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53-808: Ashworth Hospital is a high-security psychiatric hospital in Maghull , 10 miles (16 km) northeast of Liverpool . It is a part of Mersey Care NHS Foundation Trust , catering to patients with psychiatric health needs that require treatment in conditions of high security. The hospital is one of four psychiatric hospitals in the United Kingdom providing psychiatric care within conditions of high security, and one of three in England (alongside Broadmoor Hospital in Crowthorne and Rampton Secure Hospital near Woodbeck ). For Scotland and Northern Ireland,

106-451: A 1988 television documentary which alleged that a patient, Sean Walton, had died after being beaten by staff allegedly with a snooker cue and a series of other serious allegations, a Committee of Inquiry into Complaints about Ashworth Hospital, Merseyside, headed by Sir Louis Blom-Cooper , was set up; it published its findings in 1992. Blom-Cooper was highly critical of the regime, which was felt to be more custodial than therapeutic, describing

159-568: A controlled environment due to their psychiatric condition. Patients may choose voluntary commitment , but those deemed to pose a significant danger to themselves or others may be subject to involuntary commitment and treatment . In general hospitals, psychiatric wards or units serve a similar purpose. Modern psychiatric hospitals have evolved from the older concept of lunatic asylums , shifting focus from mere containment and restraint to evidence-based treatments that aim to help patients function in society. With successive waves of reform, and

212-503: A convalescent home for children from Liverpool's workhouses, which was established on the site in 1878. For the duration of the First World War , it became Moss Side Military Hospital, the first specialist hospital for the treatment of what is now known as Post-traumatic stress disorder . Moss Side became a special hospital in 1933. In 1974, overcrowding at Broadmoor led to the construction of Park Lane Special Hospital on land at

265-402: A daily basis. The CPT expressed misgiving about the use of overwhelming force deployed at Ashworth including the use of personal protective equipment, helmets and shields. The committee found that night-time confinement was being used. This is a policy in which all patients are locked in their rooms between the hours of 9.15p.m. and 7.15a.m, with the aim to save money. The committee considered that

318-509: A day rehabilitation trip in protest against his treatment and the management of the Personality Disorder Unit. He made multiple allegations including that pornography, drugs and alcohol were freely available, that patients were running businesses and that a child had been put at risk of abuse at the hands of a number of paedophiles, that security had been compromised and that a number of staff were corrupt. The Fallon Inquiry

371-449: A number of institutions specializing only in the treatment of juveniles, particularly when dealing with drug abuse, self-harm, eating disorders, anxiety, depression or other mental illnesses. In the United Kingdom, long-term care facilities are now being replaced with smaller secure units, some within hospitals. Modern buildings, modern security, and being locally situated to help with reintegration into society once medication has stabilized

424-593: A range of other staff including six modern matrons, five nurse managers, 24 charge nurses, 173 registered mental health nurses and 254 healthcare support workers and assistants. The CQC inspection of 2013 found that the services were good for all domains; the services provided were caring, responsive and well-led. Psychiatric hospital#Secure units Psychiatric hospitals vary considerably in size and classification. Some specialize in short-term or outpatient therapy for low-risk patients , while others provide long-term care for individuals requiring routine assistance or

477-445: A resident physician . At the beginning of the 19th century there were a few thousand people housed in a variety of disparate institutions throughout England, but by 1900 that figure had grown to about 100,000. This growth coincided with the growth of alienism , later known as psychiatry, as a medical specialism. The treatment of inmates in early lunatic asylums was sometimes very brutal and focused on containment and restraint. In

530-592: A review (the Tilt Review ) of security at the three high-security hospitals in England ( Ashworth , Broadmoor and Rampton ). The Tilt Review suggested increased security measures, and altogether made 86 recommendations, all of which were subsequently accepted by the government. Following a critique of the Tilt Review by Tim Exworthy and John Gunn in the British Journal of Psychiatry , Tilt published

583-527: A time, though this practice still is periodically employed in the United States , India , Japan , and other countries. Modern psychiatric hospitals evolved from, and eventually replaced, the older lunatic asylum. Their development also entails the rise of organized institutional psychiatry . Hospitals known as bimaristans were built in the Middle East in the early ninth century; the first

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636-612: Is far less risk of patients harming themselves or others. In Dublin , the Central Mental Hospital performs a similar function. Community hospitals across the United States regularly discharge mental health patients, who are then typically referred to out-patient treatment and therapy. A study of community hospital discharge data from 2003 to 2011, however, found that mental health hospitalizations had increased for both children and adults. Compared to other hospital utilization, mental health discharges for children were

