The high dependency wards are for patients who pose less of an immediate risk to themselves and others than those on Cranfield, but who are not well enough to be considered for the assertive rehabilitation wards. The mental illness high dependency wards are Ascot Ward, with 12 beds, and Woburn Ward, with 15 beds. The personality disorder high dependency ward is Epsom Ward, with 12 beds. For patients assessed at a slightly lower risk level, there is one medium dependency personality disorder ward: Chepstow Ward, also with 12 beds.
The high dependency wards have an unsettling atmosphere. There is a great deal of shouting, stress, locked doors and violence. The violence is often patient against patient; assaults on staff are virtually daily occurrences on these wards.
From the very beginning, we were keen to talk to the staff and patients about what it is like to experience one of these high dependency wards. Again, what we saw here were men who were raised in the most damaging of circumstances. Many parents feel guilty for what are – in comparison – mundane reasons: forgetting a piece of fruit for their child’s lunch box, fretting over the amount of screen time they have. Many mums and dads worry that these small lapses in perfect parenting will have a detrimental impact on their child’s future life. What, then, of children subjected to horrific physical, mental and sexual abuse?
Anile Parrymore, a nurse on Chepstow, made some very memorable patient observations from his long nursing experience in a secure hospital during the filming of the television series. ‘I can definitely empathise with them. Often, they haven’t come from different backgrounds to me, but they have come from different parents. You can probably see, if you go back into the lives of our patients, you can probably identify them at five or six years old. And say I’ll be seeing you later on.’ It is nothing short of chilling that Anile’s experience created such conviction in him that the fate of many of Broadmoor’s patients was fixed from early childhood. Critically, theirs was a childhood not just of deprivation and economic hardship, but of abuse too.
Many of the men we met during the book research and filming had chaotic childhoods. Many have been the victims of sexual and physical abuse. Childhood experiences, often shocking and sickening beyond belief, seal the fate of many patients very early on. Dillon’s story, even in this bleak context, was incredibly powerful. When we met him for the film, Dillon was aged 49 and it was his second time in Broadmoor, as a patient in high dependency. Driven by mental illness and need, he’d been a violent offender and an arsonist: ‘I shudder at a lot of the things that I’ve done in life and the bad mistakes and opportunities that I’ve missed.’
He remembers his childhood as a living nightmare – ‘I got born into a satanic family – very, very violent. In some cases it would have been better to have killed me than to have allowed me to have had this abominable life that I have had. My father, thankfully, he died a homeless alcoholic. He was the bone breaker – he would break my bones. I had to learn pain very quickly. My father raped and beat my mother very badly. In his twisted thinking, he could raise a demon from the dead by raping her in the way that he did. From the moment I was born she freaked out, saying I was evil, my eyes were evil, and that was it. She kept trying to kill me. She would keep me locked up in the attic, I wasn’t allowed to talk to my brothers. My mother, she also liked the sexual abuse, she was adamant that every single avenue of my childhood would be destroyed and she done her best with that. I was very thin, I had to steal my food, and it was fire that got me away. By the time I was five or six, I had learnt to light a match on the wall, like my mother did to light the gas oven. I was allowed to go to Kindergarten and I smelt the food, the boxes of sandwiches, and I scoffed my face big time and then set fire to the kitchen.’
Dillon later told us as a child he was tethered naked outside to a post and made to eat food off the floor like a dog, and sexually abused by his parents and their friends. He was in care from the age of seven to 18 and as an adult, he became a homeless alcoholic.
‘I became an arsonist and a violent offender. Unfortunately, I did some kidnapping of some people who never did any harm to me. I was very very drunk. I threatened the police, I had the guns on me if I didn’t put the knife down. I wanted them to kill me. I wanted them to kill that wild, out-of-control alcoholic inside me. And I was inviting them to do that. And I was very, very bloody close and then put the knife down.’
This is the type of childhood and adolescence, and subsequent substance abuse and psychotic behaviour, which can merit two stays in a Broadmoor high dependency ward.
