The wards of the Forensic Services are among the most dangerous places to work – this is the first time cameras have been allowed inside this hidden world. This program is a moving account of people coming to terms with the trauma they have caused and hoping for another chance.
The wards are home to more than 100 patients, many of whom have committed serious acts of violence and are considered too mentally disordered to be in prison.
Patients are eventually released, but how do you decide to discharge someone who’s committed terrible acts of violence in the past? The documentary follows patients as they face the prospect of discharge after decades under lock and key.
The wards are home to more than 100 patients, many of whom have committed serious acts of violence and are considered too mentally disordered to be in prison.
Patients are eventually released, but how do you decide to discharge someone who’s committed terrible acts of violence in the past? The documentary follows patients as they face the prospect of discharge after decades under lock and key.
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TVTranscript
00:00They made it clear that I was different, unusual, strange, and that my differences were almost
00:08unacceptable. I think also that a lot of it is about choice. I made the decision to go
00:15into the pub to get the drink, to pay for it, and drink again, to drink again, and drink and
00:19drink and drink. I made that choice. I made the choice to go to the kitchen to get a knife to
00:24attack the person, because I didn't have a solution. It just didn't occur to me. I wish I had, but it didn't.
00:36Rarely seen, little known, the world of forensic psychiatry is a mystery to most of us.
00:43We deal with the most complex and risky individuals in our country.
00:49Staff at the Bethlehem Royal Hospital work in one of the most dangerous parts of the NHS,
00:58treating extreme paranoia and violence on a daily basis.
01:11If I don't change, I'm going to drink, and if I drink, I'm going to re-offend.
01:14These patients have committed some very violent crimes.
01:17I set about carving the geezer up with a razor blade.
01:20You have to learn to live with what you've done.
01:25And most are here because they've been judged too mentally ill to be in prison.
01:29There's a long history of violence when it's psychotic, and it's really been very threatening, very aggressive indeed.
01:35But how do you contain people who pose such a threat to the public?
01:40Can you make them well again?
01:45I've just got to, you know, show it. You know, Daddy's not angry Daddy anymore. He's getting better.
01:52And is it possible for some of the most dangerously unwell people in Britain ever to rejoin the outside world?
01:59They don't want to see me go out there because they know what I'm like outside.
02:03I can understand why certain elements of society just don't want to give people like me another chance.
02:18The Bethlehem Royal in South London houses 120 mentally disordered offenders.
02:24A bed here costs four times more than one in prison.
02:29So we're in effect really working with patients who are mentally sick and have been involved in serious crime.
02:39We're not talking about minor offending but major acts of violence such as homicide, serious sexual violence.
02:47And patients are complicated further by having very complex emotional and mental health issues.
02:58250 staff work on these wards.
03:00And their aim is to reduce the patient's risk to a level where one day they can be safely discharged.
03:06Oh mate, thank you.
03:14A great majority of offenders will be discharged at some point.
03:18But the time taken to achieve that discharge might be one of a few months through to even perhaps many years, even a decade.
03:28James came to the Bethlehem Royal from prison two and a half years ago.
03:38For the last month, he's been allowed to venture outside the locked doors of the wards.
03:44This is River House.
03:46This holds about eight wards, six to eight wards.
03:49All different illnesses, cuteness, all different, you know what I mean, yeah?
03:53You know, you've got to be on buddy, you know what I mean, yeah?
03:57You've got to be on a tagging system for like, I don't know, six months to eight months.
04:03You know, it's baby steps at a time, but it's all progression, you know?
04:07A couple of months, I could be up the high road with an escort, you know, looking for voluntary work in the community.
04:14You know, the word's my oyster, it's what I make of it.
04:21James is serving a life sentence for committing a violent attack while in prison.
04:27He's been diagnosed with borderline personality disorder and has been undergoing long-term psychological therapy.
04:36A lot of this is like, you know, therapy work, folders and folders and folders and this is all about my history, where I've gone wrong, you know what I'm saying, yeah?
04:45It's just working, you know, it's just working through things to help me improve my chances of making it out of there, do you know what I mean, yeah?
