is the alternative? If these people committed crimes because they were suffering from an acute mental illness then they should be in hospital."

Governance

From its opening until 1948 Broadmoor was managed by a Council of Supervision, appointed by and reporting to the Secretary of State for the Home Department (Home Secretary). Thereafter, the Criminal Justice Act of 1948 transferred ownership of the Hospital to the Department of Health (and the new NHS) and oversight to the Board of Control for Lunacy and Mental Deficiency established under the Mental Deficiency Act 1913. It also renamed the hospital Broadmoor Institution. The Hospital remained under direct control of the Department of Health - a situation which reportedly "combined notional central control with actual neglect" until the establishment of the Special Hospitals Service Authority in 1989, with Charles Kaye as initial Chief Executive.

In 1996 the SHSA itself was abolished, being replaced by individual special health authorities in each of the High Secure Hospitals. The Broadmoor Hospital Authority was itself dissolved on 31 March 2001. Then on 1 April 2001 West London Mental Health (NHS) Trust took over the responsibility for this hospital. This Trust reports to the NHS Executive through the London Strategic Health Authority.

Current research

A new unit called the Paddock Centre was opened on 12 December 2005 to treat patients with a dangerous severe personality disorder (DSPD). This is a new and much debated diagnosis or label that has two criteria. The first criterion is that the individual be 'dangerous', i.e. they are considered to be or represent a 'Grave and Immediate Danger' to the general public. It has been suggested that the threshold for this criterion be set at a greater than 50% chance of that individual committing serious harm upon another, from which the victim is unlikely to recover.

The second DSPD criterion is that the individual suffers from a 'severe personality disorder', meaning that he or she has:

Rather than create a new Mental Health Act, it may now only require the existing laws to be updated in order that people can be assessed for this condition before they have been committed to the forensic services by another route. The DSPD service in the Paddock Centre will be limited to men, as it is not yet scientifically agreed whether any women meet this criterion.

Individuals who do meet this criterion will be admitted to the new Paddock unit only as and when sufficient staff have been trained to be able to provide and maintain the right therapeutic programmes and environment. The Paddock Centre is designed to eventually house 72 patients, and is one of four units being set up in England and Wales. The architects were Oxford Architects LLP

As the West London Mental Health NHS Trust already carries out research, the Trust hopes that Broadmoor will become a centre of learning for this new type of therapy. The ultimate aim of this work is to reduce the cost to society compared to that which would accrue if no treatment was provided.

Notable patients of Broadmoor Hospital - past and present