| Description | Summary
MANAGEMENT AND ADMINISTRATION: Commissioners in Lunacy reports, 1863-1879; Commissioners in Lunacy correspondence, 1863-1909; Commissioners in Lunacy special report into Broadmoor's running costs, 1876; Council of Supervision minutes, 1863-1949; Council of Supervision agendas, 1927-1949; Council of Supervision attendance books, 1861-1894; Chairman's letter books, 1862-1863; Correspondence from Whitehall, 1861-1952; Correspondence with the Treasury, 1863-1917; Correspondence relating to the hospital chaplain, 1903-1905; Correspondence relating to Council membership, 1910-1949; Board of Control reports, minutes, papers and correspondence, 1938-1957; Building inspection report 1939; Committee of Visitors minutes, 1949-1963; Minutes, correspondence and papers, 1949-1964; Special Hospitals Office Committee minutes and papers, 1976-1985; Mental Health Act Review Tribunal correspondence, 1980-1984; Health Advisory Service correspondence, papers and reports, 1987-1989; Mental Health Act Commission minutes 1990-1994; reports and correspondence, 1986-1994; correspondence and papers' 1983-1995; Biennial reports 1985-1991; Broadmoor Hospital Board reports, correspondence and papers, 1987-1988; Special Hospitals Service Authority information booklets, n.d. [1989]; Special Hospitals Service Authority reviews, 1991-1995; newsletters, 1990-1993; Special Hospitals Research Bulletin journal, 1992-1993; Special reports and policy documents, 1992-1995; Annual reports, 1996-1997; Papers relating to admissions, 1990-1995; West London Mental Health National Health Services Trust annual reports, 2001-2002; Broadmoor information booklet, n.d. [2001]; 'Merger Update' magazine, 2001; , 2001-2002; Medical Superintendents' annual reports, 1863-1984; Annual report files, 1914-1975; Journals, 1863-1949; Letter books, 1863-1886; Order books, 1867-1970; Memorandum book, 1863-1950; Order book - attendants, 1863-1900; Civil defence papers, 1939-1965; Correspondence and papers related to visitors, 1980-1983; Minutes of inner cabinet meetings, 1968-1971; Statistical returns relating to patients, 1863-1912; Dr William Sullivan's personal papers, 1919-1941; Dr Patrick McGrath's personal papers, 1959-1984; Dr Edgar Udwin's personal papers, 1966-1979; Dr John Hamilton's personal papers, 1971-1990; Hospital Management Team minutes, 1980-1991; Hospital Management Team papers, 1988-1990; Hospital Management Team and Heads of Departments Committee Minutes, 1979-1985; Management Team and Heads of Departments Committee Discussion papers, 1980-1985; Hospital Policy Committee minutes, 1985-1988; Hospital Policy Committee discussion papers, 1985-1988; Professional Advisory Committee minutes, 1979-1981; Professional Advisory Committee discussion papers, 1978-1981; Medical Advisory Committee minutes, 1981-1993; Medical Advisory Committee correspondence and papers, 1990-1996; Minutes of a Medical Advisory Committee Sub-Committee set up to examine Hospital Committees and communications, 1970; Medical Advisory Committee papers relating to remands to Special Hospitals for assessments, 1982-1984; Security Committee minutes, 1990-1992; Security Advisory Committee minutes, 1991-1993; Security correspondence and discussion papers, 1990-1994; Outings Committee minutes, 1986-1988; Outings Committee correspondence, discussion papers, guidelines and forms, 1980-1988; Minutes of the Main Health and Safety Committee, 1979-1982; Correspondence and papers of the Main Health and Safety Committee, 1980-1982; Ethics committee Minutes and agendas, 1976-1993; Ethics committee correspondence and papers, 1975-1995; Complaints Sub-Committee minutes, 1976; Minutes of the administrative committee, 1987-1989; Financial returns, 1867-1928; Abstract cash books, 1906-1924; Auditor's queries, 1963-1915; Provisions account books, 1917-1918; Workroom supplies books, 1952-1963; Requisition books, 1949-1975; Press cuttings, 1974-1986; Correspondence and papers relating to public relations, 1946-1984; Photographs of opening ceremonies and celebrity visitors, 1975-1991; Public relations information for professionals, n.d.[1990s]; Photographic slides showing hospital buildings and activities, n.d. [c.1970-1990]; Central filing system files, 1958-1995; Administrative papers on patients' complaints, 1976-1995, 1981-1983; Printed material relating to complaints, 1992-1994; Reports of action taken on individual complaints, 1992-1993; Reports by the Hospital Complaints Manager to the Hospital Management Team, 1992-1995; Files relating to patients' weddings, 1989-1994; Papers relating to Patients' Council, 1993-1999; Other administrative files and papers, 1973-1995; Minutes of meeting of the Broadmoor Historical Society, 1991-1995; Correspondence and papers relating to the Broadmoor Historical Society, 1991-1993; Museums and Archives Report Appendices, 2002-2003; Papers on aspects of the history of Broadmoor, n.d. [20C].
PERSONNEL: Establishment files, 1939-1961; Instructions to staff, 1926-1970s; Staff instruction booklets, 1863-1980; Hospital policies and procedures, 1979-1992; Defaulter's books, 1863-1922; Staff uniform issue books, 1941-1960; Staff key issue books, 1952-1956; Reports and correspondence by the Prison Officers Association, regarding staffing issues, 1966-1970; File relating to staff housing, 1977-1985; File related to the Occupational Health Service for Broadmoor staff., 1982-1990; Registers of staff appointments, 1863-1949; A-Z lists of appointments and resignations, 1947-1970; Certificates of qualification (female staff only), 1962-1892; Mounted certificate of proficiency in mental nursing,1894; Monthly salary and wage books, 1863-1953; Maintenance staff weekly salary books, 1928-1948; Farm staff weekly wage book, 1944-1953; Temporary staff wage books, 1937-1942; Staff pay lists, 1953-1958; Other staff payment records, 1948-1973; 'Management Information Bulletin', 1981-1991; 'News Sheet', 1981-1991; 'Nursing Advisor News Sheet', 1990-1991; 'Broadly Speaking' magazines, 1991-2001; 'Broadcast' staff circulars, 1995-2001; Chief Executive's Briefing Notes, 1998-2000; Ephemera, n.d. [c.1890-1997]; Photographs of staff, n.d.[1885-c.1990s]; Formal photographs of chaplains, n.d. [1906-1967]; Files relating to staff leisure activities and celebrations, 1937-1963; Staff Dancing Class (later Assembly) scrap book, 1873-1911; Reports on staff pay and conditions and staffing levels, by outside bodies, 1964-1989; Files relating to staff training, 1930-1982.
ESTATE MANAGEMENT: plans and papers relating to building work, 1873-1951; Plans and papers relating to cemeteries, 1864-1975; Minutes and agenda papers of the hospital redevelopment working group, and related committees, 1981-1987; Schedules of condition of areas to be redeveloped, 1978-1979; Reports on hospital redevelopment by the Property Services Agency and the Special Hospitals Services Authority, 1976-1992; Hospital redevelopment Operational Team reports, 1980-1988; Plans relating to redevelopment, 1978-1988; Plans relating to drainage, 1871-n.d. [early 20C]; Estate plans, n.d. [1880s]; Photographs and slides of estate and buildings, n.d.-1998; Documents relating to the closure of the hospital farm, 1957-1958.
