More locks, but less care for patients

Many of Britain's mental health patients face unnecessary isolation and unfair assessment according to a former chief of Britain's top secure hospitals.

Charles Kay, who was Chief Executive of the Special Hospital Authority for Broadmoor, Rampton and Ashworth from 1989-1996, yesterday demanded a rethink on patients' confinement.

In an article due to be published in the Mental Health Review later this year, he criticises a shift from individual care towards a focus on control and detention.

The Independent on Sunday has highlighted the plight of hundreds of patients wrongly held in secure hospitals and is campaigning for the transfer of these people to accommodation where they can be treated properly.

Some forgotten prisoners have languished in places such as Broadmoor, Ashworth and Rampton for more than 20 years.

Speaking to The Independent on Sunday yesterday Mr Kay said: "There has been a significant change in atmosphere with the result that many patients are now being treated like offenders."

Criticising the recent £55m allocated to enhance building security at the three hospitals he said: "It seems wrong to be squandering resources in this way, especially since the Tilt report of 1996 revealed Ashworth previously had a better confinement record than most prisons."

There has also been a large increase in the number of staff specifically employed to handle security measures at each hospital. Every planning or assessment meeting now has to be attended by one of the 100 security staff employed at Broadmoor.

"Clinicians and security staff worked side by side. There now appears to be a tension, with some of the decision-making process being removed from psychiatrists. The probation service has also been instructed to stop calling patients 'clients' and replace this with 'offenders'."

Outside "rehabilitation trips" have been reduced ten-fold, it was also revealed in a television programme Inside Broadmoor screened by Channel 5 last month.

In order to offer a "no risk" service that will meet externally imposed targets, Mr Kay believes subsequent alterations to the system will prove damaging to patients and impede their personal development.

"I suspect it will become more difficult for them to move clearly from different levels of security. The isolation of patients behind barriers means doctors and nurses do not have the opportunity to monitor them in more open situations.

"If patients cannot be tested then there is a danger they may relapse. Their hopes are raised and it is no surprise that, when refused, they experience a breakdown. Some patients are potentially dangerous individuals, but we can never hope to move them along if we don't move them to less isolated areas."

In the Mental Health Review, Mr Kay outlines a set of proposed measures, including staff support, reintroduction of clinical assessment and brokering working agreements with other trusts and services about the easier movement of patients up and down the security ladder.

He is convinced that such measures need to be taken to avoid a repeat of the negative climate of the 1979s and 1980s.

"There has been an over-emphasis on the mechanics of security. Hospitals now need to take certain action if they hope to ameliorate the present situation."