“Terrible timing” for closure of secure women’s ward at Ashworth

July 6, 2003 - Source: The Royal College of Psychiatrists

The Royal College of Psychiatrists issued a number of its own reports of its annual conference in Edinburgh. This below is one of them.

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The secure women’s unit at Ashworth Hospital, Liverpool – which houses some of the most mentally disturbed women in Britain – is to close next March, despite the fact that there are no adequate facilities to which the women can move.

Dr Sarah Davenport, clinical director for women’s services at Ashworth, told delegates that the timing for closure of Ashworth was “terrible”.

The female population in prison was set to double to by 2006, there was a rising suicide rate in prison and a third of women remanded for psychiatric report following a violent incident had a psychosis and needed hospital treatment. “The thinking does not appear to be joined up in any way. The government, in its concern to achieve targets, has neglected the continuity of care.”

The closure is in the vanguard of the government’s plan to move 400 people out of high security hospitals by next March into medium secure services near their homes. However, psychiatrists say the government has given little or no thought as to how, in reality, these women can be managed and treated now or in the future. Psychiatrists told delegates at the conference today that the decision to close the units was ill-thought out and was being conducted with undue haste.

“We were told last October that the unit at Ashworth would close,” said Dr Sarah Davenport. “That is not an appropriate length of time to close a service safely if the average length of stay is seven years and many of the services that these women need to move on to are not yet available. The timescale is too rapid to be safe.”

These women need dedicated services, with specially trained nursing staff experienced in dealing with the complex mental health problems with which the women suffer. Most have abusive childhoods, 90% self harm and a majority have personality disorders. Many are violent and have a history of committing arson.

At Ashworth, many patients, fearful of the move, have deteriorated already, said Dr Davenport. Ashworth had around 150 staff highly experienced in the management of women with complex mental health disorders, but many have left to find new jobs. “All that expertise has been dissipated. This situation is unsafe for the women – some have become suicidal – and the risk of violence, to the dwindling number of staff, has also risen,” said Dr Davenport.

There are roughly 50 women in each of the high security hospitals – Ashworth, Broadmoor in Berkshire, and Rampton, near Retford, Nottinghamshire. The women’s unit at Broadmoor will be close in 2004/5. The 150 women who need care in high security facilities will move to the last remaining high security hospital, Rampton, or be dispersed around the country. Most need treatment in medium secure hospitals – only a dozen women need to be treated in the highest security, Category B, facilities.

A quarter of the women at Ashworth will moved to Rampton. But Dr Ray Travers, clinical director of Rampton Hospital, believes that Rampton, as the country’s remaining high security hospital will be under too much pressure to deliver too many targets. “These women will suffer,” he said. “Where are these extra women going to go? They will be pushed into prison or challenge local services. We cannot do everything.”

Regions across the country have been told to make plans to develop women-only medium secure services, but what had not been properly considered was that there was a group of women who need more than medium security said Dr Davenport. “They don’t need Category B, but they do need a unit with specialised and experienced staff and it’s best that these women are kept in a handful ‘supra-regional’ centres rather than dotted around the country.

“That will happen in the south, but not the north. If you have a patient north of Stafford or in Wales she won’t get access at a level of enhanced security. The government hasn’t considered properly the range of needs and the risk that is associated with caring for this very small group of women.”

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