PATIENTS' RECORDS: Admission registers to 1900, 1863-1900; Admission registers 1900-1906, 1900-1906; Admission registers 1907-1965, 1907-1965; Admission registers: prisoners of war, 1916-1919; Patient reference information cards (males only), n.d. [c.1951-1964]; Patient photograph books, 1923-1951; Patient description books, 1863-1877; Patient weight monitoring books, 1877-1972; Rough books of admission, transfer, discharge and death, 1863-1965; Daily logs of admissions, removals and deaths, 1989-1959; Numerical lists of patients and staff, 1912-1923; Indexes to patients, 1863-1967; Patient review registers, 1946-1982; Quarterly patient review books, 1863-1888; Annual patient review books, 1919-1924; Restricted patients' annual review reports, 1923-1961; Discharged patients' report books, 1930-1965; Discharge registers: males and females, 1863-1900; Registers of discharges, removals and deaths, 1900-1965; Registers of deaths: males and females, 1864-1865; Warrants for admission of patients, 1863-1876; Papers relating to transfer of patients from Broadmoor to other hospitals, 1865-1976; Correspondence and papers relating to patients' clothing, 1954-1963; A-Z patient report books, 1867-1874; Census book, 1930s-1965; Case books: males, 1864-1915; Case books: females, 1864-1915; Case books: males, supplementary, 1865-1915; Case books: females, supplementary, 1907-1915; Case notes: males A-Z, 1915-1946; Case notes: females A-Z, 1915-1943; Patients case files: males, 1864-1917; Patients case files: females, 1863-1928; Journals of restraint and seclusion, 1929-1953; Patients weekly medical journals, 1908-1914; Post-mortem books, 1870-1917; Visitors books: males and female patients, 1960-1991; Indexes to Visitors books, 1963-1964; Visitors books: male patients, 1972-1981; Visitors books: female patients, 1960-1983; Information booklets for visitors, n.d. [1970-1990]; Property registers: male patients, 1898-1972; Property registers: female patients, n.d. [1898-1920]; Deceased patients burial expenses and property register, 1952-1982; Cash and property account: males and females, 1863-1871; Cash and property account: males, 1875-1878; Cash balances, 1872-1886; Cash accounts: males, 1889-1893; Cash accounts: females, 1902-1906; Cash accounts: males A-Z (incomplete), 1956-1961, 1956-1961; Cash accounts: males A-Z (incomplete), 1961-1962, 1961-1962; Cash accounts: males A-Z (incomplete), 1962-1964, 1962-1964; Cash accounts: males A-Z (incomplete), 1963-1965, 1963-1965; Cash accounts: females A-Z (incomplete), 1956-1962, 1956-1964; Cash accounts: females A-Z (incomplete), 1962-1964, 1962-1964; Cash accounts: deceased females, A-Z, 1961-1964, 1961-1964; Information for patients, n.d. [c1970]-1998; 'The Broadmoor Chronicle' magazine, 1944-2004; 'The Chronicle Newsletter,' later 'The Chronicle Community Magazine', 1987-1992; Occasional publications by 'The Broadmoor Chronicle', 1980-1990; Correspondence related to 'The Broadmoor Chronicle', 1985-1995; Literary and artistic work published by individual patients, 1985-1987; Patients' private literary and artistic work, 1868-1984.
CLINICAL DEPARTMENTS: Admission ward, day and night report books, 1961-1964; Male block 1, ward journals, 1952; Male block 1, day and night report books, 1962; Male block 1, night report books, 1945-1969; Male block 2, day and night report books, 1964-1972; Male block 2, night report books, 1939-1956; Essex house [male block 2] register for schedule 4 drugs, 1969-1972; Male block 2 scrutiny books, 1938-1944; Male block 3, day and night report books, 1964-1972; Male block 3 night report books, 1940-1951; Night report books for Kent House infirmary [in male block 3], 1944-1972; Register for schedule 4 drugs, Kent House infirmary [in male block 3], 1971-1973; Register for schedule 4 drugs, Kent House [male block 3], ward 2, 1964-1965; Dangerous drug record book, night sedations, Kent House infirmary [in male block 3], 1967-1974; Records of patients' daily activities [in male block 3], 1974-1976; Scrutiny books [male block 3], 1938-1941; Male block 4 day and night report books,1965-1972; Male block 4 night report books, 1940; Report book, Dorset House ward 3 [in male block 4], 1971-1972; Scrutiny books [Male block 4], 1944-1951; Day and night report books day and night report books, 1963-1964; Day and night report books, Gloucester House ward 2 [male block 5], 1962-1970; Male block 5 night report books, 1943-1944; Male block 5 dangerous drugs record book, 1863-1864; Male block 5 scrutiny books, 1942-1950; Male block 6 day and night report books, 1962-1964; Male block 6 night report books, ward 1, 1940-1954; Male block 6 night report books, ward 2, 1959-1960; Male block 7 Day and night report books, 1961-1962; Female block 2 day and night report books, 1965-1971; Drug registers for unknown Blocks, 1972-1976; Night superintendent's report books for all Blocks, 1951-1962; Clinical reference library records, 1967-1975; Photographs of patients engaged in occupational therapy, n.d. [c.1960s].
RELIGIOUS ACTIVITIES: Chaplain's journals, 1906-1947; Registers of services, 1934-1934-1975; Papers relating to chaplaincy services, 1978-1988.
ENTERTAINMENT: Cricket score books, 1904-1958; Photographs of sports teams and events, n.d. [1980s]; Posters and programmes for theatrical and musical events, 1880-1989; Scrapbooks, 1909-1972; Photographs of theatrical and musical performances, n.d. [1970s-1990s]; Correspondence, 1941-1953; Administration of general entertainment and activities, 1985-1990.
FRIENDS OF BROADMOOR HOSPITAL: Minutes and agenda papers, 1972-1987; Scrapbooks, 1973-1988; Correspondence and papers relating to various projects, 1965-1986; Ephemera, 1964-1996; Newsletters, 1977-1987; Loose press cuttings, 1972-1988.
RAMPTON BRANCH HOSPITAL: Council of Supervision minute book, 1912-1919, Council of Supervision letter book, 1912-1917; Council of Supervision correspondence, 1910-1915; Medical Superintendent's letter book (indexed), 1912-1919; Superintendent's order book, 1912-1920; Annual reports, 1913-1959; Bundle of correspondence, mainly relating to transfers between Broadmoor and Rampton, 1899-1912; Bundle of correspondence, mainly relating to transfers between Broadmoor and Rampton, 1913-1923; Cash account book, 1912-1920; Register of staff appointments, 1912-1920; Admission records, 1912-1919; Case books, 1912-1920; Registers of discharge, removal and death, 1913-1920; A-Z index of female patients, 1912-1920; Post mortem books, 1912-1920; Numerical lists of patients and staff, 1912-1920.
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| Admin History | The building of Broadmoor
Before 1800 there was no legal provision for sentencing people who committed a criminal act but were thought to be mentally ill. In 1800 this changed after a man named James Hadfield attempted to murder King George III. At his trial he claimed that he was acting on the commands of God, and he was judged to be insane. The mentally ill were judged to be innocent of any crime they might have committed, and could not be sentenced to prison. However, most of those acquitted of a crime on the grounds of insanity were sent to prison without legal justification, or sent to Bethlem or private asylums. Hadfield's case was a prominent one, so those options, existing in a legal grey area, were obviously unsatisfactory. The Criminal Lunatics Act 1800 (39 & 40 Geo. 3, c. 94) gave special legal status to the mentally ill, allowing all persons acquitted by court on the grounds of insanity, or found insane on arraignment (unfit to stand trial) to be detained in close custody 'until his Majesty's Pleasure be known' - in other words, indefinitely. Hadfield was detained in Bethlem Royal Hospital, an asylum in London, for the rest of his life.
Another man, Daniel McNaughtan, was responsible for a further change in the law on the insanity defence in 1843 when he shot and killed Edward Drummond, private secretary to the Prime Minister Sir Robert Peel, because of his delusions that the Tories were persecuting him. McNaughtan's trial, and subsequent debate in parliament, created the 'McNaughtan Rules'. The principle that a person would be judged insane of they were shown to be incapable of knowing 'right from wrong'. These rules were used as the sole test of criminal responsibility until the Homicide Act 1957 (5 and 6 Elizabeth II, c. 11) largely replaced them with the concept of 'diminished responsibility'.
