Hospital where staff can never relax: Martin Whitfield reports from Broadmoor where nurses must remain vigilant at all times to guard against the risk of violence

THE ROOM in which Orville Blackwood died is in the most modern part of Broadmoor hospital.

Like others in Abingdon ward, it consists of a moulded plastic bed, a moulded bookcase and little else. Private lavatory and washing facilities are equally functional.

The window, made up of a succession of reinforced glass panels four or five inches wide, opens across a courtyard garden. Fresh air flows in freely.

A common room, a television room, an exercise room and a dining room make up the remainder of the purpose-built accommodation for 20 of the most dangerous and mentally disturbed men in the country.

The new building contrasts with the older parts of Broadmoor where slopping out, high walls, iron bars and a lack of light are the norm. The appearance there is a peculiar cross between an old hospital and an old prison.

A group of visiting Russian psychiatrists, including the new head of Moscow's Serbsky Centre for Forensic Psychiatry, said the new Broadmoor buildings were typical of the best equivalent accommodation they had seen during tours of Germany and Holland.

The female high-security ward remains old-style Broadmoor, but the hospital is undergoing a pounds 20m refurbishment programme, and the women's ward is next on the list.

Patients placed in the secure wards are considered the least stable of Broadmoor's 500 residents, 100 of whom are women.

They all have records of extreme violence, murder, and manslaughter. Many will have some form of sexual deviation. Admission to Broadmoor, one of three special psychiatric hospitals - Rampton in Nottinghamshire, and Ashworth, Liverpool, are the others - is decided solely on grounds of potential danger to the public.

More than 80 per cent of inmates are schizophrenic with 'voices' liable to tell them to attack other patients or members of staff. One female patient 'in love' with a nurse wrote to her recently saying that the hospital's protection would not be enough and described in detail that eventually she would find her alone and kill her.

Assaults, such as being caught from behind in attempted strangulation, or using dining cutlery as weapons, are relatively common. Each item of cutlery is counted out and counted back at meal times.

Some patients have to be watched continuously 24 hours a day, and glass viewing panels are fitted to each bedroom door. Attempted suicide is as likely as attempted assault, and a routine regime is for observation every 15 minutes.

Patients spend years in secure wards before they progress to other wards where behaviour, although still unpredictable, is more stable.

Nursing such patients is a team effort between psychiatrists, social workers and the nurses themselves. Calming techniques and a cool manner are essential and Broadmoor is an intense training ground for psychiatric nurses.

In the most secure wards there are almost as many staff as patients. The ratios are needed for constant vigilance as nurses can never fully relax because of the ever-present risk of violence.

Like psychiatrists, they feel badly portrayed as either weakly pandering to the whims of the criminally insane or as bullies mistreating those in their care.

Alan Franey, the general manager, is looking forward to the completion of the refurbishment programme, roughly two-fifths done, and the abolition of slopping out, which he described as a 'barbaric practice in a hospital'.

'The important thing is that we prepare patients for the day they leave this hospital in a way that, as far as possible, can help them cope with the very heavy demands that they will face eventually in society.'