The brilliant and dedicated director on the TV documentary, award-winning Olivia Lichtenstein, spoke to another memorable patient in high dependency through the tiny hatch of his door.
‘I was a child soldier in Somalia,’ he said. ‘I had my first AK47 at the age of nine years old.’ We were told that the patient was well on the way to moving to an assertive rehab ward and was doing really well, after this utterly shocking start in life on the other side of the world from Berkshire.
Dillon and the child soldier from Somalia are two extreme cases of childhood abuse that has brought both to incarceration in Broadmoor. Does evil exist in this world? Perhaps Dillon’s parents, and the child soldier’s captors were evil, but perhaps they had been abused as children in turn – Dillon’s mother turned her own abuse towards her child – and their abusers had been abused, and so on. While it’s true that many abused children do not turn into abusers themselves, it seems clear that a cocktail of factors, including abuse and mental illness, lead to the victims of abuse becoming violent criminal offenders in later life.
We observed Executive Director Leeanne McGee walking around the ward and talking to patients at the doors to their rooms. Trained as a nurse, she loves going back to the wards and being on the floor. ‘It is where you want to be really,’ she told us. ‘It’s better to spend the day with people that you are paid to look after than sitting at a desk, which can seem somewhat meaningless.’
In one crucial conversation about high dependency, Leeanne was keen to draw an important distinction: ‘There is a difference between being mentally ill and not being mentally ill, and if you are mentally ill and have done something you are perhaps not in full control of at the time, society owes you a break and everyone deserves to have a bit of hope. If you have no hope, you are just going to give up.’
Having to deal with some of the notorious patients we have described, it is therefore no surprise that on the intensive care and high dependency wards, the job is incredibly demanding.
Broadmoor has 800 staff and many have been there for years despite the daily risk of assault. It may be a hospital but staff need specialist training from restraint, from giving patients forced medication to managing full-scale riots.
Staff members are carefully trained in the prevention and management of violence and aggression. Wearing helmets and shields, they are prepared for events that they are likely to encounter, including hostage and riot situations and armed patients. While this is highly unusual training for nursing staff, it is necessarily completely standard inside the walls of Broadmoor.
In the documentary, we attended breakfast time on Epsom, with the risk on Epsom Ward perceived to be a little lower than on other high dependency wards or, of course, Cranfield. We witnessed breakfast being pushed through the hatches. Patients on Epsom are allowed out to associate with each other, but only with plenty of staff around to watch. No room for complacency here, or anywhere within Broadmoor’s walls.
An interesting story finally broke in the press about Epsom Ward in 2014, an incident several staff members had referenced to us in confidence. The incident was a riot at the hospital in July 2013, which NHS officials and the police had not put in the public domain, but which emerged as the result of Freedom of Information disclosures.
Patients managed to take over the nurses’ office and were thought to have accessed confidential medical files on other patients. The police and an ambulance crew had to be called out to restore order. Thames Valley Police said they sent a ‘public order response’, also known as officers in riot gear, but that staff were able to get things back under control.
South Central Ambulance Service Trust sent out what they called a ‘hazardous area response team’ to Broadmoor and treated two people at the scene. The story only came out following an insider telling the Health Service Journal that staff shortage were so bad that patients were often locked in their rooms for 20 hours of the day. The CQC had already been told exactly the same thing about the staffing levels being too low.
The communications team at West London NHS Trust tried to deny that the riot had anything to do with Broadmoor being short-staffed. They tried to say that calling it a riot was exaggerated, and only two patients had got into the nurses’ office and had managed to damage a ward. A Trust spokesperson wouldn’t say how much damage or confirm (or deny!) the story about the medical notes being accessed, and they refused to release a report on security grounds.
It is salutary that as recently as a few years ago, during the time of Jonathan’s TV show filming, this type of incident could take place on a secure ward. Even so, the majority of patients demonstrate enough healing and progress over time to transfer up to assertive rehab.