Responseto the Fallã³ninquiry: from the Ashworthhospital Medical Staff

REVIEW ARTICLES Responseto the FallÃ³nInquiry: from the AshworthHospital Medical Staff

P. M. Abbott and J. D. Collins on behalf of the Ashworth Hospital Medical Staff

The FallÃ³nInquiry into the Personality Disorder and leads to the development of a safe and Unit at Ashworth Hospital was established in secure therapeutic milieu. As clearly acknow February 1997 and reported two years later ledged by the College, it is impossible to (FallÃ³n,1999). The Inquiry was precipitated by eliminate completely the risk of adverse events serious allegations including those of paedophile in the management of mentally disordered activity on Lawrence Ward. These allegations offenders, a matter recognised in other areas of shocked Ashworth Hospital and the nation. medicine (Vincent, 1997). Public recognition of The Blom-Cooper Inquiry into Ashworth Hos this could pave the way for a wider debate as to pital (Blom-Cooper et al 1992) described an what constitutes an acceptable level of risk authoritarian and anti-therapeutic regime. The within a democratic and humanitarian society. hospital subsequently experienced a period of The FallÃ³nInquiry Report (1999) criticised all rapid change and liberalisation in response to the clinical professions within the hospital, and the Blom-Cooper recommendations. Seven years management systems both within and beyond on, the FallÃ³nInquiry team recognised that some the hospital. We recognise that Ashworth medi positive therapeutic and cultural changes had cal staff have been subject to serious criticism occurred within the hospital following on from within the FallÃ³nReport. We accept that many of the Blom-Cooper Inquiry. However, they also these criticisms were justified. Professional iso acknowledged the part played by the liberal lation has been repeatedly cited as a major issue. isation process in setting the scene for the Ashworth Hospital has been exhorted to address adverse events on Lawrence Ward. In retrospect, this issue in both inquiry reports. However, the the political pressure for the rapid implementa way in which the structure and training of the tion of the Blom-Cooper recommendations did national forensic psychiatric services have devel the hospital a disservice in preventing a properly oped has contributed to this problem. It is not managed process of change. Large organisations only the attitudes within Ashworth which need to with an historical emphasis on security tend to change. be ill equipped to deal with rapid change (Handy, Like the Blom-Cooper Report, the FallÃ³n 1993). Ashworth Hospital is also a clinically Report offers important observations and valu complex institution which cares for exceptionally able recommendations as well as others about challenging patients whose diverse needs many which we would have reservations. Themes other services are unable to meet. The delicate within the report pertinent particularly to Ash balancing act between the requirements of high worth itself have been addressed within the security and treatment and rehabilitation (Royal hospital's Action Plan. These include the devel College of Psychiatrists, see pages 452-454, this opment of clear systems of accountability and issue) renders it imperative that great care is the recruitment and retention of high calibre exercised in any change process. staff across all clinical disciplines. We appreciate The experience of the hospital following the the support given to Ashworth by the Secretary of Blom-Cooper Inquiry indicates the need for a State and senior figures within the National considered approach to the implementation of Health Service Executive. Some issues within change following the FallÃ³nInquiry. We agree the report have a wider relevance, such as the with the College's comments concerning the discussions concerning personality disorder importance of avoiding oscillations of emphasis which will feed into the wider debate on this between security and treatment based regimes. complex subject. Of particular note to the Proper integration of treatment and security psychiatric profession as a whole is the role of obviates the possibility of artificial polarisation the responsible medical officer (RMO)within a

Psychiatrie Bulletin (1999), 23, 461-462 461 REVIEW ARTICLES multi-disciplinary context. The responsible med based services for the spectrum of challenging ical officer has special responsibility for the patients currently cared for within special overall treatment and care of detained patients. hospitals. We look forward to the continuing However, the extent to which this should involve support of the College in these endeavours as the direct supervision of other professional offered within the response to the Inquiry Report. disciplines in their day to day work (for example, nursing staff in ward searches) needs clarifica tion. We would welcome the input of the College References in this matter. BLOM-COOPER.L..BROWN,M., DOLAN.R.. et al (1992) Report There are important questions to be asked in of the Committee of inquiry into Complaints About relation to appropriate training for consultant Ashworth Special Hospital. Cm 2028-I-H. London: psychiatrists working in special hospitals. High HMSO. levels of forensic expertise are essential within FALLÃ“N.P.,BLUGLASS.R..EDWARDS.B.. etol(1999) Reporto/ the Committee into the Personality Disorder Unit, high security services. However, it is our view Ashworth Special Hospital. Cm 4194-I-H. London: The that the complexity of the special hospital patient Stationery Office. population demands a range of specialist clinical HANDY,C.D. (1993) Understanding Organisations (4th edn). skills in addition to forensic skills. London: Penguin Books. It is our view that the development of compre VINCENT,C. (1997) Risk, safety and the dark side of quality. hensive services for patients who need longer British MedicalJownal. 34, 1775-1776. term secure care requires change across the whole spectrum of current services - not just the *P. M. Abbott, Consultant Psychiatrist special hospital sector. The clinical staff within (Rehabilitation); and J. D. Collins, ConsuÃ-Ã-ont special hospitals have the expertise and experi Forensic Psychiatrist, on behalf of the Ashworth ence to play a key role in these service develop Hospital Medical Staff, Ashworth Hospital ments. We hope that the wider profession takes a Authority, Parkboum, Maghull, Liverpool L31 1HW fresh look at the essential but very challenging work of the high security services and plays a part in the development of reconfigured needs * Correspondence

CAN: Camberwell Assessment of Need Mike Slade, Graham Thornicroft, Linda Loftus, Michael Phelan & Til Wykes

The Camberwell Assessment of Need (CAN) is a tried and tested approach to assessing the needs of the severely mentally ill which is suitable both for research studies and routine clinical use. Rigorously developed by staff at the Section of Community Psychiatry (PRiSM), Institute of Psychiatry, the CAN is suitable for use in primary care settings, specialist mental health teams, and social services. It will be of particular interest to care managers and mental health staff who wish to meet the legal requirement that the severely mentally ill receive a comprehensive needs assessment.

July 1999, Â£45.00,144pp,Ringbound pack incl. photocopiable material, ISBN 1 901242 25 0

Available from Book Sales, Royal College of Psychiatrists, 17 Be/grave Square, London SW1X 8PG Tel +44 (0) 171 235 2351 (extension 146), Fax +44 (0) 171 245 1231 http:l/www. rcpsych.ac. uk

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