Case Studies

Security at Kew: disordered prisoners

by Mark Rowe

A file at the National Archives at kew in west London shows how the health service and prisons worked out over the 1960s who was to do what about the security of prisoners.

File HO 343/47 began with draft guidance for medical staff on the respective roles of the hospital and prison services. Broadly, it began, the NHS would provide psychiatric facilities in prisons, ‘supportive to the penal function of the Prison Services’, ‘within a framework of effective custody’. However, the document raised the differences between medics and the job of prisons. Prison, according to the guidance, was not a suitable place for a ‘severely sub-normal person’ such as a chronic schizophrenic.

Hospitals might accept offenders for treatment, ‘and they [hospitals] are responsible for exercising reasonable care in tendering them’. A case would depend on ‘the degree of risk which an offender might present to the public should he abscond’. That implied an assessment (who by?) of the offender and his history; and that the hospital would have some prison-like security while the offender was on the premises. Among civil service notes on file are press reports from March 1967 of ‘security problems at All Saints Hospital, Birmingham. A named patient convicted of attempted rape and given a two-year restriction order was absent from the hospital for days; and the consultant in charge of him asked for permission for the man to go on weekend leave. Hence the draft guidance, except that a note of February 1968 said it had ‘unfortunately not been as rapid as we would have wished’. The Ministry of Health, and the Home Office (then in charge of prisons) each had input; and indeed was still discussing the ‘final text’ in late 1971.

The Department for Health and Social Security hosted a meeting between the DHSS and the Home Office in August 1967, ‘on the roles of the hospital and prison services in the treatment of ‘mentally disordered offenders’. The officials began by listing three problems: those with psychopathic disorders and chronic recidivists; the adequacy (or not) of security arrangement in the National Health Service for psychotic offenders; and placement of adolescents. The service was inadequate, and the number of prisoners was rising. Lastly, medical services and psychiatric care was ‘on the whole directed at the less extreme forms of mental disorder’.

The Home Office said it ‘recognised the difficulties in dealing with the problem of security requirements’, if mentally disordered offenders were to be treated, where appropriate, in NHS hospitals. The two departments drafted some 2500 words of guidance. While they were quibbling, someone had to handle the violent and criminal. Prisons and hospitals had to decided who should have the ‘difficult inmates’, before what the security would look like anywhere.

The Guardian newspaper in September 1970, as quoted in the file, wrote about the three ‘special hospitals’, at Broadmoor, Rampton and Mosside, that together had 2200 patients. A letter to the junior Home Office minister Mark Carlisle suggested that part of the solution would be two or three more such hospitals; but it would be expensive. The Guardian also reported the court case of a mentally disordered man who had been in solitary confinement at Horfield prison, in Bristol; ‘many hospitals simply decline to find vacancies for difficult patients’, such as aggressive and violent people in court for perhaps quite minor offences, such as criminal damage.

A Home Office note dated October 1969 said that when making an order under the Mental Health Act, a court ‘may wish to satisfy itself that the degree of security available at the receiving hospital is such as to provide adequate protection for the public … security in this context is not to be measured only in terms of locks and walls: much would depend on the facilities and regime in the particular hospital concerned’. The note suggested that the two doctors making a report for the court should include security (although the note left unsaid how medics would know about locks, and walls).

In March 1969, a Birmingham Conservative MP, Jill Knight, sought to bring in a Ten Minute Bill to amend the Mental Health Act. The background was that in 1967 in England and Wales some 187,000 patients were receiving psychiatric care in hospitals. The file acknowledged that patients might be admitted to Broadmoor, though they did not really require treatment in conditions of ‘high security’. Too much security could be as bad – unnecessary, and depriving someone of it who did require it – as too little. The file admitted that courts might take a ‘firmer view of the protection of the public’ than doctors who assessed cases from the clinical aspect. Pasted into the file was a long article from the Daily Telegraph from April 1968 by a Conservative MP (and former minister) Bill Deedes, quoting a volume by Nigel Walker, on criminality and insanity.

The Ministry of Health was receiving a deputation in November 1967 of hospital managers. The brief for the minister beforehand predicted that the deputation would argue that NHS psychiatric hospitals did not have adequate security for the mentally disturbed; and those hospitals should not be expected to; because that would ‘detract from the treatment of the great majority of the population’. The NHS had an ‘open door principle’. But, some offenders did suffer the same mental disorders as non-offenders. According to the file it was proposed that the health minister admit ‘that arrangements are less than satisfactory and that there have been incidents of the public being attacked by patients.

A Surrey Conservative MP Sir Peter Rawlinson and others was complaining that patients were allowed to wander about Epsom (that is, Rawlinson’s constituency). Rawlinson for example picked up a Sunday Telegraph story of May 1967 that a mental patients fired a pistol in Epsom high street. The civil servants suggested that the minister was to say it was wasteful to provide elaborate security precautions for patients who did not need them: “It is true that security was a feature of the old custodial system [of asylums] and has no place under modern psychiatry for the great majority of patients. It is understandable that those responsible for the management of psychiatric hospitals are opposed to turning back the clock.”

The Ministry of Health was proposing to segregate ‘the few who are troublesome’ in a security unit in the grounds of a psychiatric hospital, in each region. The heart of the problem, as the file stated, was the ‘mentally disordered offender’ and where to put him – in a prison or a hospital. There was two-way traffic between NHS and ‘special’ hospitals; such as, mentioned in December 1967 in the file, girls who set fire to themselves in Holloway prison in London.

