Carstairs To Send 100 Patients To Less Secure Hospitals

Almost half the patients at the State Hospital at Carstairs, including several killers, are to be released to lower security institutions.

The chief executive of Scotland’s top security hospital has told The Herald how the institution plans to cut its bed numbers from 240 to 140 by 2011.

In an exclusive interview, Andreana Adamson revealed that male patients not requiring the high security of the State Hospital would be moved to medium secure units such as the Orchard Clinic in Edinburgh, which is part of the Royal Edinburgh, and the Rowanbank Clinic in Glasgow, on the Stobhill site.

In those units, they would be subject to less stringent rules and eventually allowed out on their own. Patients can be moved from Carstairs only if they are considered not to pose a major risk to the public.

The move follows concerns that, under the European Convention on Human Rights, patients kept in an “excessive” level of security could sue the government. It is also dictated by new national mental health policy to provide appropriate local services where possible.

Under the Mental Health (Care and Treatment) Act 2003, patients have the right to appeal against excessive security and compulsory measures. There have already been 66 appeals against excessive security and some 24 have been upheld. Some of the patients have been referred directly to low security units, others are awaiting transfer.

The psychiatric hospital at Carstairs houses some of Scotland’s most disturbed and dangerous patients. Some two-thirds are referred from court or prison and the patients include some of country’s most notorious multiple killers and sex offenders. The remaining third have committed no crime.

Ms Adamson explained that only patients requiring high security will be admitted to the State Hospital in future. By 2011, a new purpose-built hospital will be built on the existing site with 100 fewer beds and no facilities for women. She explained that the new hospital will be about providing better “holistic care and treatment” for patients. To meet the change in service, there is a planned reduction of patient numbers over the next three to four years, as patients move on to medium security settings.

Traditionally, there have been about 15 women in the hospital each year, but in future there will be none and all female patients will be cared for by local facilities. “The new hospital will ensure patients are treated in accommodation appropriate to their needs in an environment that supports their rehabilitation,” she said.

The tribunals, which are completely independent, sit across Scotland. Background and forensic reports are provided by psychiatrists and specially trained social workers, but the decision on what level of security is required, is taken by the tribunal itself. To prepare patients for transfer, they are taken to the lower security hospital for short visits to acclimatise them to their new surroundings.

Ms Adamson, who is also leading the development of the forensic network in Scotland, says the re-design of forensic services across the country, including the increase in medium secure places, will improve patients’ ongoing care and treatment.

In the past, patients considered suitable for transfer to a lower security setting may have had to wait up to five years for a place because of a national shortage.

“In the past, between 50 and 60 patients were on the transfer list at any one time but often waited longer than necessary because of a lack of appropriate local facilities,” said Ms Adamson. “Today, patients are no longer waiting excessive times for transfer.”

Patients spend on average around seven years in the State Hospital, but some of the patients have been there for 40.

The State Hospital is Scotland’s only high-security hospital. It provides assessment, treatment and care in conditions of special security for individuals with mental disorder who, because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting.