Patients who find solace in life of high security: Rosie Waterhouse talks to patients at Rampton special hospital following its reprieve with Broadmoor and Ashworth

FRANK, a long-stay patient in Rampton high security special hospital in Nottinghamshire, put down his book, Medical Murders: Classic True Crime Stories, to explain why he wanted to stay locked up.

The last time he was released, in 1977, he had been out for only two hours when he was desperate to get back in. Then, after five years in the institution, he was completely unable to cope with the concept, still less the reality, of freedom. Now, after a total of 21 of his 67 years in Rampton, he still is.

To force Rampton to take him back Frank set fire to a barn. He had to start another fire before they got the message but Frank intends to spend the rest of his life in Rampton. He is a patient on Drake ward, an intensive care ward for 'high risk' patients who are a danger to themselves or others.

Frank is one of the 1,700 patients for whom the three special hospitals - Rampton, near Worksop, Broadmoor in Berkshire, and Ashworth on Merseyside - were built, and he will be as relieved by Rampton's reprieve as any member of staff worried about their job. 'I look on Rampton not as a prison, not as a hospital, but as my home,' he said. He would have preferred to be in the monastery where he spent three years as a lay brother in the 1950s, but in Rampton he has the same sort of secure and ordered existence. Only more so.

Patients are sent to special hospitals under the 1977 National Health Service Act because they must be detained 'in conditions of special security on account of their dangerous, violent or criminal propensities'.

The special hospitals are principally for mentally disordered offenders, some of them 'high profile' such as Peter Sutcliffe (Broadmoor) and Ian Brady (Ashworth). Four out of five patients are referred from prisons or the courts, and the remainder are sufficiently dangerous to require special security. All are mentally ill, suffering from conditions such as psychopathic disorders, schizophrenia and 'mental impairment'.

Of Rampton's 518 patients, 101 are women; 344 are 'restricted' and cannot be moved or discharged without approval from the Home Office; 171 are unrestricted and can be released by the patient's Responsible Medical Officer or by the Mental Health Review Tribunal, and three are on remand.

Since responsibility for the three special hospitals was transferred from the Home Office to the National Health Service in 1989, administered by the Special Hospitals Service Authority, there has been an attempt to change the atmosphere and culture so they feel less like prisons.

The main features retained are high-security perimeter fencing and locked doors. Rampton has 4,000 doors, and one of the first impressions once inside is the jangling of keys carried by each member of staff. Every few yards there is a door to be unlocked, passed through and re-locked.

Since 80 per cent of the patients are offenders who include murderers, rapists and arsonists, there is an air of tension and constant watchfulness. But with a staff and patient ratio of more than two to one, staff contrive to make the atmosphere seem informal and relaxed. Built in 1912, after Broadmoor filled up, Rampton has 29 wards, some of them in institution-like dark, red brick blocks, others in detatched 'villas' dotted around the grounds of the 169-acre (68-hectare) site, where patients who are not an imminent danger are housed.

There are two main pre-discharge wards where patients are prepared for release, usually to regional medium secure units. A shortage of such places means patients spend months, sometimes years, awaiting discharge.

Peter, a patient on Moss Rose pre-discharge ward, has been waiting for seven years. Paul, who was once allowed out alone on trial leave, could not cope outside after 13 years in Rampton. He felt he should have been better prepared to handle money, find his way around and mix with people. 'The freedom was more or less thrown at me,' he said.

Contrary to preconceptions that Rampton would be a cross between the sets for The Silence of the Lambs and One Flew Over the Cuckoo's Nest, the main building looks, on approach, more like a naval academy. Once inside there is the unmistakable smell of hospital food and disinfectant. Seemingly miles of echoing corridors are newly decorated in soft pastel colours and with patients' art work.

There are no padded cells, (the most immediately dangerous patients are kept under observation in 'seclusion' with just a bed and a cardboard bedpan), and lobotomies went out with the 1960s, according to Richard Tear, the hospital's first public relations man, appointed in October last year.

The special hospitals have an image problem. The brutal and 'dehumanising' regime at Ashworth exposed in a report by Sir Louis Blom Cooper last year prompted Virginia Bottomley, the Health Secretary, to order the Reed review.

After the death of a Rampton patient after a 'violent incident' last year five staff faced criminal charges. A manslaughter charge against one male nurse was dropped and four men charged with conspiracy to pervert the course of justice were recently discharged after magistrates decided they had no case to answer. After an internal inquiry one of the five was dismissed.

Mr Tear said the hospital could not comment on the circumstances of the death until after an inquest later this year.

Although many staff are members of the Prison Officers Association, they are nurses and as part of the image change at Rampton the wearing of uniforms - a blue suit - was stopped. Staff are no longer addressed as 'Sir' or 'Miss'. First names are used. Gary, a patient for 24 years on and off, approves. 'In the past it was all work and standing to attention. Nowadays you are treated like a normal person. Years ago we were treated like animals.'

But Frank, with his military-style moustache, is one of the few patients who dislike the new order. After a strict upbringing by a father he likens to Adolf Hitler, he requires discipline and rules.

'It's a question of respect,' he said. 'The patients treat the staff like dirt and get stroppy and violent. Now staff are wearing civilian clothes it's only those bits of plastic (identity passes worn by staff) that separate them from us.'

(Photographs omitted)

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