In 1807 a Select Committee of the House of Commons recommended building a separate place for those confined under the 1800 Act, feeling that neither prison nor ordinary asylums were suitable places of detention, and accordingly separate wards were built at Bethlem in 1814, but these were soon full. In 1849 the government arranged with Fisherton House, an asylum near Salisbury, to build extra wards for criminal lunatics, but by 1856 these were also full.
Meanwhile, another Select Committee of the House of Commons reported in 1860: 'To mix such persons, that is criminal lunatics, with other patients is a serious evil; it is detrimental to the other patients as well as to themselves; but to liberate them on recovery, as a matter of course, is a still greater evil, and could not be sanctioned, for the danger to society would be extreme and imminent.' In the light of this report, the Criminal Lunatics Asylum Act 1860 (23 and 24 Victoria, c. 75) was passed. It would later become known as 'the Broadmoor Act'. This act empowered the government to create criminal lunatic asylums in England. The act gave the Home Secretary control over all criminal lunatics, which remained the case until 1948. He was to appoint a Council of Supervision to govern the asylum, and also to appoint the asylum's senior staff. The Home Secretary was to authorise the admission of people to the asylum, and also their release. The Commissioners in Lunacy, the inspecting body for ordinary asylums in England and Wales, were to visit the new criminal lunatic asylum at least twice a year, and report back on its conditions.
The site chosen for the first criminal lunatic asylum, named 'Broadmoor', was in Berkshire, near the village of Crowthorne, easily accessible from London but in an isolated situation, with pleasant views from the top of a high ridge. The architect was Sir Joshua Jebb, a military engineer who had previously designed Pentonville Prison. The original design was for two walled enclosures, one for females, containing two patient accommodation blocks, and one for males, containing six patient accommodation blocks, The Medical Superintendent's house was in between the two, and houses for staff were nearby. Broadmoor originally had 170 acres of farmland, a large kitchen garden, a laundry and workshops including a shoemaker's, upholsterer's, tinsmith's and carpenter's. There was also a chapel and a central hall within the male patients enclosure.
Early years
Broadmoor admitted its first patients on 27th May 1863. All of these were women, transferred from other institutions, and male patients were transferred from Bethlem and Fisherton House the following year. The asylum was not finished when the first patients arrived, and the boundary walls were incomplete. This, coupled with new and inexperienced staff, meant that between 1863 and 1870 15 patients escaped, two of whom remained at large. After the initial influx of patients full capacity was soon reached and there were about 400 male and 100 female patients.
Two types of patients were admitted to Broadmoor. The majority of patients were at there 'until her Majesty's pleasure be known,' and were known as 'Pleasure Men' or HMPs. Some of them had been found insane on arraignment. This meant that a special jury was called upon to examine medical evidence showing that the accused was unfit to plead - in other words they could not understand the charges brought against them, instruct their lawyers or follow the proceedings in court. Others had been tried and found not guilty by reason of insanity. This was later changed to 'guilty but insane', at the insistence of Queen Victoria. In 1883 Roderick Maclean attempted to shoot her, and was found not guilty by reason of insanity. The Queen found this verdict unsatisfactory, and the wording of such verdicts was changed in the Trial Of Lunatics Act 1883 (46 and 47 Victoria c.38). The second type of patient was transferred to Broadmoor from prison, having become insane following their incarceration. Unlike the HMPs, these patients did not require the sanction of the Home Secretary to leave Broadmoor. They could be released or transferred to an ordinary asylum once they had served the term of their sentence, or transferred back to prison if they recovered before their sentence had expired.
By 1870 Broadmoor's six male blocks, two female blocks, auxiliary buildings and 16 ½ foot high boundary walls had been completed. The staff felt unable to cope with the large numbers of patients being transferred to Broadmoor from prison, and complained about this to the government, who finally took action after the escapes of four convict patients in 1873. They built a new wing at Woking prison for mentally ill prisoners, and by 1875 most of Broadmoor's convicts had been transferred there. In 1888 the remaining 56 convict patients were brought back to Broadmoor, as the total prison population, and therefore the number of mentally ill prisoners, was diminishing, and their numbers were so few it was not thought worthwhile to accommodate them in a separate unit. In Broadmoor they were housed in block 6, which had been enlarged and strengthened for that purpose, as they were found to be more dangerous and liable to escape than the HMPs.
The Medical Superintendents were reluctant to release patients, which meant that the numbers of patients grew. By 1901 there were 486 male patients, and 179 female patients so a further block, block 7, was completed in 1902 to accommodate extra male patients. However, Broadmoor remained overcrowded, and by 1908 there were 577 male patients and 224 female patients.
Rampton
In 1908 the Home Office decided to build a new Criminal Lunatic Asylum to relieve the overcrowding at Broadmoor. Between 1908 and 1912 overcrowding was tackled by transferring the remaining convict patients to a new unit at Parkhurst Prison on the Isle of Wight, and 21 patients were also transferred to county asylums. In 1912 the new asylum, Rampton in Nottinghamshire, was completed and admitted its first patients, all women transferred from Broadmoor, on 1 October. That year 128 patients were transferred from Broadmoor to Rampton, and in the following years more patients were transferred there en masse, allowing the patients at Parkhurst and county asylums to be transferred back to Broadmoor, and the patient numbers to be reduced. Rampton was managed separately to Broadmoor, by its own Medical Superintendent, but followed the rules already laid for Broadmoor, and its accounts were merged with those of Broadmoor into one criminal lunatic asylums account, for which the Superintendent of Broadmoor was the accounting officer.
During World War One Broadmoor operated a much more generous release policy. During the five years of the war 130 patients were released as cured, compared to 316 during the previous 40 years. This meant that by 1918 there were 250 vacant beds in Broadmoor, which rendered Rampton superfluous. Rampton closed at the end of 1919 and re-opened at the start of 1920 as a state institution for mental defectives (i.e. those with learning disabilities) who needed high security care, owned and managed by the Board of Control under the Mental Deficiency Act 1913 (3 and 4 George V, c.28). Most of the original patients were transferred back to Broadmoor. Rampton's later history followed a similar pattern to that of Broadmoor. It was managed as a Special Hospital for a time, and is now part of Nottinghamshire Healthcare NHS Trust. Its records up to 1919 form part of the Broadmoor collection, and thereafter its records are held by the Nottinghamshire Healthcare NHS Trust.
Broadmoor during the World Wars
During the First World War the numbers of Broadmoor patients fell, from 768 in 1914 to 591 in 1918. This was mainly because more patients were released. Broadmoor experienced considerable difficulty in procuring enough supplies, especially in providing enough food. Many of the young male staff were called up to active military service, and were replaced by untrained older males, putting a great strain on the remaining, experienced, older male staff.
Broadmoor also acted as a prisoner of war camp for mentally ill German soldiers, operating a separate unit for them called 'Crowthorne War Hospital'. This opened on 11 December 1916, in block 1, which was then empty, and closed on the 29 March 1919. The Medical Superintendent and three other members of staff ran this unit, with the assistance of Orderlies from the Royal Army Medical Corps. 317 Germans were treated there in total, and of these 93 were removed to ordinary prisoner of war camps in England and 172 were repatriated to Germany during the course of the war. In August 1917 the War Hospital was inspected by the Swiss Embassy, with favourable results. The remainder of the prisoners were moved on at the end of the war.
During the Second World War many members of staff were called up into active service, and their places had to be taken by untrained staff. In 1941 further recruitment of staff to Broadmoor was banned because of the shortage of workers. Existing staff had to work far more than their allocated hours, and many female staff who had left upon marriage came back to work. Patients assisted with the air raid precautions such as blackouts and sandbagging the windows and some patients were formed into an additional fire brigade, often meeting outside the walls when the alarm sounded. None of these men attempted to escape. At night all the patients slept downstairs in the corridors and dayrooms, close to the exits, in case incendiary bombs fell - the upstairs wards had very few fire escapes, and all the windows were barred. Fortunately the precautions proved unnecessary, but bombs were dropped on Broadmoor's farm, damaging the pigpens, though not killing any people or animals. The severity of the food rationing was also eased for patients and staff by Broadmoor's farm and vegetable garden.