689-557: Is widely known for his comprehensive critique of the use and abuse of the mental hospital system in Madness and Civilization . He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under a bourgeois family. It was a microcosm symbolizing the massive structures of bourgeois society and its values: relations of Family–Children (paternal authority), Fault–Punishment (immediate justice), Madness–Disorder (social and moral order). Erving Goffman coined

742-663: The Home Secretary can, under various sections of the Mental Health Act, order the detention of offenders in a psychiatric hospital, but the term "criminally insane" is no longer legally or medically recognized. Secure psychiatric units exist in all regions of the UK for this purpose; in addition, there are a few specialist hospitals which offer treatment with high levels of security. These facilities are divided into three main categories: High, Medium and Low Secure. Although

795-821: The Irish National Liberation Army together within HM Prison Maze , giving this evidence on 10 December 2008. He served as chairman of the following National Health Service trusts and authorities: Appointed as Social Fund Commissioner for Great Britain and Northern Ireland in December 2000, Tilt served in this part-time post until 2009. He was also elected to chair the Social Security Advisory Committee in 2004, serving two terms, his second term ending on 31 March 2011. In 2000, Sir Richard Tilt chaired

848-1118: The Isle of Man , and the Channel Islands , medium and low secure units exist but high secure units on the UK mainland are used for patients who qualify for the treatment under the Out of Area (Off-Island Placements) Referrals provision of the Mental Health Act 1983 . Among the three unit types, medium secure facilities are the most prevalent in the UK. As of 2009, there were 27 women-only units in England. Irish units include those at prisons in Portlaise, Castelrea, and Cork. Psychiatrist Thomas Szasz in Hungary has argued that psychiatric hospitals are like prisons unlike other kinds of hospitals, and that psychiatrists who coerce people (into treatment or involuntary commitment) function as judges and jailers, not physicians. Historian Michel Foucault

901-698: The Social Security Advisory Committee (2004–11) and Independent Chair of the Internet Watch Foundation (2012–17). He was appointed a Knight Bachelor in the 1999 Birthday Honours . Tilt was educated at the King's School, Worcester and the University of Nottingham . Tilt first worked within Her Majesty's Prison Service , as an Assistant Governor, in 1966. He served as Governor of HM Prison Bedford and HM Prison Gartree . Following

954-521: The mental patient liberation movement . There are several different types of modern psychiatric hospitals, but all of them house people with mental illnesses of varying severity. In the United Kingdom , both crisis admissions and medium-term care are usually provided on acute admissions wards. Juvenile or youth wards in psychiatric hospitals or psychiatric wards are set aside for children or youth with mental illness. Long-term care facilities have

1007-516: The 1973 academic investigation by Rosenhan and other similar experiments , several journalists have been willingly admitted to hospitals in order to conduct undercover journalism . These include: Richard Tilt Sir Robin Richard Tilt (born 11 March 1944) is a British public servant . Formerly a prison governor, he served as Director General of Her Majesty's Prison Service (1996–99), Social Fund Commissioner (2000–09), Chairman of

1060-630: The Chaucer Unit. The Chaucer unit was created in order to investigate the services of Kent for instances of corruption and serious misconduct, as a consequence of the so-called ATM scam within HM Prison Blantyre House . Tilt gave evidence to the inquiry into the death of Ulster loyalist Billy Wright , regarding the validity of a decision to house imprisoned individuals of the Loyalist Volunteer Force and

1113-524: The Prevention of Torture and Inhuman or Degrading treatment or Punishment visited Ashworth Hospital. The conclusions included that living conditions were variable. The CPT expressed serious concerns relating to the necessity and application of the use of Long Term Segregation (LTS) finding that some patients were kept in LTS for years at a time. It found that some patients were unable to access outside areas on

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1166-507: The aggression of some of the patients. In Western Europe , the first idea and set up for a proper mental hospital entered through Spain . A member of the Mercedarian Order named Juan Gilaberto Jofré traveled frequently to Islamic countries and observed several institutions that confined the insane. He proposed the founding of an institution exclusive for "sick people who had to be treated by doctors", something very modern for

1219-959: The condition are often features of such units. Examples of this include the Three Bridges Unit at St Bernard's Hospital in West London and the John Munroe Hospital in Staffordshire . These units have the goal of treatment and rehabilitation to allow for transition back into society within a short time-frame, usually lasting two or three years. Not all patients' treatment meets this criterion, however, leading larger hospitals to retain this role. These hospitals provide stabilization and rehabilitation for those who are actively experiencing uncontrolled symptoms of mental disorders such as depression, bipolar disorders, eating disorders, and so on. One type of institution for

1272-477: The difficulty of distinguishing sane patients from insane patients. Franco Basaglia , a leading psychiatrist who inspired and planned the psychiatric reform in Italy , also defined the mental hospital as an oppressive, locked, and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents. Patients, doctors and nurses are all subjected (at different levels) to