04:56So he's completed the main treatment programme on the unit. Although he's made quite a lot of good progress, he certainly has been involved in quite a few incidents in the ward.
05:05Being verbally abusive, made threats to kill, really quite serious incidents.
05:12I'll give you a shout when we need to lock it, yeah?
05:15And I think the difficulty that we have is trying to reconcile the fact that he's saying he wants to change and that he's keen to continue to work with the fact that he's continuing to engage in that kind of anti-social behaviour.
05:26Lovely mate, cheers.
05:28Anti-social behaviour, to me, I'm 45, so let's just say I've had, to the age of 15, I've had three decades of it.
05:36That's not something you can just discard and put away overnight. Rome weren't built in a day, you know what I mean, yeah?
05:43Anti-social at the time behaviour to me was my identity. It was about who I was, you know what I mean, yeah?
05:48To put it down and just say, right, I'm not going to be this way any more, it don't happen that way.
05:58Do you plan to get out of here?
05:59Yeah, absolutely, you know what I mean, yeah?
06:03This painting here, which I finished a couple of days ago, so there was two titles.
06:10The first one was, been double in anguish like a tree in a storm, or sometimes a river, and I opted for sometimes a river, it was easier to manage.
06:24John has been in secure institutions for 22 years.
06:29Growing up in Zimbabwe, he had corrective surgery for a rare birth defect.
06:34I mean, a lot of my friends just accepted me, but there was a minority who didn't.
06:41They made it clear that I was different, unusual, strange.
06:45And that played on my confidence and my self-esteem, really.
06:50You know?
06:52And one of the ways that I thought I'd combat the feelings that that produced later on was to drink.
06:57And that just magnified some of those feelings that I really had.
07:01John has a personality disorder, and when he drinks, he can be unpredictably violent.
07:08This is the timeline.
07:12So these are historical events, significant events in my life, that may have had a psychological, emotional impact on me in some way.
07:26This is, this forms part of the Violet Reduction Programme.
07:33So these are highs and lows.
07:36So a low, for example, would be, as a child being bullied, some sexual abuse.
07:45And, um, this is my index offence.
07:52It's the primary offence.
07:54I stabbed a man several times.
07:56I spent the night drinking with him.
07:58I was drinking out of a can in his lounge, and I, and I said, could I get a glass for the, um, for the beer?
08:05And he directed me to the kitchen, and when I went to the kitchen, I started opening up the cupboards, but I completely forgot why I was in the kitchen.
08:14And I saw a block of knives, and I came back out with a carving knife, and I, uh, and I attacked him.
08:19They can do a huge amount of therapy, understanding their offending history, their offence, their risk profile, but at some point you've got to test it out with reality.
08:34You've got to be outside the hospital to see how you manage with community life, the stresses, the challenges of being in a big city like London.
08:50Today, John is facing those challenges.
08:53After decades inside, he has permission to go into the local community without a member of staff.
08:59It's really quite exhilarating.
09:08Being unaccompanied.
09:10Being on my own.
09:13Feels quite liberating.
09:21Everyone's fascinated by the concept of extreme violence, murder, mental illness.
09:29The sort of terminology that the news of the world always used was the stock phrase, scum of the earth.
09:41It's a very powerful statement, isn't it? Scum of the earth.
09:46Uh, they're, they're very conscious of that.
09:49Our patients obviously want to return back to the community in a safe and successful way.
09:58I suspect often the public would wish they stayed here, perhaps indefinitely.
10:03Most of them would see them as sick, dangerous and nasty individuals.
10:08We have to, in many ways, persuade them that what we're doing is safe, thought through and very responsible.
10:20I might experience anxiety, you know, and I do every day.
10:30But there are varying intensities and depths to that.
10:34And most of the time, it's just, you know, it's manageable. It's just, you know, it's okay.
10:39I'm okay. If I'm okay, you're okay, we're okay. We're all right.
10:41Random things will happen. That's life. It just feels, it feels unmanageable.
10:47That's me, my mind, playing tricks on me.
