Broadmoor Hospital

Broadmoor Hospital is a high security psychiatric hospital at Crowthorne 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, located at Carstairs, officially known as The State Hospital; also called Carstairs Hospital.

The Broadmoor complex houses about 260 patients all of whom are men since the female service closed in September 2007, with most of the women moving to a new service in Southall, a few moving to the national high secure service for women at Rampton and a small number transferring 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 of the patients 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 stay is about 8 years.

The catchment area for the hospital has recently undergone some rationalization of the London area 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
Previously known as the Broadmoor Asylum for the Criminally Insane, the change of name reflects a change in attitude to mental illness and criminals, and usage of the word "asylum".

The hospital was built in 1863 to a design by Sir Joshua Jebb, and covers 210,000 square metres (53 acres) within its secure perimeter.

Due to the potentially violent nature of some of the patients the hospital has an alarm system, which is activated if any dangerous patient escapes to alert people in the vicinity—including those in the surrounding towns of Sandhurst, Wokingham, Bracknell and Bagshot. This alarm system 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. The system 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. During the early 1990s at least one nearby school maintained, and on occasion used, procedures designed to ensure, in the event of a Broadmoor escape, that no child was ever out of the direct supervision of a member of staff.

As well as providing patient care Broadmoor is also 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. Up 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. 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—this includes procedures and equipment for reducing the amount of contraband smuggled into the hospital.

Before the Langlands report, it had been anathema to think of enclosing the mentally ill behind razor wire, which was seen as reinforcing the stigma against them.

Governance
The previous Broadmoor Hospital Authority was dissolved on 31 March 2001. Then on 1 April 2001 West London Mental Health (NHS) Trust took over the resposibility 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 is comprised of two criteria: firstly that the individual be 'dangerous', i.e. that 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 part of the DSPD criteria requires that the individual must suffer from a 'severe personality disorder', meaning that he or she has:


 * 1) A diagnosis of two or more personality disorders that meet the criteria as laid out in the Diagnostic and Statistical Manual of Mental Disorders DSM IV –TR; or
 * 2) A significant score (i.e. 30 or higher) on the Hare Psychopathy Check list – Revised (PCL-R); or
 * 3) A slightly lower score (i.e. 25 to 29) on the Hare Psychopathy Check list and with one or more personality disorders but not including an Antisocial personality disorder diagnosis.

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 males, as it is not yet scientifically agreed as to 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 just 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 that would accrue if no treatment was provided.