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11 Crim. Behav. & Mental Health 1 (2001)

handle is hein.journals/cbmh11 and id is 1 raw text is: Criminal Behaviour and Mental Health, 11, 1-5 2001 © Whurr Publishers Ltd Editorial A state of siege: the English high security hospitals Over the past 12 years, life in the English high security hospitals could be likened to existence in a disputed stronghold in the middle of a protracted civil war. The hospitals, Ashworth, Broadmoor and Rampton, have undergone three management reorganizations (the third to come into effect in April 2001, although Ashworth remains the wallflower at the Amalgamation Ball); two statutory inquiries (both starting with Ashworth but spreading influentially across all sites); and had their number reduced from four to three (with the awkward coalescence of Moss Side and Park Lane into Ashworth in 1990). They have witnessed escapes, suicides, a strike by nurses and been accused of racial intolerance (long before the Lawrence Inquiry) and physical and psy- chological ill treatment of patients. They have been inspected for evidence of torture and they have seen many managers and clinical leaders arrive, armed with enthusiasm, and depart, usually downcast if not disgraced. There have been continued calls for their closure (arguments summarized in Gunn and Maden 1999). They have been savaged by the media; they have opened their doors and then closed them again. They have been told that they are unman- ageable and hopelessly institutionalized. They have been ordered to become part of the NHS and then classified as equivalent to the Category B prisons (Tilt, 2000). Patient numbers have fallen from 1715 in 1989 (Kaye and Franey, 1998) to 1292 in 1999 (Tilt, 2000) but demand for admission remains high, with 'waiting lists' in operation. They have been declared incompetent in their handling of personality-disordered patients and then proposed as the site for a 'new approach' (the 'third way') for just such patients. In the middle of this maelstrom they remain, somehow continue to func- tion and even make optimistic noises (now generally in muted tones) about their future. And, even more surprisingly, many dedicated staff still feel that it is worth working in such a turbid environment. When one has reviewed the above catalogue of catastrophe, which can only be likened to a blindfolded walk across an unknown minefield, and gasped at the sheer absurdity of events, one has to ask the question 'what does it mean?'. Surely there is no theory of management, or of psychiatric or psy- chological practice, that would seriously suggest that such a random battering 1

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