10:50So I don't engage with them. I'll stick to my plan.
10:53What everyone else is doing, that's their plan.
10:56My plan is different. My plan is looking after me, mate.
10:59One of his problems is that when things don't go according to plan, or when others make mistakes, or when things are unpredictable, he gets very stressed, very anxious.
11:22And in the past, he has coped by drinking alcohol, taking illicit drugs.
11:31That would lead to risk of violence to others.
11:40When I was a child and I did something wrong, I was very aware that I've done something wrong.
11:45You have that sense of, I'm in trouble.
11:48And I've been, I've been in situations where I've had a sense of being in trouble, done something wrong or panic, but I have to phone somebody.
11:57And invariably what I do is I phoned the police.
12:01John phoned the police in 1998 after he stabbed a man he'd been drinking with.
12:07He was found guilty of attempted murder.
12:10At the time when the police officer arrested me, asked me how many times that I stabbed.
12:14And I, in my mind it was once, my mind had completely censored the whole event.
12:22And that it seemed like it was only once, but in actual fact it was several, it was 13 times.
12:28Hello, it's Helen Bristow here.
12:33Tony, is he up and about? He was supposed to be ready, I think.
12:39I've got to go through his risk assessment.
12:43Hi, Mike. Can you just do us a favour? Is Tony, is he up and about?
12:46The Bethlehem Royal Hospital treats mentally ill offenders who pose a risk of violence.
12:55Today, ward manager Helen is getting a patient ready to see his clinical team.
13:01They want to decide if he's safe to go outside the hospital on his own.
13:05Oh, good heavens. Tony, are you decent?
13:11Hi. Do you remember we spoke about it yesterday?
13:14It's, it's quarter past two in the afternoon.
13:18Just let's get up and about.
13:20As I don't think it looks awfully good, you're spending all day in bed really.
13:24So, come on, let's see some action.
13:26All right, lovely. Thanks very much, Mike, that's great.
13:29Tony's been in and out of secure institutions since he was 18.
13:35He's been diagnosed with a personality disorder and paranoid schizophrenia.
13:40Tony's got a risk of aggression and violence when he's unwell.
13:48And when he's unwell, he does tend to use illicit substances.
13:53And so when he uses these substances, he becomes even more risky.
13:56He has attacked staff on the ward.
14:00And then when he's out in the community previously,
14:02he's attacked people when he's been unwell
14:05and under the influence of substances.
14:08I reckon we should all have a fight.
14:11I'm not a lad.
14:16We've got a total of 36 convictions since 1997.
14:20That's quite a high number.
14:21Oh, yeah, yeah, yeah, yeah.
14:24What's this world going through, eh?
14:28He's still quite a risk. His parents are quite worried.
14:38Um, about him absconding, about the risk of violence and aggression,
14:45the risk of him using drugs on the outside.
14:48And it's only fairly recently that he's been using,
14:51he's been using illicit substances here on the ward.
14:56Tony's recovery is at risk from the legal highs in cannabis
15:00that, despite tight security, are smuggled onto the ward by patients on leave.
15:04Tony has a great difficulty in understanding the dangers of drugs.
15:13Um, and of how those substances change his mental state
15:19and turn him into somebody who we would consider dangerous.
15:26The beef fur with Tony, he has been trying.
15:30He's certainly making good improvements.
15:32But I think it's just a little step too far
15:34to give him on a score to leave at the minute.
15:37You could have done with a shave, but never mind.
15:40I don't know why you're languishing in bed for.
15:42I've got no toothpaste on, I think.
15:44Well, we'll get some. We shall organise it.
15:46Why on earth didn't you tell me that yesterday?
15:47Wow.
15:49He has no concept of the fear that has been engendered in his family
15:58and people around him when he becomes angry or aggressive or violent.
16:07Let's see him then and see what he says.
16:09Yeah, brilliant.
16:11So our job is to try and help him understand what he needs to be
16:16before he can get that unescorted leave.
16:19First of all, what I'd like to say is that in general, I think we're all agreed
16:24that you've been doing really well and we're all working towards you
16:29eventually being discharged from hospital.