Post-war Broadmoor
In 1952 there was a very serious incident in which a patient, John Straffen, escaped by scaling the 10 foot high external wall, and during the four hours he was at large killed a young girl. This was the first time a patient had escaped and committed murder. This incident led to the installation of an escape alarm in the local area, which is still operational, and is tested every Monday morning at 10am, followed by an 'all clear' signal. An escape centre was created in the staff clubhouse to coordinate hospital and police responses to an escape. However, the escape rate remained at less than 1 patient every three years, far less than in the early years, and most of the escapees were recaptured almost immediately.
The 1950s and 1960s were a time of sweeping changes at Broadmoor, with the introduction of the National Health Service Act 1946 (9 and 10 George VI, c.81), which incorporated Broadmoor into the NHS, the Criminal Justice Act 1948 (11 and 12 George VI, c.58), and the Mental Health Act 1959 (7 and 8 Elizabeth II, c.72).
The Criminal Justice Act 1948 changed Broadmoor's name from 'Broadmoor Criminal Lunatic Asylum' to 'Broadmoor Institution', and stipulated that patients were no longer to be known as 'criminal lunatics', but should be called 'Broadmoor patients' instead, signalling a that Broadmoor was moving away from the criminal justice system, and becoming incorporated into the healthcare system. The Act also transferred the ownership of Broadmoor from the Home Office to the Minister of Health, and the roles of inspection and management were transferred from the Commissioners in Lunacy and the Council of Supervision to the Board of Control. The Board of Control also appointed a Committee of Visitors, made up of members of the former Council of Supervision, to visit the hospital and grant interviews to individual patients between Board visits, and to deal with lesser administrative issues. The committee had a mainly honorary role, and was dissolved in 1964 when the members no longer wished to continue.
Under the Mental Health Act 1959 Broadmoor and its sister institutions (Rampton and Miss Side) became known as 'Special Hospitals,' and Broadmoor became simply 'Broadmoor Hospital'. The Board of Control was dissolved and most of its members were transferred to the Ministry of Health. Most of the Board's functions were also transferred to the Ministry Health, with the rest, including inspection, being transferred to local authorities. The Ministry of Health created a committee, the Special Hospitals Office Committee [SHOC], also known as the Special Hospitals Service Board, to be responsible for the Special Hospitals, including for major policy decisions, finance, manpower planning, and senior appointments. The day-to-day management of Broadmoor and the other Special Hospitals was carried out by their own Hospital Management Teams (HMT) of senior staff. The Board of Control's 'watchdog' functions relating to inspections and review of individual cases of compulsory detention were taken over by Mental Health Review Tribunals (MHRT), which reviewed the cases of compulsorily detained patients and could recommend their discharge. The MHRT consisted of medical, legal, and lay members, appointed by the Lord Chancellor in consultation with the Minster of Health.
The 1959 Act also brought in sweeping changes to the way patients were admitted and discharged from Broadmoor. The Act replaced the McNaughtan rules and the 'diminished responsibility' concept of the Homicide Act 1957 with four different categories of mental disorder (sub-normality, severe sub-normality, mental illness and psychopathic disorder). A person could be found guilty of a crime and then medical evidence could be brought to show that they had one (or a combination) of the mental disorders. Rather than being sentenced to prison a 'hospital order' for compulsory detention and treatment in a mental hospital would then be made. A hospital order was not therefore a verdict of the court - it was a decision made after the verdict was given. The hospital order could be for treatment in a normal mental hospital, if the patient was not considered dangerous, or it could be for admission to Broadmoor, Rampton or Moss Side, if they were. The new law allowed the admission of prisoners, who could then be transferred during their sentence under a hospital under, and also for the compulsory admission of 'civil patients', people who had not been convicted of any crime, but were thought to need secure care. Civil patients were usually transferred from other hospitals. Broadmoor could also transfer patients back to ordinary mental hospitals, if they continued to need care and treatment but were no longer considered dangerous. This created greater flexibility in the system and meant that Broadmoor was not so isolated. For convicted patients compulsory detention and treatment lasted an indefinite period, but for civil patients compulsory treatment was time limited, to different periods in different instances, but after the expiration of the time period the compulsory treatment order could be renewed if necessary. The courts could also make a 'restriction order' for convicted patients, meaning that they could only be released with the agreement of the Home Secretary. Patients who were not subject to this restriction order could be discharged or transferred to another hospital upon the recommendation of their doctor, or upon the recommendation of the MHRT, to whom they could periodically appeal against their detention.
In 1963 The 'Friends of Broadmoor Hospital' was formed. It is a charitable body whose main functions are to support patients and the families and friends of patients. They assisted patients' visitors by running a minibus service between the train station and the hospital and creating a refreshment room for visitors in one of the former staff houses just outside the hospital. They engaged in fundraising activities such as an annual fete, and used the money raised to improve patients' recreational opportunities. Their contributions included installing an outdoor swimming pool in 1973, and building new changing rooms and storage facilities for the hospital sports field. In 1980 the Friends and the Broadmoor social work department jointly set up a visiting panel, to encourage and train members to visit patients who would not otherwise have had any visitors. The Friends were strongly supported by television personality Sir Jimmy Savile, who helped them with fundraising and recreational activities for patients, and also visited patients. The work of the Friends continues today.
Broadmoor in the 1970s
In order to increase understanding of mental illness, and to integrate the Special Hospitals more into the health service, the Special Hospitals Research Unit (SHRU) was created during the 1970s, and generated a series of research papers on the Special Hospitals. SHRU had a London office, and research and clerical assistants at each of the Special Hospitals. They kept a 'case register' of information on all new patients, which could be used for research purposes, which included information from court papers, other mental health services, tests, and interviews with patients and their relatives.
During the 1970s there was a greater range of professionals at Broadmoor, including more psychiatrists, psychologists and social workers. There was an increasing concern about the ethics of new treatments, and the 1959 Act began to look inadequate for the contemporary world. This led to the creation of various management committees. The HMT continued to be the main executive committee, and was responsible for day-to-day management. Under this team were various others such as the Professional Advisory Committee, the Hospital Management Team Heads of Department Committee, the Hospital Policy Committee and the Management Support Group, committees which succeeded each other as the main forum for discussion of policy between HMT and the other professionals. There was also a Medical Advisory Committee, consisting of all the senior medical professionals, which advised on medical matters, a security committee, and a health and safety committee. There were also ethics and research committees, considering day-to-day issues such as patients' consent to treatment, their rights and treatment, and setting the ethical component of research projects.
Between 1975 and 1992 Broadmoor underwent a major rebuilding programme. The programme was announced in 1963 at the hospital's centenary celebrations by the Health Minister Enoch Powell, but did not begin until the 1970s. The main reason for the delay was that Broadmoor was so overcrowded that building work would have been impossible. This led to the decision to build a new Special Hospital, Park Lane, situated at Moss Side, Merseyside (previously in Lancashire), next to Moss Side Hospital, to relieve the overcrowding. Park Lane was opened in 1974, although not completed until 1986, and it enabled the rebuilding at Broadmoor to begin. The rebuild included a new gatehouse, a new administration complex to house the increasing numbers of administration staff, the creation of two new Houses, Oxford House and Bedford House, which included within them a new admission ward and a new medical centre, and the demolishing of Cornwall House. Patients' rooms in the new Houses all have ensuite facilities, but the rooms in the old Victorian wards currently [2008] do not. There was also a staff club, which included a canteen for the first time, and a staff education centre and library, outside the walls, which was later named 'the Patrick McGrath Library.' A new patients' occupation and education centre was also built, and patients' rooms were refurbished, and modernised. The rebuild took far longer than anticipated and it went over budget by at least 300%.