A Ministry of Health document of January 1967 on security in NHS psychiatric hospitals began by describing it as a problem, and as ‘not simple and cannot be considered in isolation’ from law-abiding patients and the penal system. As the document later admitted, psychiatrists in general were ‘not willing to take on more than the minimum of difficult patients’. Hospitals, to put it another way, were not willing to take patients for treatment in conditions of continuous security. Somewhere had to have security to keep the ‘continuously difficult’. Whatever policy was decided, the NHS would have some ‘security patients’. As the document admitted, the respective responsibilities of NHS and special hospitals were ‘not separately defined’; that is, who should accept what sort of patient. The document admitted that some special hospital patients ‘clearly do not need to be there’. And courts saw hospital security as inadequate to hold, for example, sexual offenders. Between 60 to 80 offenders were admitted to NHS hospitals a year after conviction for serious violence or sexual violence that might have warranted admission to a special hospital. Different local hospitals had different definitions of ‘continuous security’, such as whether wards or rooms were locked. The document could not put a number on how many ‘non-security’ patients shared a locked ward with security patients; ‘but enough cases show that it happens’.

A common psychiatrist view was that physical security was out of place in an open hospital, because it would ‘spoil the therapeutic atmosphere’. Most hospitals had some locked wards or rooms. The need, for years, was for a defining of policy for adults and ‘unmanageable children’. As the document mentioned, the role of the hospital psychiatrist had changed, ‘from custody to therapy’. And the hospital in practice was ‘reluctant to reintroduce physical security although some of the old locked accommodation is still used’. Physical security in hospitals was not ‘modern’.

The document suggested that you had to assume that the NHS would not increase capacity to accept ‘security patients’: “It may be easier to recruit a few extra doctors to work in the special hospitals than to persuade a larger number of doctors to treat patients in a regional security unit.” In other words, what the professionals felt would drive policy rather than what was best for the public, or indeed the patients themselves.

The document went so far as to admit that the principle of who provided services for mentally disordered patients – hospitals or prisons – was ‘not entirely clear’ to the ministry, despite the 1959 Mental Health Act. The document ended with the practical point of waiting lists for a bed with clinical priorities, and if public safety mattered, some patients should accept dispersal to prison-run hospitals.

The News of the World in June 1967 quoted a Dr Norman Imlah, medical director of All Saints, Birmingham, a 900-bed hospital. An attempted rapist escaped so many times that a nurse had to accompany him at all times; ‘but we haven’t a locked door in this hospital and we are not going to have one now. If we lock the doors they get out through the windows. So we keep the doors open and save the glass being broken. I see no reason why the treatment and conditions of 880 patients should suffer because of 20 or so we have here on restriction orders. Though no-one will admit it, the blunt truth is that the special hospitals like Broadmoor and Rampton are overcrowded and these violent criminals are sent to ordinary mental hospitals because a place cannot be found for them in maximum security hospitals.’ The Sunday newspaper’s headline was ‘110 killers in hospitals without locks’, a number the article called ‘staggering’.

Also on file was Bill Deedes in the Daily Telegraph from April 1967, who raised the question, as the broadsheet’s headline put it, ‘what to do with mental criminals’. For example; could they be cured? As Deedes set out, the first and only ‘psychiatric prison’ was at Grendon in Buckinghamshire from 1962. Besides inadequate building and staffing, ‘we seem to have loosened up on the mentally disordered but put the policy under lock and key’.

In March 1967, FLT Graham-Harrison of the Home Office chaired a meeting there about a Ministry of Health paper on security in NHS psychiatric hospitals. NHS hospitals were not equipped to prevent a potentially dangerous patient from escaping, and supervising took staff time. And the mentally disordered patient ought to be within easy reach of family. A working party had recommended in 1961 setting up regional special units for the mentally disordered offender; ‘very little appeared to have been done since 1961’. Echoing Imlah in the News of the World, the meeting heard that security among psychiatrists was regarded as a ‘negative rather than a positive’. Imlah was also quoted in the Sunday Citizen in March 1967 (a newspaper about to cease publishing) who complained that a thief went over the wall 11 months ago from his hospital, ‘and completely disappeared’. Another patient was free for 22 months. Imlah asked for escape-proof hospitals, that gave modern treatment. The Times reported similarly earlier that month.

On file was a letter from Imlah to the Home Office dated January 1967. Imlah named a 20-year-old who had absconded 11 times between December 1965 and May 1966, and who was then away until January 1967. He had nine patients who were ‘definite escape risks’. All Saints had 23 patients who were referred there under the Mental Health Act and that had criminal records. As for the absconder who was watched by nurses, that was ‘highly uneconomical in view of the nursing staff shortage’. “Undoubtedly on his past record he will escape again,” Imlah wrote, “without this special vigilance. His admission to hospital followed an attempted rape and in my opinion he is no different now from the time of his admission.’ In fact, Imlah added, because the man had been out of hospital so long, he hadn’t had any treatment likely to change him. As Imlah wrote, All Saints was not suitable for the absconder; but the hospital did not want to restrict a considerably larger number of patients to guarantee security of a few. Presumably Imlah chose to approach the newspapers and get publicity a few weeks later, because official channels got him nowhere and publicity might help.

In the early to mid-1960s, the ‘special hospitals’ were taking about 300 to 400 people a year. A letter of January 1969 said that Broadmoor was becoming ‘increasingly selective’ about psychiatric offenders. Because of ‘a hard core of …. About 50 trouble-makers;, most of them psychopaths, doctors and nurses at Broadmoor felt that numbers had reached ‘flash point’. They feared rioting and escapes; presumably that meant they resisted taking too many of the ‘explosive’ and ‘psychiatric offenders’.

Photo by Mark Rowe; Leicester prison.

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