16:30Yeah, yeah.
16:31But I think it's a little bit too soon to think of unescorted leave.
16:36The best thing that you can do is carry on with your medication, carry on with the groups
16:42and the biggest message I can give you is to stay off the legal highs or the drugs.
16:46Yeah, that's right.
16:47Yeah?
16:49Yeah.
16:51All right, anything else you want through?
16:53Yeah, I've got to pull on through, I've got to continue not to,
16:56I've got to not fight no one, I've got to get myself into no bother.
17:00Keep myself to myself, mind my own business and get along slowly but surely.
17:05Yeah?
17:07And take it in respect that the people around me are trying to help me
17:11and I'm trying my hardest to cooperate, but there is times I am turning against the staff
17:16and thinking, what shall I do, what shall I do, what shall I do?
17:20But when it goes quiet and no one explains to me, I don't know how to continue, you know?
17:25Stay off the legal price, stay off the cannabis.
17:26Yeah, that's right, yeah.
17:27All right.
17:28Well done.
17:30Bye-bye.
17:31Bye-bye.
17:34Have any of your patients ever gone on to commit serious offences again?
17:39They have, and I think that's one of the most difficult parts of the job.
17:45I mean, risk assessment is clearly not an exact science, and we don't always get it right,
17:54and on very rare occasions patients have gone on to commit other offences.
17:58So why take the risk of letting these patients out at all, Dr Campbell?
17:59I think quite strongly that they should be given that opportunity to address their very real mental health problems,
18:10rather than just pretending that it's not an issue and keeping people in prison for however long it would need before the risk was reduced, which in many cases would be never.
18:23I think that's a good point.
18:24I think it's a good point.
18:25I think it's a good point.
18:26I think it's a good point.
18:27You ready?
18:28Yeah.
18:29All right, let's go, mate.
18:31We're going to go over to the patient's cafeteria so I can just get myself some...
18:36Because of his sentence, James's first trip out of the hospital must be approved by the Ministry of Justice.
18:44So for now, he can only look at the outside world from the perimeter fence.
18:49I try and go up there a couple of times a week just to sort of...
18:52Prepare myself, really, for maybe in a couple of weeks when my community leaves granted and just familiarise myself with just the comings and goings of life outside these grounds, you know what I mean, yeah?
19:13A world carrying on, you know what I mean, yeah? A world going, getting by without me in it.
19:22I've done a lot of growing up, mate, over the last couple of years, but, you know, it's been really hard.
19:28Hard actually facing up to shit that I used to make excuses for.
19:3316 years ago, while serving time for armed robbery, James made an unprovoked attack on a fellow inmate.
19:40He was given a life sentence.
19:43Trying to fit in into a high-security status jail, feeling totally out of place.
19:48I was trying to sort of make a point that, you know, I'm not here to be bullied by anyone.
19:54I went in the cell with another inmate, you know what I mean, yeah?
19:58He punched the geezer up, you know what I mean, yeah?
20:01I set about carving the geezer up with a toothbrush and a razor, mate.
20:05I'd have died in the system, I wouldn't have been released.
20:10You know, I lost everything in the process, you know?
20:15My ex-partner, my kids, loved them dearly, you know what I mean, yeah?
20:20But, you know, I was no good to them, mate.
20:23I was out of control, mate, you know what I mean, yeah?
20:27I was a villain, I was violent.
20:29Why would you want to be involved in someone like that?
20:33And now I'm here, been here two and a half years, I'm on a journey to try and build someone I'm proud of.
20:41And I just don't want to go back to that old lifestyle, mate, you know?
20:47Not just get out there, I'll deteriorate, crash and go back to square one again.
20:52I can't do it. I can't afford to do it.
20:55You know what I'm saying, yeah?
20:56I'd rather take the solely approach and I'll get it right this time.
20:59You know what I mean, yeah?
21:11So what have we done today to get you ready to go out?
21:13Erm, I've had a shower.
21:15Yep.
21:16Erm, I washed my clothes last night.
21:18That's it.