In 1972, in the wake of a scandal in which the patient Graham Young was discharged, and went on to commit murder by poisoning, the government set up the Aarvold Committee. The committee was chaired by Sir Carl Aarvold, and investigated the procedures for discharging Special Hospital patients. The committee recommended deciding soon after a patient was admitted whether they would need special care in assessing for discharge, and referring those cases to a discharge advisory committee. The Advisory Board on Restricted Patient's was therefore created in September 1973 and chaired by Sir Carl Aarvold, with five other members of the legal, medical and social professions as members. It considered the discharge and transfer of restricted patients.
Also in 1972 the government set up the Committee on Abnormal Offenders, under the direction of Lord Butler. Its remit was to consider by what criteria and to what extent mental illness was to be recognised in law, and how that should affect fitness to stand trial, sentencing and treatment, and to consider possible changes in care and treatment of the mentally ill, especially in relation to discharge and after care. Their full report was published in 1975, but in 1974 they published an interim report calling for the creation of Regional Secure Units (RSUs) as a matter of urgency. These units would be able to provide secure care in local areas, and would act as a half-way house between the Special Hospitals and local psychiatric care, creating greater flexibility in the system. The report called for a nationwide system to be in place by 1977, but by then there were only three such units, and by 1983 there were only six. Butler's full report provided a detailed examination of many different aspects of the mental health care system, and concluded that the 1959 Act was no longer adequate.
Broadmoor from the 1980s
The Mental Health Act 1983 (1983, c.20) was inspired partly by the findings of the Butler Report, partly by the campaigning work of high-profile charities such as MIND and MENCAP, and partly by the need to move with the times. The Act brought in an emphasis on patients' rights. Patients now had to have their rights explained to them, their complaints had to be properly investigated, and patients had to be discharged unless there was good reason to detain them for longer. The new emphasis on patients' rights mirrored changes taking place throughout the whole NHS at this time. During the 1970s Broadmoor patients themselves had agitated for greater freedom and autonomy and some patients held rooftop protests against their detention.
The 1983 Act increased the role of the MHRT by doing away with the Aarvold procedure, and by giving them the final say on the discharge of patients. It also created the Mental Health Act Commission (MHAC), whose role was to inspect places where patients were detained under the Mental Health Act, monitor the way the powers of the Act were used, and investigate complaints from individual patients. It also created guidance and codes of practice relating to medical treatment, consent to treatment, and second opinions. It was an independent body with lay and professional members, but was responsible to, and appointed by, the Secretary of State for Health.
The 1980s and 1990s saw great changes to the structure of management at Broadmoor. A Hospital Board for Broadmoor was introduced by Statutory Instrument [SI 1986 number 2004] and came into force on 1 January 1987. The other Special Hospitals had similar Boards and together they were known as 'the Special Hospital Boards'. This development meant that certain functions were transferred from the Department of Health and Social Security to the Boards. The Boards were appointed by the Secretary of State and determined the priorities and policies of the hospital, implemented policies, advised staff, and allocated the budget, but had no power to appoint staff or to admit or refuse to admit patients. The Boards set up a procedure for reporting and investigating complaints made by or on behalf of patients.
In 1989 the Boards were abolished and the Special Hospitals Service Authority was created to replace both SHOC and the Special Hospital Boards. It was created with the aims of integrating the Special Hospitals more fully into the NHS and strengthening leadership and accountability through the appointment of general managers within each hospital, who would be accountable to the Chief Executive of the SHSA. The SHSA was designed to be a small and flexible body, delegating most responsibilities to the general managers and local hospital management. Many of these changes were brought in as a result of the findings of the 1992 Ashworth Inquiry Report into alleged abuses of patients at Ashworth Hospital.
A further innovation at Broadmoor in1995 was the introduction of 24-hour nursing care. This means that patients in rooms in the old Victorian wards, which currently [2008] don't have en suite toilets, are no longer locked in their rooms at night and can get up to use the facilities.
In 1996 the purchaser-provider split, and the internal market, were introduced in the Special Hospitals, as they had been throughout the NHS during the 1990s. The SHSA was disbanded and in its place three Special Hospital Authorities and their purchaser, the High Security Psychiatric Services Commissioning Board, were created. The HSPSCB commissioned high security care and developed and coordinated strategy for secure psychiatric services, while the SHAs were responsible for managing the hospitals as separate provider units, similar to hospitals managed by NHS trusts.
In 2001 the Broadmoor Hospital Authority was abolished by Statutory Instrument, and its responsibilities were taken over by the West London Mental Health NHS Trust. The Trust consisted of the former Ealing, Hammersmith and Fulham Mental Health NHS Trust and the Broadmoor Hospital Authority. The Trust provides a wide range of services from local services to secure care in West London and high security care at Broadmoor. In 2002 the Hounslow Mental Health Services also joined the Trust. Since then Broadmoor has opened the Paddocks, a purpose built unit for patients with dangerous and severe personality disorders, which has 70 beds. However, the numbers of patients within Broadmoor as a whole have stabilized at around 300, as there is greater flexibility to move patients, especially the elderly, to long-stay medium secure units.
In 2003 the Department of Health published a consultation document called 'Women's Mental Health: Into the Mainstream', which highlighted the fact that whilst many mentally ill women required high-dependency care, very few actually needed high security care. This led to the decision to consolidate high security care for female patients into one unit, enabling greater economy and specialisation of services. The National High Secure Healthcare Service for Women was created at Rampton, in Nottinghamshire, and has 50 beds. By September 2007 Broadmoor was able to phase out women's services, moving female patients on to the new unit at Rampton, or to the Orchard, an enhanced medium secure service in Ealing, part of the West London Mental Health NHS Trust, or to other services.
Patient care and treatment
During Broadmoor's early years patients were not given any specific treatments, beyond some sedative drugs. The treatment was a strict regime of rest, fresh air and exercise, a healthy diet, and work. The male and female patients were kept strictly segregated, each having their own walled areas that included secure outside areas known as 'airing courts' for the prescribed daily fresh air. They were accommodated in wards within blocks designated for patients with differing needs. There were initially three blocks on the male side, and one on the female side. Building work continued after Broadmoor opened until there were six male blocks and two female blocks. A further male block, block seven, was built in 1902. Male blocks one and six were known as the 'back blocks', as unlike the other blocks they had no view over the countryside. They were used to house patients who were violent or difficult to manage, and therefore needed extra care. Female block two was used for the more violent or high-dependency female patients. Block four housed the admissions ward, where patients would be housed initially, so that they could be observed and an appropriate block chosen for them. Each ward had its own day room and dining room, as well as dormitories and single rooms and washrooms. The majority of patients slept in dormitories, with the single rooms being used to seclude patients if they became violent or disturbed, or if they were ill. The majority of patients in the back blocks slept in single rooms. The rooms for disturbed patients were furnished as sparsely as possible, with only a mattress and bedding and a chamber pot. Although strait jackets were not used at Broadmoor, disturbed patients often slept in 'strong' bedding made from canvas, to prevent them from tearing up the bedclothes to use for self-harm.
The patients' day began at 7am when they got up, and washed and dressed, if necessary with help from the attendants, before having breakfast in the ward dining room. Patients had to take a bath once a week. Male patients could be shaved three times a week, although they were not allowed to shave themselves, and two attendants had to be present. Patients' meals were delivered from the central kitchens and eaten in their dining rooms. The cutlery was carefully counted out and back in again after every meal, to make sure patients did not take anything that could be used to harm themselves or others.
Patients were encouraged to attend the chapel for worship, but they were not forced to do so. The chaplain held services in the chapel, and also visited the wards to conduct prayers and speak to patients individually. Provision was made for those patients who were not Anglican by a visiting Roman Catholic priest, and ministers of other faiths.
