£67million rebuild to transform secure unit

HEJ editor Jonathan Baillie visited the hospital, one of only four high secure mental healthcare units currently operating across the UK, where he discovered that the rebuild is a key element of a significantly wider programme to improve forensic mental healthcare provision throughout Scotland.

Set in a rural location close to the village of Carstairs in Lanarkshire, roughly equidistant between Glasgow and Edinburgh, the State Hospital is the only high secure psychiatric hospital currently serving Scotland and Northern Ireland. Patients, each of whom spends around 10 weeks in an assessment ward on arrival to determine their optimal care pathway, are admitted from a variety of sources, including prisons, the courts, NHS acute hospitals, low and medium secure mental healthcare units, and the community. While one third of those admitted have not committed an offence, all will have engaged in some form of violent behaviour. Offences committed by those that have broken the law might typically include attempted murder or murder; armed robbery; indecent assault; fire-raising; hostage-taking; assault with a weapon; drug abuse, and rape. Patients held in such forensic psychiatric units are, as the State Hospital Board that governs the facility succinctly puts it, “more likely to have complex needs”. Many might thus typically be suffering from a treatment-resistant psychotic illness, may come from a disadvantaged socio-economic background, and may have, or have previously had, significant substance abuse problems. The State Hospital’s own website adds: “More likely to be living with the consequences of previous institutional care, patients are likely to need specialist treatments for specific offending behaviours in order to reduce the risk both to themselves, and to others”. Entering the current facility via the existing main entrance, all visitors, and even staff, must undergo rigorous security checks. In my case, as a first-time visitor, this included having my photograph taken for a special access card, and for the image to be held on the State Hospital’s database to speed security procedures should I re-visit in the future. There are also the type of strict security procedures, such as putting one’s briefcase through an X-ray machine, and being body searched, that one normally encounters at airports. While in 1976, in a now infamous case, two prisoners escaped, sadly killing three people, the security director at the State Hospital today, Doug Irwin, who kindly showed me around, told me there had since been no successful escape attempts, a statistic no doubt largely attributable to the high level of physical security immediately evident as one enters the site.

Varying stay lengths