Surrounded by a vast perimeter fence, the tall, forbidding old east wing of the state hospital in Carstairs looks more prison than hospital. Its beginnings in 1948, as the criminal and lunatic department of Perth prison, take some shaking off. Hospital bedrooms, with heavy metal doors and peep holes, still look like smartened up prison cells.
Strings of keys hanging from the waists of black-trousered male nurses make clear who holds power. Baring tattoos, some still look like prison warders and the Prison Officers' Association represents most of them.
Broadmoor, Rampton and Ashworth - Carstairs' sister hospitals in England - have been judged irreformable by a special inquiry into alleged brutality at Ashworth, which reports tomorrow.
But Carstairs begs to differ. The authorities in Scotland want it to be known that Carstairs is now a therapeutic institution devoted to nursing and rehabilitating dangerously ill people. Carstairs' PR company, TMA Communications, invited the Independent in to see the new model of secure care.
The paradoxes of Carstairs abound. Immediately striking on a summer's day is the wonderful open space, albeit enclosed by the fence, between the low-rise wards on the newer west wing. But not a soul is out enjoying it. They are, of course, locked in, unless escorted by staff. A few enjoy parole - unsupervised walks in the grounds - as a step towards freedom in the outside world.
There is a thick plate glass window at the entrance and, within this confinement, a fabulous greenhouse, producing 40,000 bedding plants a year. Maiden hair, a delicate fern which dies in all but the most sensitive households, is abundant. Close by patients care for captive birds, kept in a large cage. It is a place of tranquillity for troubled minds.
And then there is the railway. Between the east and west wings roar express trains to Glasgow. Patients must feel they are so near, yet so far.
Many are very sick. A quarter have murdered and another quarter have been convicted of assault or attempted murder. It is a place of tragedies.
Steve Novosel, a psychiatrist, recalls the case of a patient suffering a 'pathological sense of altruism'. He killed his family after developing an acute sense of danger they faced in the world. 'He perceived killing them as an act of kindness,' Dr Novosel said. The man eventually recovered and then had to deal with the horror of what he had done.
Half the patients come from other psychiatric hospitals after becoming unmanageable, while most of the rest come from the courts and prison. Gordon, 33, was sentenced to 10 years in prison for armed robbery and seven for holding a prison officer hostage. Now he breeds exotic fish at Carstairs.
'At Peterhead, they blamed me for starting the riot. I was locked up 23 hours a day. There were prison officers in US football gear with helmets and shields. I have what's called a prison psychosis. If I go back to prison, I get ill again,' he said.
'I've been here for 15 months. It's completely different. They try and rehabilitate you. I go home every four weeks to see my family with two members of staff. I get medication, largactyl, three times a day and at night. It keeps me calm. I get upset very easily.'
Staff highlight the changes. Padded cells disappeared last year. Slopping out has finally ended after years of complaints from Scotland's Mental Welfare Commission.
Seclusion of patients, during which most allegations of abuse have arisen at Ashworth, is much reduced. Mixed wards, with both patients and staff including men and women, are being introduced. Mail is still read by staff but patients can telephone out on a direct line.
Dr William Boyd, vice-chairman of the commission until last year, said: 'Given the very untherapeutic environment - single rooms which were once cells - and a pretty institutional atmosphere which does not help, they are really trying to change at Carstairs.' Robert, 31, sums up the mood change: 'I've been here for three and half years. It's my second time. There has been a lot of improvement. They used to wear screws' uniforms. They don't now. That helps to ease the burden. We used to call them screws. We don't anymore.'
But the tension of sudden change is telling on staff, some of whom, faced with the stress of so much illness, hark back to the old days which are being constantly challenged. Many still live nearby on a special estate which solidified the hospital's culture.
In a union survey, more than half the 300 nurses who care for the 225 patients said that management had failed to ensure there was adequate consultation. To some, the breathe of fresh air from the NHS management culture is a howling gale.Reuse content