21:19Erm, I've washed my hair.
21:21Yes.
21:22Erm, I'm good-looking.
21:24Check, check, mic, check, check, one.
21:26Alls on the mic to write the version.
21:28It's me, mana, mana, me, I'm on the mic to get you lightly.
21:31I'll tell my lady, check, check, one, two, three.
21:36Gets out of hand sometimes.
21:38What does?
21:39Erm, just my, my, my human being, you know?
21:42It's not being fucking like an idiot, like silly and that.
21:45Makes me laugh just, whoa, be careful with that.
21:49You know?
21:51For three weeks, Tony has avoided taking any of the legal highs
21:54that get smuggled onto the wards.
21:56Ready to go.
21:57Yeah.
21:59His team has allowed him two hours out in the local community.
22:03Let's do this.
22:06You got everything you need?
22:07Yeah.
22:10But he won't be going on his own.
22:12Wow.
22:15Escorted leave is the first test of a patient's ability to cope
22:18with the outside world.
22:21We're good to go.
22:22It's something Tony has struggled with since being
22:24diagnosed with schizophrenia 18 years ago.
22:28Are you feeding cold?
22:29No, it's all right.
22:31It's quite warmish, isn't it?
22:32Yeah, if you say so, if you say so.
22:38He has a long history of absconding from hospitals,
22:41often making his way back to his mother's house.
22:44Now you know why I need one-to-one supervision, you know what I mean?
22:49Yeah? Why?
22:51Because I'll wander off.
22:52I'll go on my own missions, you know?
22:55Someone's got to stay with me, you know?
22:57I don't mind it, though, because it helps me out, you know?
23:00Yeah, yeah, it's true.
23:01It makes me feel ten times better about yourself, you know,
23:05when you feel like shit and that.
23:08Yeah.
23:10In the past, there have been physical attacks against his parents.
23:15Tony's turned up at three, four, five o'clock in the morning,
23:19started throwing things at the windows,
23:21trying to gain entry into the house.
23:26There's been a lot of fear, a lot of anxiety.
23:30And I think, at the moment, it's the first time that his family
23:33have felt safe, knowing that he's in a secure hospital
23:38and that he can't cause them any more distress.
23:44I would have made it once upon a time, but...
23:50But I fell unwell, you know?
23:52Yeah, you're getting better now.
23:53Getting better, yeah.
23:56It'd be any time, two in the morning, ten o'clock at night.
24:00Early hours, Tony would be walking up and down the street,
24:05calling, calling me.
24:08And I used to...
24:10to block it out, try and block it out.
24:11I used to go into the kitchen
24:14and stand out in the kitchen,
24:16so he couldn't have no contact of seeing me.
24:19And what would he show you?
24:21Mum, help me, help me.
24:24Help me.
24:25Heartbreaking.
24:26Heartbreaking.
24:31Heartbreaking, knowing that...
24:33You've done...
24:34You've tried in your power to do what you can.
24:38It's just heartbreaking.
24:43Doing this is just going to be able to tell that I'm doing all right,
24:45you know?
24:46Yeah, you are, yeah.
24:47I'm doing well and that.
24:49Schizophrenia is a chronic condition.
24:53There are all sorts of psychological treatments
24:55that we can employ
24:57to try and help them live with those symptoms
25:00and cope with them as best they can.
25:03But we do have to be
25:06always aware that we have our limits too.
25:08And that's very difficult to come to terms with.
25:15But maybe we've achieved the best we can
25:17but somebody is still unwell.
25:22Is it all right?
25:24No, no.
25:25Oh, no.
25:27I don't eat bacon.
25:31We have to continue to try
25:33but I think it's a case of balancing always the risk
25:36to the public.
25:40And it may be that some people can never leave hospital.
25:47This is what I have to cope with.
25:49It's a drama.
25:50Why is it a drama?
25:51Oh, look at his boots.
25:52You know what I mean?
25:53That would just...
25:54They've got mud all over them, mate, from yesterday.
25:56I can't wear those.
25:58John's been living under lock and key for 22 years.
26:02I can't wear those, mate, you know?
