Village life

The Rheinische Klinik, near Cologne, is a model for long term high security accommodation. Robert Montgomery visited the scheme.

A recent report on Ashworth High Security Hospital in Merseyside drew attention to largely unsuitable accommodation and environment for current forensic psychiatry. It is now considered that a large proportion of the patients in the high security hospitals at Broadmoor, Rampton and Ashworth, would be better located nearer to their home towns or cities, where local services can work towards rehabilitation for the category of patient who would benefit in a more therapeutic environment. For instance, Broadmoor Hospital in Berkshire has many patients from the London area, but it is not easy for their families to provide support.

In this context, sites are now being sought for the expansion of existing secure units and the building of new units in the London area where improved environments can be achieved, particularly, for longer stay patients. A 'village' model created at Duren near Cologne, was visited recently by NHS Estates, to consider any lessons that could be applied to the UK.

THE CONCEPT

The original psychiatric hospital at Duren opened in 1880, and is visually similar to the Victorian institutions built in the UK. The new village clinic opened in 1988 for 120 patients, with the aim of creating a therapeutic community where the objective of treatment is to reduce the risk of recidivism by means of psychotherapy.

Staffing

There are 120 trained nurses providing a nurse/patient ratio of 1:1. There are also 30 other therapeutic staff including physicians, psychiatrists, psychologists, social workers, teachers, occupational therapists and out patient workers.

Accommodation

The village contains three residential houses. Each house contains 32 patients, evenly divided on two floors. Each floor consists of two connected eight-bed units. Patients have individual en suite bedrooms and communal social spaces for cooking, eating and relaxing. The internal finishes are quarry tile floors and skirtings, painted block work walls and painted concrete ceilings. The quality of window frames and doorframes is very high and it is difficult to believe that the unit is 12 years old. The materials and maintenance are of typical German quality and the extensive glazing means that the house units have good day lighting and good views to private gardens.

The 24-place crisis intervention centre (intensive care unit) is more secure than other parts of the village. Patients are confined to their cells at night. The unit functions in two parts; an eight-bed very intensive care area and a separate 16-bed area. This unit has its own high security garden.

Patients are allowed to visit the shop and fast food snack bar, which gives the impression of a pizza-type restaurant. This building also contains facilities for patients to meet visitors and their families.

The sports hall is an impressive building with prominent roof-lights and extensive glazing. It is constructed to a very high standard, and with particularly good joinery. The multi-purpose space is used not only for sport, but also for concerts, theatre and art exhibitions to which members of the local community are frequently invited. Adjacent to the hall are workshops for art therapy woodwork, education, computer skills and music therapy.

A free standing industrial therapy workshop provides separate areas for metal work, woodwork and packing. The patients make high quality products and the workshops negotiate contracts with outside businesses. The policy is for every patient to have a workplace, which could include gardening.

Security

A formidable wall around the village provides security. This is a pre-cast concrete structure 5.5 m high but set in a ditch, or 'ha ha', which reduces the visual impact, and which is also lessened by the curving of the wall on plan and the extensive landscaping, both inside the village and outside, beyond the wall.

Within the village, the objective is to make life behind the wall resemble life in the community. Violence is reduced through intensive psychotherapy in small groups, with everyone entitled to live free from harm. The clinic was created to treat mental illness, but has subsequently found itself obliged to accept a number of essentially untreatable patients with personality disorders, which has altered the therapeutic regime for which the unit was designed. So the clinic now provides long stay accommodation for the most dangerous patients.

The perimeter wall contains sensors both at the top of the wall and also embedded in the ground at the foot of the wall, which are linked to infrared cameras mounted on the wall. These are monitored from a security office, located near to the entrance to the village where all the facilities are screened.

All members of staff carry a personal alarm with several levels of activation, and there are also alarms in all rooms in the unit. The personal alarms act as trackers so that each individual member of staff can be pin pointed within the village.

The clinic has been open since 1988 and during that time, there have only been two escapes, but none of these was over the wall. There have been no suicides in 12 years. Staff believe this reflects the very high level of social control.

LOCATION AND SITING

The site of the village occupies an area of approximately 20 acres, including the landscaped zone outside the wall. This area allows for extensive landscaping within the walled area, including sports pitches and a lake. If anything, this seems over generous, but space for expansion is available.

The two main features of the plan are the curving plan of the perimeter wall and the straight axis of the village street. Both provide significant contributions to the overall security. The village street can be viewed from the security office located by the gatehouse but also provides access to all the accommodation, including the individual house units. Each house has a front door or external stair directly onto the village street. The house unit has its own private garden at the rear. The gatehouse contains an enclosed vehicle holding area between two sets of gates.

The clinic was built in the grounds of the old psychiatric hospital, most of which has now been sold off for private housing. The clinic is actually located in a residential area, and surprisingly the outward appearance is not oppressive or out of keeping. However, not surprisingly, difficulties with obtaining planning permission have been experienced when it has been attempted to build similar units elsewhere in the Rhineland region.

Alternative design approach

A second clinic has been planned with an inward looking courtyard design concept.

The buildings themselves form the security perimeter wall. However, some clinicians feel this to be inward looking and therefore oppressive.

In the UK, the Kenneth Day Medium Secure Unit at Northgate Hospital, Morpeth, Northumberland, is based on a courtyard design, and considered to be successful in providing a good secure environment.

Costs

The Duren clinic has been built to a very high standard and therefore at an accordingly higher cost than would be normal in the UK.

The current cost of building new units in Germany is considered to be between (500 000 to 600 000 DM) per bed with no real economy of building units above 70 beds in size. The current cost of building a 120 bedded unit of similar size is therefore currently between 122m and L26.4m in Germany. Comparisons should not be made with UK costs.

Guidance

Information gained from this visit will be used in the preparation of guidance on secure accommodation to be published as Volume 4 of Health Building Note 35, which is currently being written by NHS Estates.

Robert Montgomery is all estates adviser al NHS Estates, based in the London Regional Office.

Copyright Wilmington Publishing Ltd. Oct 1999
Provided by ProQuest Information and Learning Company. All rights Reserved