After breakfast patients were encouraged to work. Female patients cleaned their wards and worked in the laundry and did sewing. Male patients worked on Broadmoor's farm and in the kitchen gardens, cleaned their blocks, and worked in the various workshops including the shoemaker's, tailors', tinsmith's and mattress makers'. This work acted as an early form of occupational therapy, and also helped to keep Broadmoor's running costs down. Almost everything Broadmoor needed, except coal, was grown or produced on site, meaning that it operated as an almost self-sufficient community. This was true of most asylums at the time. The annual report for 1863-1864 states that there were an average on 209 patients at Broadmoor during the year, and an average of 119 employed in useful work. The female workers produced a huge quantity of needlework, including, amongst other things, 197 gowns, 172 hand towels, 629 sheets, 602 linen shirts, 536 flannel shirts, and 529 flannel drawers. They also mended clothes including 2259 pairs of stockings. The male shoemakers made 152 ½ pairs of men's shoes, 160 ½ pairs of boots, and mended 455 pairs of men's shoes, and 313 ½ pairs of women's shoes. Male patients also helped to produce 120 pounds worth of food on the Broadmoor farm in its first year, an amount that increased as the farm became more established.
Patients who could not spend the day working stayed in the dayrooms where newspapers, books and board games were provided, as well as piano for female patients, and later on billiard tables for males. All patients had to go to the airing courts for exercise, and attendants were instructed that they should help feeble patients to walk about outside if necessary, as no patients should be allowed to form the habit of simply staying in the day room all day. Patients had their evening meal early, and retired to bed at between 7 and 8pm.
In 1865 another daily activity was created when a schoolmaster was employed to teach the patients, many of whom were illiterate. There was not much uptake for his lessons, however, with between 3 and 28 patients attending classes in his first year. In later years the numbers of patients he taught increased to around 60, but he taught them in small groups or individually, as large classes were found too difficult to teach. He also played the harmonium in the chapel, trained the choir, took charge of the patients' library, and trained the asylum band, and by 1874 he was also responsible for organising entertainments for patients. His post was abolished in 1877, and patients' education ceased. The schoolmaster's other roles of teaching the choir and the band, and playing the harmonium, were taken on by other staff members. A patient began to help the chaplain to manage the library.
In 1874 a significant change was introduced to patients' work - they received payment for their work for the first time. Previously working patients had received two pints of beer and extra cheese with their lunch, but now they were to receive 1/8 of the estimated value of their work to spend on luxuries like tobacco and sweets. The result of this was that the output of the workshops more than doubled, so the running costs of the asylum were actually reduced by the new expense. Patients could not actually receive money, as it was thought that handling cash could increase the risk of escapes or lead to gambling, bribing staff to bring in alcohol, or thefts. Instead the steward kept accounts for each patient, who could make any purchases through him.
Patients' friends and relatives were able to visit patients in the mornings or afternoons, usually after writing to make an appointment with the Medical Superintendent. Patients could write and receive letters and parcels, but these all had to be censored by the Medical Superintendent or other senior staff. Visits to patients were infrequent because of the time and cost involved to relatives, who had to travel by train and horse-drawn vehicle from all over the country. Patients were allowed to write to officials such as the Home Secretary complaining about their detention, or their treatment, but were prevented from sending abusive or threatening letters. If letters sent to patients contained distressing news, such as the death of a relative, this news would be first broken to the patient by the chaplain. Parcels sent to patients or gifts brought for them could never be handed to them directly, but had to be checked first for contraband materials.
Patient's entertainment and recreation was initially very limited, with staff putting on amateur musical and theatrical shows for patients. In about 1900 a cricket pitch was laid out for the use of patients, with the chaplain acting as head of the cricket team. The Treasury also allowed an extra 20 pounds a year to spend on entertainments so that visiting professionals could be engaged to put on performances in the central hall.
During the 1920s the range of entertainments and sports on offer was increased, patients were allowed to stage their own variety show, and the workshops were expanded to give more scope for paid work. Patients could 'buy' plots of land to use as gardens to grow vegetables and flowers, and were able to send their own food to the kitchens to be cooked for them, either using produce they had grown, or items bought or sent for them by relatives.
During this period a visiting dentist and a consulting surgeon were added to the staff, and they performed dental work and minor surgery in a room in an administrative block.
In the 1930s there was another innovation in patient care - the introduction of the 'parole' system. This meant that patients who were recovering were given greater freedom of movement to help assess their suitability for release and to give other patients an incentive for good behaviour. Male parole patients were usually housed in block two, the 'privilege block', and were given a green parole card. This meant that they could wander within the block as they pleased, and go out into the airing court unaccompanied whenever they wanted. This was later extended to allow parole patients complete freedom of movement within the male side, and to attend chapel unaccompanied. Another privilege was added in 1944 when male patients were allowed to borrow razors so that they could shave themselves. Female parole patients had the same privileges within female block one and its airing court, although the female side was much smaller than the male side, so they did not have the same freedom. In the parole blocks patients usually had their own rooms, which they could furnish as they wish, and fill with their private possessions. Patients in other blocks usually slept in dormitories and could only keep small quantities of personal items in their lockers. The parole system also led to the introduction of outside trips for patients, accompanied by staff. These included countryside walks, trips to the cinema, and shopping trips to Crowthorne, and later places further away such as Reading. These outside trips were suspended during World War Two because of insufficient staff, but were resumed afterwards, and continued in the form of occasional rehabilitation trips. The parole system improved patient morale, and gave patients a certain amount of independence, which helped to counter the negative effects of institutionalisation.
In 1920 an annual sports day was created for male patients. Initially a simple affair organised by patients, it grew to become the highlight of the patients' year. The sports day had the atmosphere of a village fete, with the Broadmoor band playing, and marquees set up with refreshments and sideshows such as games of skill or chance, with cash prizes to be won and added to the patient's accounts. The sports included athletic events such as the long jump, high jump, shot put, races, and also a tug of war. Most of the races were handicapped, and there were special events for the over 50s. At the end of the afternoon tea was served, and prizes were awarded with much formality. Patients were not forced to attend, but were encouraged to do so, although those from the 'back blocks' were only considered well enough to attend if they were regularly involved in an occupation. A small number of female patients were also allowed to attend as a privilege, and all the senior staff and their husbands or wives were expected to attend. There was also a sports day for patients from the 'back blocks'. This was similar to the main sports day, but was usually held in one of the airing courts, rather than on the sports field, and involved more gentle activities, including pass-the-parcel. The only women present at the back blocks sports day were the matron and a nurse, and parole patients attended as helpers. In 1933 a similar event was created for the female patients, known as the garden fete. This included the finals of the women's boules and croquet tournaments, along with tea and a band, and was held on the women's side.
An annual flower show for patients was created in 1926, where patients could display the flowers and vegetables they had grown on their plots, and also arts and crafts. The show ran for several days, allowing all the patients time to visit it, and on the final day it was open to the public. Prizes were awarded for the best entries in the various categories, usually in the form of cash added to the patients' accounts.
The annual sports day led to the creation of the Social and Sports Committee, which organised sports and entertainments for the patients. The committee was very well organised and created a series of tournaments for teams from different blocks to compete against each other in sports and activities such as bridge and billiards. Patients also competed in game of their own invention called 'throw-ball', which was used as an alternative to football, this being banned until 1938 on the grounds that it was too violent and dangerous. Two bowling greens were also laid out in 1939, table-tennis tables were set out in every block, the cricket team were allowed to play 'away', cinema shows were staged in the central hall, and a choral society was set up.
In 1939 a further recreational activity was added. This was the Broadhumoorists, a dramatic society that performed revues in the central hall every year. The revues usually had a week-long run, and one of the performances was set aside for paying members of the public to attend, the proceeds being donated to charity. Additional funding was generated for sports and entertainment by setting up a small shop within Broadmoor, known as the Canteen, which was run by an outside contractor in exchange for a percentage of the profits, which were then put into the recreation fund. The Canteen sold tobacco, sweets, magazines, and other small luxuries to the patients, who had an allotted time to visit it each week.