1325-411: The doctors at Ashworth were described as follows. "Doctor 1: moderately capable but with a serious alcohol problem. Doctor 2: moderately capable but feeble. Doctor 3: appalling. Doctor 4: never there. Doctor 5: weak. Doctor 6: made very poor provision for patients on the ward. Doctor 7: lazy. Doctor 8: unstable and not clinically good. There were three competent doctors." The Fallon inquiry recommended that

1378-695: The facility meeting the same high security environment is the State Hospital in Carstairs . Ashworth is one of the three high-security psychiatric hospitals in England and Wales , alongside Rampton and Broadmoor , that exist to work with people who require treatment due to their "dangerous, violent or criminal propensities", with the majority experiencing psychotic conditions such as schizophrenia , comorbid or other personality disorders . Ashworth currently has 14 wards. Five locked wards constitute

1431-485: The facility. In 1989, Moss Side and Park Lane hospitals merged to form Ashworth Hospital. The name "Ashworth Hospital" was chosen by a ballot among patients and staff. In 1987, members of the Prison Officers Association, which then represented almost all the nurses were involved in a dispute during which more than 200 patients were locked in their rooms for 23 hours per day for 10 days. Following

1484-399: The focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits, depending on

1537-545: The fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals; due to the extreme conditions in them. The psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily. The mental patient liberation movement emphatically opposes involuntary treatment but it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time. Alongside

1590-730: The goal of treatment and rehabilitation within a short time-frame (two or three years). Another institution for the mentally ill is a community-based halfway house . In the United States, there are high acuity and low acuity crisis facilities (or Crisis Stabilization Units). High acuity crisis stabilization units serve individuals who are actively suicidal, violent, or intoxicated. Low acuity crisis facilities include peer respites, social detoxes, and other programs to serve individuals who are not actively suicidal/violent. Open psychiatric units are not as secure as crisis stabilization units. They are not used for acutely suicidal people; instead,

1643-606: The hospital should close. As a result of the Fallon Inquiry, a review into security was undertaken by Sir Richard Tilt , who recommended in May 2000, that security be upgraded to that of a Category B prison. Another inquiry, The Swann Report, was also conducted in the 1990s in relation to the overuse of drugs, but is unavailable. As part of the 2016 review of the United Kingdom as a whole the European Committee for

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1696-486: The hospital. Seven staff and two managers were relieved of their duties. Prof. Robert Bluglass who was the medical member of the inquiry concluded that all the Special Hospitals should be closed. In 1993, a patients' advocacy service was set up in the hospital. This was the first mental health advocacy service to be introduced in a high security hospital in the United Kingdom. In 1997, a patient absconded from

1749-413: The introduction of effective evidence-based treatments, most modern psychiatric hospitals emphasize treatment, usually including a combination of psychiatric medications and psychotherapy , that assist patients in functioning in the outside world. Many countries have prohibited the use of physical restraints on patients, which includes tying psychiatric patients to their beds for days or even months at

1802-429: The introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment; and further, they attempt—where possible—to help patients control their own lives in the outside world with the use of a combination of psychiatric drugs and psychotherapy . These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by

1855-410: The late 19th and early 20th centuries, psychiatric institutions ceased using terms such as "madness", "lunacy" or "insanity", which assumed a unitary psychosis, and began instead splitting into numerous mental diseases, including catatonia, melancholia, and dementia praecox, which is now known as schizophrenia . In 1961, sociologist Erving Goffman described a theory of the " total institution " and

1908-470: The lavatory. Child A's father also took the young son of a friend to visit a second patient found guilty of kidnapping, sexual torture, mutilation, and murder of a 13-year-old boy. The inquiry team reported that Dr John Reed, chairman of the Reed Committee on Mentally Disordered Offenders, described a conversation with Prof Pamela Taylor, then head of medical services of the special hospitals, in which

1961-574: The lowest while the most rapidly increasing hospitalizations were for adults under 64. Some units have been opened to provide therapeutically enhanced Treatment, a subcategory to the three main hospital unit types. In the UK, high secure hospitals exist, including Ashworth Hospital in Merseyside , Broadmoor Hospital in Crowthorne , Rampton Secure Hospital in Retford , and the State Hospital in Carstairs , Scotland . In Northern Ireland ,

2014-542: The many 'pauper lunatics'. Nine counties first applied, the first public asylum opening in 1812 in Nottinghamshire . In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every county compulsory with regular inspections on behalf of the Home Secretary , and required asylums to have written regulations and

