This is Ashworth, Britain's biggest top security mental hospital. It houses hundreds of the country's most dangerous and disturbed criminals, including Ian Brady, the Moors murderer. After decades of obscurity, guaranteed by the Official Secrets Act, a new openness has broken out at the sprawling 200-acre site.
A year ago, complaints about persistent neglect and abuse of patients by a substantial minority of staff at the Merseyside hospital were upheld by a government inquiry. Evidence of systematic ill- treatment of patients created 'an unwholesome image of a criminal lunatic asylum'; a 'brutalising, stagnant, oppressive' regime held sway for five years, according to the inquiry team, headed by Sir Louis Blom-Cooper.
This damning report was the spur to sweeping changes designed to replace Ashworth's outdated practices and grim atmosphere with a culture of care, therapy and rehabilitation. The theory, backed by health ministers, is this: mentally ill people convicted of murder, child-killing, rape and arson have rights and needs; however horrific their crimes, they are as much entitled to compassionate treatment and the chance of rehabilitation as those who are physically ill.
Eight staff have been sacked since the report. Other disciplinary actions are pending.
Now the daily routines and treatments are increasingly tailored to what patients want, not what staff think is good for them. It costs a shade under pounds 60,000 a year to keep someone at Ashworth. Soon incoming patients are likely to be offered aromatherapy to complement the psychotherapy.
Provision of condoms and the allowing of conjugal rights are topics under discussion; the threat of Aids and the engagement of three couples on a mixed ward have made difficult decisions pressing.
Already the 606 patients, 90 per cent of them men, who spend an average of eight years at Ashworth, elect a council to protect their interests and lobby for improvements.
The new openness manifested itself last week in the managers' decision to allow themselves, staff and a few patients to talk about daily life and the substance of positive changes proclaimed both by the hospital management and by Virginia Bottomley, Secretary of State for Health.
The chairman of the patients' council, who asked not to be further identified, shares the management's ambitions to project a positive image. An intelligent and articulate man, he was happy to talk.
He thinks much of the bad publicity Ashworth has attracted is undeserved. 'The tabloids portray us as the monster hospital, a sort of Jurassic Park,' he says. 'They judge individuals on the basis of perhaps a single deed, without looking at the people behind it, many of whom have had very sad childhoods. Perhaps horrifying people sells newspapers, but that image has really been overplayed. We are not wandering around swinging from chandeliers. Certain individuals seem to attract media interest, and then we all get tarred with the same brush.
'I think the events that led to the Blom-Cooper report were also not as widespread as was supposed. I have never witnessed brutality at Ashworth, although I have at Broadmoor. Certainly staff are less likely to be rude and offhand than before. They are more accountable, and aware of the new complaints procedures. Previously, there was no channel for legitimate concerns.'
Many of the instances of brutality investigated by the Blom-Cooper team allegedly involved members of the Prison Officers' Association, which represents about one-third of the 900-strong nursing staff. The chairman of the patients' council says: 'They have a lower profile now; there isn't the same tension that there was between patients and the POA. There are more women on the staff, which is good. They are a civilising influence. We now have a woman general manager. If you are locked up in an all-male environment, it encourages the worst kind of barrack-room culture. If you introduce women, the guys are less likely to behave in an unacceptable way.'
Some patients would like to see the POA barred from Ashworth. 'There are some staff, thankfully not on my ward, who are nothing more than glorified screws,' said one. 'I don't think the POA should be in this hospital, but they are a very powerful organisation . . .' The conversation was cut short by a manager since it had not had the prior approval of his consultant psychiatrist.
The greater choice given to patients does have some side- effects. Since they were allowed not to attend workshops there has been a drop in the numbers doing carpentry, sewing, art and other rehabilitation work.
Many of those who opt out pass a lot of time sitting and smoking. Ian Brady, now in his mid-fifties, reportedly spends most days alone reading in the library, or writing letters and articles. He apparently tends not to mix with other patients.
All patients have their own small room, with a television set. There are glass peepholes the size of letter boxes in each door, so privacy is relative. Most are locked into their rooms between 9pm and 7am. Those on three of the 24 wards still 'slop out' but the hospital is committed to ending this.
But patients are getting more glimpses of the outside world. Payphones have been installed on the wards, although calls are still supervised; visiting arrangements are more flexible. A Citizens Advice Bureau is to open soon. There are more recreational trips; to the cinema (Jurassic Park next week), or perhaps to the Alton Towers theme park.
In Eiders, the 20-bed mixed ward, a couple of cats doze on armchairs. It has a homely, relaxed atmosphere. It is for the lower-dependency patients, a final 'testing ground' to assess whether they are ready for discharge to medium-secure units. Patients clean the ward themselves. Three engaged couples live here, and a fourth couple on the ward want to get engaged.
But the question of whether they should be allowed to marry, and perhaps have children, presents the hospital with one of its trickiest moral dilemmas.
Sandy Hastings, formerly a charge nurse and now Eiders ward manager, is one of the most ardent advocates of further liberalisation. When he took charge of the ward earlier this year, there were 56 rules in force. He invited patients to choose the ones they wanted to keep. They got the list down to 40, then he knocked off another six.
When the patients there said they would like to make a garden at the back - a request which in the old days would have become snarled up in red tape - he gave it an almost immediate go-ahead.
Mr Hastings is contributing to an internal review of the present bar on sexual relationships, both heterosexual and homosexual, between patients. 'We would be foolhardy to ignore these issues, but it does open up a whole can of worms.
'The first question we have to resolve is the issuing of condoms. The patients themselves seem to be split on the issue. We do have to think of the possibility of Aids infection. But then where do you stop? Do you allow patients to use blow- up dolls?'
Elaine Murphy is a vice- chairman of the Mental Health Act Commission, which oversees the work of England's three so-called special hospitals: Ashworth, Broadmoor and Rampton. A leading consultant psychiatrist, Professor Murphy believes the regime at Ashworth has changed markedly for the better, but thinks the medical leadership should be strengthened.
'We are disappointed at the speed with which Ashworth is moving towards good psychiatric decision-making. It is not just the fault of the doctors. The system still tends to marginalise the social workers, psychologists, even nursing staff.' None of the doctors was available for interview during the visit.
Janice Miles, who arrived as general manager a few weeks ago, has the unenviable task of spurring on Ashworth's quiet revolution, while at the same time eliminating the pounds 250,000 deficit on its pounds 33m budget.
'My philosophy is to work with the staff organisations and to encourage a flexible, co-operative approach. What impresses me is that most staff express a real willingness to change. There will always be a need for psychiatric care within a secure environment. But I see Ashworth very much as part of the NHS. This is a hospital, not a prison.'
That is the message Amanda Robinson, Ashworth's public relations manager, battles to put across. But surely she occasionally felt the odd moment of fear, working where she did? 'Oh no. I feel much safer in here than I do walking around Liverpool at night.'
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