1941 saw the introduction of the parole patient's dances. These were very formal occasions held four times a year for male and female parole patients and featured ballroom dancing with a live band. Senior staff and their wives or husbands were expected to attend and to dance with patients. The end of the dance was always announced at 10pm, when the Medical Superintendent was asked to allow just one more dance, which he always did, bringing the night to a close with a final waltz and the national anthem.
In 1944 the parole patients were encouraged to start a monthly magazine, the very successful Broadmoor Chronicle, which continued to be published monthly until 1984, and periodically thereafter until 2004. The Chronicle was written, edited and published by patients, and was available for patients and visitors to purchase. It featured news and information about events taking place within Broadmoor, such as entertainments and sporting matches. It also featured articles, poems, stories, artwork, jokes, puzzles, and letters, all by patients writing under pseudonyms. It was also used to advertise items that patients wished to swap or sell, and services that they could provide for a fee, such as altering clothing. The magazine was censored by the Medical Superintendent to ensure that nothing offensive appeared, and that patient anonymity was not compromised. The Chronicle was a great outlet for patients' creativity and allowed them to have a voice within the hospital and to comment on their care and treatment.
Broadmoor began to bring in the new treatments for mental illness during the 1940s. These included both physical therapies, and talking therapies such as psychoanalysis, which had been created during the 1920s and 1930s. In 1941 electro-convulsive therapy (ECT) was introduced, and in 1942 a psychotherapist was appointed. In 1943 a visiting ophthalmologist was also appointed, as well as an after-care worker for discharged patients. In 1948 insulin coma therapy was also introduced, a very popular, but dangerous, treatment for schizophrenia at the time. Lobotomies were never used at Broadmoor, even though they were widely used during the 1950s. An x-ray unit was added to the infirmary in 1943, and a proper dental surgery and operating theatre were added in 1944, so that by the end of the war Broadmoor was in step with the times, applying modern medical and psychological treatments for mental illness, and allowing its trusted patients greater freedom.
By the 1950s visits to patients had become more formalised. The visits took place in the central hall, and a parole patient would act as an orderly and bring in tea and snacks bought from the patient's canteen. In the summer parole patients could take their guest out on to the terrace. Visitors could bring gifts for patients, but these had to be left in sealed boxes, and opened later by staff in the patient's presence.
During the 1950s a competition was announced in the Broadmoor Chronicle to choose appropriate names for the blocks, to replace their old numbers. The use of English Counties was the winning idea, and the blocks then became known as:
male block 1- Norfolk house
male block 2 - Essex House
male block 3 - Kent House
male block 4 - Dorset House
male block 5 - Gloucester House
male block 6 - Monmouth House and Somerset House
male block 7 - Cornwall House
female block 1 - York House
female block 2 - Lancaster House.
Part of Monmouth House was later turned into an 'adolescent unit' for young male patients (usually in their twenties) and named Somerset House. Later the whole house became Somerset House, and the admissions ward was moved from Dorset House to Somerset House. Block 7 was demolished during the hospital rebuilding programme of the 1980s.
The 1959 Mental Health Act ushered in a new era at Broadmoor. During this period the range of treatments available for mental illness expanded dramatically with a pharmacological revolution that created an increasing range of drugs, where there had previously been only a limited number of simple sedatives. This meant that the physical therapies were gradually phased out. The Act created the position of Responsible Medical Officer [RMO], who oversaw patients' care, and who took on many of the responsibilities previously held by the Medical Superintendent or delegated to nurses. This period also saw an increase in the numbers and range of clinical staff, which led to the introduction of multi-disciplinary case conferences to assess new arrivals to Broadmoor. These were held about six weeks after the patient's arrival at Broadmoor to allow time for observation and psychological tests to be administered. The patient and his or her primary nurse would attend the conference along with the psychiatrist, psychologist, and social worker, and be interviewed, and then a course of treatment would be prescribed. In the 1970s the roles of the different professional disciplines were enhanced still further by the introduction of clinical teams, who collaborated to create structured treatment programmes for patients involving all the clinical disciplines.
A further change during this transitional period was the closure of the Broadmoor farm, which took place from 1957-1959, when the farm had ceased to be economical. The treatment of mental illness was increasingly becoming medicalised, and the idea that fresh air, exercise and hard work could provide a treatment became anachronistic.
Patients' occupations were expanded to include printing, bookbinding and woodwork. Patients still worked primarily on items that were used around the hospital, except for those in block 6, who had their own occupations centre where they made various handicrafts. Until the 1960s there had been several working groups of patients who worked outside the security wall to maintain the Broadmoor estate, for instance the roads and paths, staff areas and gardens, but these were gradually reduced in number and then phased out altogether. A patients' education service was created in the 1960s, teaching basic skills and also allowing patients to sit their O and A levels. This service gradually expanded to encompass a whole range of vocational and academic subjects, with a few patients continuing their studies to degree level by taking Open University courses.
During the 1960s and 1970s patients' recreational activities changed a great deal, mainly reflecting changes in wider society. The Broadhumoorists moved away from revues and began to perform plays and musicals, and the availability of television, which was gradually provided in all the patients' day rooms, led to the decline in popularity of many outdoor activities such as gardening. This in turn meant that the annual flower show became dedicated to showing patients' arts and crafts instead. The very formal parole patients' dances became discos with a DJ instead of a live band, in keeping with the times. The entertainer and DJ Sir Jimmy Savile became involved with Broadmoor, acting as an unofficial entertainments manager and visiting patients, helping to raise funds for their recreational activities, and helping to run events. Jimmy Savile was also instrumental in persuading Princess Diana to make several visits to the hospital, both officially and unofficially.
In the late 1970s patients stopped doing paid work in Broadmoor. It became much cheaper to outsource the hospital's needs than to create them in house. There were also objections from patients' rights groups that patients were being exploited, and from trade unions that patients were undercutting costs. By this time patients had also started to receive benefits, so they no longer needed the paid work. In 1980 the first professional occupational therapist was employed, and patient's daily activities became tailored to their needs, rather than to the needs of the hospital.
During the 1970s patients' treatment expanded further, primarily in the areas of psychotherapy and social skills as the psychology and social work departments were extended and a speech therapist was added to the staff. New treatments involved both group and individual therapy, and informal discussion groups. Behavioural therapies were also used, including anger management, social skills training, and relaxation techniques. The behavioural therapies often used video to record a patient's 'performance' so that they could see how their skills in normal social interaction were progressing. There was also an experimental programme specifically for sex offenders, including mixed-sex social skills therapy. Patients took part in more psychological experiments as Broadmoor became more involved in research into the causes and treatments of mental illness and an experimental 'psyklab' was created to carry out this research.
During the 1970s and 1980s there was a move towards creating greater integration of male and female patients at Broadmoor, with more mixed sex occupational and social activities, including therapy groups. Integration was seen as very therapeutically important. A number of patients' weddings were also held at Broadmoor during the 1980s and 1990s following a change in law that allowed housebound persons to be married in their home by a registrar - this law also applied to those in mental hospitals. Some patients married their outside visitors, but some went on to marry each other, but none of these couples were allowed to consummate the marriage inside Broadmoor. During the 1990s there was a move away from integration and towards single-sex therapies and activities, led by women's rights pressure groups and some hospital staff. By 2007 women's services were phased out at Broadmoor, following the recommendations of the Department of Health's consultation document 'Into the Mainstream', and the hospital became single-sex for the first time.
During the 1990s links were forged with the Royal Shakespeare Company, through one of the psychologists who had a friendship with Mark Rylance, then the director of the company. The RSC began to visit once or twice a year on a Sunday, and perform in the central hall, afterwards holding workshops and discussion groups, or drama therapy, so that patients could discuss their reactions to plays such as King Lear and Hamlet.
