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Visit of the IAP to Broadmoor Hospital

Patients who die whilst detained under the provisions of the Mental Health Act account for a significant proportion of the total number of deaths that occur within state custody.  In order to familiarise themselves with one of the environments in which patients are detained, the Chair and members of the Independent Advisory Panel (IAP) visited Broadmoor high secure Hospital on the 23rd November 2009. The visit commenced with a presentation by the Clinical Director, who explained that there were four high secure hospitals in the UK, which provided approximately 1,000 beds.  In addition, there were in the region of seventy medium secure units (where almost all patients were detained under the Act) in England and Wales, which provided around another 3,500 beds.  He said that today Broadmoor Hospital had 280 beds (compared with 1,000 beds in the 1970s) and now provided care for male patients only.  He reported that the average length of stay for patients was six to eight years and the annual cost of accommodating a patient approximately £300,000.  More than 90% of the patients were offenders, with some patients being unconvicted at the point of admission, but subsequently being convicted of charges arising out of the behaviour which led to their transfer to Broadmoor. He said that the primary purpose of the hospital was to provide treatment in a secure setting, rather than simply to provide custodial care.   The Panel learnt that the oldest part of the hospital dated from the 1860s.  A number of wards were added in the 1980s as part of a development programme and these currently housed the admission wards, the intensive care wards and the high dependency wards.  The most modern part of the hospital, the Dangerous and Severe Personality Disorder Unit, was opened less than five years ago.  The Panel were informed that proposals for the rebuilding of the hospital (apart from the most recent addition of the DSPD unit) were currently being considered and if approved would result in a completed new hospital in 2016. Members of the Panel were accompanied on visits to wards in each of the three parts of the hospital and had the opportunity to meet with staff and discuss risk assessment arrangements.  The Panel also met with senior clinical members of staff and heard first hand about some of the practical problems associated with risk identification and reduction, especially in the older part of the hospital where particular problems arose with the observation of patients due to the physical layout of the wards.  Members of the Panel also met with HM Coroner for Berkshire who assisted the Panel in understanding more about the provisions for making recommendations under Rule 43 of the Coroners’ Rules. The Coroner had held a number of inquests in respect of deaths at Broadmoor, both from natural causes and self inflicted, and was able to give an authoritative external view on the risks inherent in such services. Members of the Panel were briefed about in particular about the cluster of deaths in 2007/8 that had occurred at the hospital and of the findings of the subsequent investigations.  It was clear to the Panel that a considerable culture of ‘learning from experience’ was promoted to ensure that any learning from a death was shared with all relevant staff members.  The Panel also found that considerable work had been undertaken in relation to the identification of risk, with suicide awareness and risk reduction training programmes in place for all staff.  Additionally, taking into account the high incidence of hanging as a cause of self-inflicted death at the hospital, an extensive review to identify and remove potential ligature points had recently been completed.  The Panel found that this review was particularly valuable and felt that there could be potential learning from this for the other custodial sectors.  The Panel were informed that discussions were underway with the Department of Health in relation to patients having access to Samaritans.  These plans were awaiting approval subject to a review of the Safety and Security Directions for high secure hospitals. This visit was of considerable benefit to the IAP and the members were grateful for the time and effort taken in its facilitation.  The opportunity to observe the workings of a high secure hospital first hand was greatly appreciated.  A specific working group has been established to identify the key work priorities for the IAP in relation to the deaths of those detained under the Mental Health Act and the information obtained during this visit will inform the work of this group.  The Panel recognise that the majority of patients detained under the Act are held in medium and low secure settings.  As a result, further visits will be undertaken to gain an understanding of the full range of environments in which patients are detained and the particular risks associated with these.

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