2067-477: The mental institution may be used for the incarceration of political prisoners as a form of punishment. One notable historical example was the use of punitive psychiatry in the Soviet Union and China . Like the former Soviet Union and China, Belarus also has used punitive psychiatry toward political opponents and critics of current government in modern times. In the United Kingdom, criminal courts or

2120-415: The mentally ill is a community-based halfway house . These facilities provide assisted living for an extended period of time for patients with mental illnesses, and they often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by many psychiatrists , although some localities lack sufficient funding. In some countries,

2173-637: The personality disorder unit. A wide variety of pharmacological, rehabilitative and psychological treatments are available. Rehabilitative and creative activity is supported with patients frequently entering work for the Koestler awards winning 27 prizes in 2011. In collaboration with The Reader Organisation reading groups have been set up in which staff and patients read literature together, promoting confidence and developing communication and other skills. The hospital has its origins in Moss Side House,

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2226-538: The phrase "Maximum Secure" is often used in the media, there is no such classification. "Local Secure" is a common misnomer for Low Secure units, as patients are often detained there by local criminal courts for psychiatric assessment before sentencing. Run by the National Health Service , these facilities which provide psychiatric assessments can also provide treatment and accommodation in a safe hospital environment which prevents absconding. Thus there

2279-443: The process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor", suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role , in other words of " institutionalizing " them. Asylums as a key text in the development of deinstitutionalization . With successive waves of reform and

2332-514: The regime as a "brutalising, stagnant, closed institution." The inquiry uncovered evidence of physical and psychological abuse of patients. Nurses had used a pig's head to intimidate patients, had placed pictures of brains in the locker of a patient who had undergone brain surgery, and had submerged one patient under water to test his breaking point. Extreme right-wing propaganda had been on prominent display. The inquiry report suggested, only half-jokingly, that international torture monitors should visit

2385-676: The removal of Derek Lewis , Director General of the Prison Service, Tilt became acting Director General in October 1995, and was formally appointed Director General on 1 April 1996, retiring in 1999. Tilt was a member of the Sentencing Advisory Panel from 1999 to 2002. Tilt was a panelist at a conference of individuals involved within the Prison Services, meeting to discuss and vote on issues regarding

2438-456: The same process of institutionalism. American psychiatrist Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the "total institution": labeling, unnecessary dependency, the induction and perpetuation of powerlessness, the degradation ceremony , authoritarianism, and the primacy of institutional needs over the patients, whom it was ostensibly there to serve. The anti-psychiatry movement coming to

2491-527: The systematic locking-in of patients, amounting to ten hours of de facto seclusion, was not acceptable in a care establishment provided there was sufficient staff. It also found that the original intention of increasing day-time activities had not been realised. At the time of the CPT inspection there were; 12 consultant psychiatrists, a general practitioner and 3.8 FTE other doctors. There were 10 clinical psychologists, seven approved social workers, two dieticians and

2544-570: The term " total institution " for mental hospitals and similar places which took over and confined a person's whole life. Goffman placed psychiatric hospitals in the same category as concentration camps , prisons , military organizations, orphanages , and monasteries. In his book Asylums Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone "dull, harmless and inconspicuous"; in turn, it reinforces notions of chronicity in severe mental illness. The Rosenhan experiment of 1973 demonstrated

2597-459: The time. The foundation was carried out in 1409 thanks to several wealthy men from Valencia who contributed funds for its completion. It was considered the first institution in the world at that time specialized in the treatment of mental illnesses. Later on, physicians, including Philippe Pinel at Bicêtre Hospital in France and William Tuke at York Retreat in England, began to advocate for

2650-482: The type of patients admitted. Another type of psychiatric hospital is medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective. Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children with mental illness. However, there are

2703-649: The viewing of mental illness as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. In the Western world, the arrival of institutionalisation as a solution to the problem of madness was very much an advent of the nineteenth century. The first public mental asylums were established in Britain; the passing of the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house

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2756-622: Was built in Baghdad under the leadership of Harun al-Rashid . While not devoted solely to patients with psychiatric disorders, early psychiatric hospitals often contained wards for patients exhibiting mania or other psychological distress. Because of cultural taboos against refusing to care for one's family members, mentally ill patients would be surrendered to a bimaristan only if the patient demonstrated violence, incurable chronic illness, or some other extremely debilitating ailment. Psychological wards were typically enclosed by iron bars owing to

2809-425: Was set up and reported in 1999. The inquiry found that Child A had visited the hospital on hundreds of occasions and had spent periods dressed only in her underwear with a patient with a history of violent sexual assaults against young girls. The patient had also visited the child at her home whilst escorted by a nurse. The nurse had taken pictures of the child for the patient. One of her on her bed and another of her on

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