In 1999 the second Ashworth Inquiry recommended carrying out an independent review of the security at Ashworth, and this was subsequently widened to include Broadmoor and Rampton. Richard Tilt, former Director of the English Prison Service, lead the review and the Report of the Review of Security at the High Security Hospitals was published in 2000. The report's recommendations caused Broadmoor to make many changes in physical security and patient management. Gatherings of patients in large open spaces, such as on the sports field, was no longer considered secure, so the annual sports day and outdoor sports such as cricket and football were discontinued. Instead an indoor sports pavilion was built, where patients can play 5-a-side football and other indoor sporting activities, and there is also an indoor swimming pool. Opportunities for patients to mix with members of the public at events such as sports matches, the Broadhumoorists performances, and in the chapel, were curtailed, as these activities were no longer thought safe. During the 1980s and 1990s long-stay patients had the opportunity to go on outings outside Broadmoor, to keep them in touch with the wider world, and there had also been "closed" coach trips which allowed groups of patients to be taken out together but not to get off the coach. These opportunities became extremely restricted, and patients were no longer allowed to perform or work outside the hospital, or go on group outings. Patients still have access to compassionate trips to visit close relatives who are unwell, or to go to funerals. However, from the 1990s onwards Broadmoor's patient population has decreased, as patients who no longer need high security care are discharged or transferred to other services, so the outside trips are no longer so necessary, and rehabilitation trips usually only take place once a discharge pathway is agreed. These trips may then involve spending a trial period at a different hospital, rather than going on outings. Outside visitors such as religious groups or musicians still visit Broadmoor to give talks or performances, but these are rare occasions, and most entertainments and activities are now wholly internal.
Broadmoor's staff
Broadmoor was initially managed by a Medical Superintendent who was responsible for patient care and all other aspects of the establishment. There was also a Deputy Superintendent, an Assistant Medical Officer, a Chaplain, a Matron in charge of the female patients and staff, a Steward, responsible for finance and administration, a farm bailiff, and nursing, clerical, and a whole range of skilled and unskilled auxiliary staff.
The Medical Superintendent had huge responsibilities. A booklet of Rules for the Guidance of Officers at Broadmoor Criminal Lunatic Asylum states that 'He shall have control over all the other officers, attendants and servants in everything pertaining to the maintenance, care, occupation, and amusement of the patients.' He was responsible hiring and firing staff, and also 'for the management and condition of the Asylum, and shall superintend the whole of the medical and moral treatment of the patients, and the general arrangements of the establishment'. He was also required to keep copious records relating to patients, for the purposes of statistics and accountability, to read and censor patients' incoming and outgoing mail and liaise with the Council of Supervision. He was allowed six weeks' leave of absence, as long as he notified the Council and arranged for his duties to be covered.
The Deputy Superintendent and the Assistant Medical Officer were the only other professionally qualified medical or nursing staff. They carried out most of the practical patient care and acted as pharmacists.
The role of Chaplain was initially a very important one within Broadmoor. As well as holding services in the chapel and on the wards, and talking to patients individually, he also acted as librarian for the patients, and was required to organise and superintend a system of elementary teaching for patients, and to 'superintend any schools established for the benefit of the families of Attendants and Servants.'
The school for staff children was initially housed in a cottage, but in 1864 the money was granted to build a proper schoolhouse, and a young female teacher was employed. As the school was established before the era of local authority education, which began in 1870, parents had to pay a subscription or 'school pence' for their children to attend. The school was officially called 'Broadmoor Asylum (Children of Servants) School'. In 1904 its management was taken over by the Berkshire County Council education authority and it became known as 'Broadmoor Council School,' and became a school for all children the local community, although children who were not the children of Broadmoor staff had been occasionally admitted prior to this. The school initially had only 18 pupils, but by 1871 there were 130 pupils. In 1966 a programme of extension and modernising started, and was completed in 1969, although there have been many further additions and improvements since then. Currently [2008] Broadmoor Primary School is managed by Bracknell Forest Borough Council and has around 150 pupils from the local community aged 4-11.
There was a steward and storekeeper in charge of accounts and the stock of food and other supplies, and responsible for managing the kitchen and the workshops.
There was also a Matron, responsible for managing the female side of Broadmoor, including the female staff, inspecting the wards for cleanliness and supervising the sewing and laundry, which was done by female staff and patients.
At first about 100 'attendants' were employed to act as care assistants or nurses, this was a ratio of about one attendant for every four patients. Attendants were employed at different grades, with the chief male and female attendants being the most senior, then attendants, then assistant attendants. There was no rota for working during the night, instead some attendants were employed specifically to work night shifts only. Initially the attendants were completely untrained and without any qualifications in nursing, or in anything else. Most of them did not have any experience of working in asylums, hospitals, or even prisons, and had to learn everything about their demanding role on the job. Applicants were examined by the Civil Service Commissioners, who gave out certificates stating that job applicants were an appropriate age, not suffering from a disease or physical defect that could hinder their ability to carry out the job, that they were of good character, and usually that they could read and write. Applications for senior positions were also examined by the Civil Service Commissioners - the first Matron was tested in reading, handwriting, spelling, and addition and subtraction and found to have the requisite knowledge and abilities for the job.
The attendants and other junior staff had very strict rules to follow. Their tasks included escorting and observing patients, especially those who were thought to be a suicide or self harm risk, carrying out security measures such as counting the cutlery in and out at mealtimes; washing, dressing and shaving patients where necessary; helping patients to take exercise; recording and reporting on untoward incidents, injuries or medical problems of the patients, and incidents of seclusion (locking the patients in single rooms for their own or others' safety); keeping the buildings scrupulously clean; and treating the patients with kindness and forbearance. They were instructed of the severe penalties for neglecting or ill-treating patients, aiding them to escape, or taking bribes or any kind from patients, their friends and relatives, or workmen. They were not allowed to use patients' clothing or bedding for themselves, use the patients' books and newspapers, or eat the patients' food. Most of the staff lived in accommodation within Broadmoor, but married staff were provided with purpose-built cottages to rent on the Broadmoor estate. In addition to wages the staff received a uniform and food whilst at work, and staff living on site were given all their meals and had their laundry done for them. The male uniform for attendants consisted of a dark suit with a military style jacket and a peaked cap, and the female attendants wore a typical nurses outfit of dress, apron, and white cap. The staff cottages could be inspected by senior staff to check that they were kept in good repair, and that staff were not taking in lodgers, or keeping dogs, pigs, or poultry without permission. Attendants and servants could be summarily dismissed if they were suspected of any wrongdoing.
Attendants usually worked from 6am until 8pm, with a half-hour breakfast break and one-hour lunch break, although the exact hours were subject to change. A small number of staff would be chosen to continue working until 10pm, checking the patients had settled down to sleep after their 8pm bed-time, and a skeleton staff of night attendants worked from 10pm until 6 in the morning. Attendants were forbidden from going to pubs or being drunk on duty, although they had little time for that because those sleeping in accommodation within the hospital were checked by the night attendants to make sure lights were out by 10.15pm, and were woken at 5.45am. Artisans and most other staff, for instance clerks and farm workers, worked from around 6am until 5 or 5.30pm, depending on the season. Attendants' leave entitlements were subject to change, but by 1869 they were allowed one day off a week - from 2pm until 10pm - and two days off together every other month. This contrasts with the Medical Superintendent and the Chaplain, who were allowed six weeks leave of absence a year, if they could provide cover for their role, and the Steward, Matron, Deputy Superintendent and Assistant Medical Officer, who were allowed one month's leave.
Salaries and entitlements at Broadmoor spanned a huge range. In 1863 the Medical Superintendent was given lodgings in his own house, situated between the male and female sides, and other staff usually received lodgings inside Broadmoor or on the estate. In addition, the Medical Superintendent received a salary of £900 a year, the Deput |