Broadmoor's heritage status blamed for high suicide rate

Broadmoor hospital, Britain's best-known high-security mental institution, was forbidden from removing windows bars used by patients to hang themselves because it was felt it would damage the nation's architectural heritage, a report reveals today. Between 2001 and 2008, there were eight suicides, five by hanging, at the former Victorian asylum in Crowthrone, Berkshire, that houses about 260 of England's most dangerous and violent psychiatric patients. At the country's two other high-security mental hospitals – Rampton in Nottinghamshire and Ashworth in Liverpool – there was only one suicide over the same period.

Removing ligature points such as hooks, curtain rails and bars from mental health wards dramatically reduces suicide rates, studies have shown. But Broadmoor, built in 1863, was prevented from going ahead with the work because older buildings on the site are Grade II-listed. A report by the Care Quality Commission (CQC) into the West London Mental Health Trust that runs Broadmoor paints a grim picture of an institution blighted by weak management, poor staffing and training, inadequate facilities and overcrowding. The hospital's chief executive left last week to take up a new post in London, and a new chairman joined the health trust in January.

Concerns about Broadmoor's failure properly to care for its patients, who are the most disturbed in the mental health system, have been raised repeatedly over the past 20 years. In 2003 the hospital was described as "totally unfit for purpose" and lacking "basic standards of dignity and privacy" by the Commission for Health Improvement, a former NHS regulator. "That remains the case today," the CQC says in its report.

Inquiries into patient deaths at all the hospitals run by West London Mental Health Trust highlighted the risks posed by ligature points. But Broadmoor executives told the CQC they could not do all the remedial work, such as removing window bars, because English Heritage had forbidden them from doing so. Margaret McGlynn, who led the commission's investigation, said: "They said they had had talks with English Heritage, and this is what they were told. What we don't know is how hard they pressed it."

The managers' response was not good enough, she said, adding: "They have got to find their way round these problems until they get what patients need, whether it's more staff, better training or other measures. We didn't get a sense of the frustration we would expect to see. There was complacency and acceptance of mediocre standards."

Barbara Young, the chairman of the Commission for Health Improvement, said: "I would expect the trust, if it had serious doubts about the ligature points, to go to English Heritage and absolutely lay down the law. We are talking about patient safety. This is an example where they ought not to have taken [the English Heritage response] lying down."

Nigel Barker, an English Heritage case officer for Berkshire, Oxfordshire and Buckinghamshire, said: "We are aware those buildings are causing great problems in delivering care and that adapting them is very difficult and we are working with the trust on plans for redevelopment. But no one has mentioned to me the problem with the bars and to the best of my knowledge they have not been discussed.

"If there had been cases where patients hanged themselves from the bars we would treat it very seriously. Just because a building is listed does not mean it cannot be changed. We would ask what is the justification and, if it were to reduce suicides, then that would be a robust justification."

Plans to refurbish Broadmoor were drawn up in 2003 but are still awaiting final approval. The provisional completion date of 2016 could slip back to 2023 because of the credit crunch and public spending squeeze.