26:03Now, he's been judged safe enough to take daily trips
26:06into the local community without an escort.
26:08I mean, we all struggle in this.
26:10And I struggle.
26:12I have, you know, everyone has difficulties, don't we?
26:14We've all got difficulties.
26:16You know what I mean?
26:18Anyway, you know.
26:20You know what I mean?
26:25Because I do have, like, this image thing,
26:28difficulty with myself.
26:30And, um...
26:32Is it problematic?
26:33It has been.
26:34You know, self-esteem, confidence.
26:37You know, the way I perceive myself,
26:39you know, like in the 90s when a guy with a camera
26:41filming me in my face, all-out image,
26:43you know, this was on my birthday, you know?
26:45And I reacted quite aggressively to that.
26:47I threatened him with a knife and went to the kitchen.
26:50Just because he was filming you?
26:52Not because he was filming me.
26:54It was the reaction that the other people had.
26:56As if, like, oh, look at you.
26:58You've definitely got a funny face.
26:59Look at your head's like all...
27:00You know what I mean?
27:02Identifying faults.
27:03That's what I felt.
27:04I felt like you were identifying faults.
27:06You were looking at, you know?
27:08I had problems with...
27:09Because I've got no knuckles.
27:10Do you know what I mean?
27:11So I can't bend them.
27:12If I've punched somebody, you know, that finger's been broken,
27:15so I've used a weapon as an extension of this
27:19or as an extension of my rage,
27:23so I might have seen a knife as like an injecting,
27:25injecting all my fear into somebody else, you know?
27:30A few days after threatening the man with the camera,
27:33John committed the stabbing that gave him a life sentence.
27:37Five years before that, he used a knife on his girlfriend
27:41in a violent, unprovoked attack.
27:46It was a similar pattern.
27:47I feel trapped and I feel...
27:48I do feel a need to kind of try and protect myself
27:52because I strongly perceived a danger, a threat.
27:56I attacked her and I had stabbed her
27:59and I phoned the police and the ambulance
28:01and I was arrested and I spent...
28:03I was sentenced to prison for six years.
28:07What did you feel about what had happened?
28:13I felt appalled.
28:14I felt appalled and disgusted in myself.
28:16The crimes our patients are involved with are very serious.
28:31They're very tragic.
28:33They're often extreme.
28:3722, 22...
28:39Because of the graveness of their crimes,
28:40they won't achieve this thing called atonement,
28:43which is almost a sense of self-forgiveness.
28:49Our job as a team is to somehow help them bear the enormity of what they've done.
28:56And that's a really compelling but also very complicated piece of work.
29:01I think it's about this process, you know.
29:02Something meaningful and real has to happen, you know.
29:03There has to be like a genuine change.
29:04There has to be some understanding about, you know, these events,
29:06however difficult they are and painful they are.
29:07It's to understand these, why these things happen.
29:08This is why I'm in a hospital and this is why I'm trying to, you know, make amends in some way.
29:17The decision about whether James can start to make short trips outside the hospital has been delayed.
29:42Frustrated, he's struggling to contain the anger that has been key to his re-offending.
29:57It's a liberty, proper liberty, bruv.
29:59You ain't been here in more two shapes, mate.
30:01You're trying to change your rules and all that.
30:03You know what I mean?
30:04It's diabolical, bruv.
30:05It's, it's about coming in alignment with what other...
30:08I mean, this whole has been running for the last four years very fine with that interference, yeah.
30:13Hang on, let me finish before we jump on because I'm left on the wayside time and time again.
30:18Do you know how this reflects to...
30:21One of the difficult things with James is the way that he was treated in his early life.
30:26I mean, a really terrible history of neglect and abuse.
30:29One of the worst that I've seen.
30:31My personality disorders, yeah.
30:33I'm not liked, I'm not...
30:35You know, and this all feeds back into, like, why don't I fit in?
30:39Why don't I be chose part of this team?
30:42He's not had the opportunities in his early life to develop an idea of how to relate to people,
30:48what relationships are for.
30:50And I think those difficulties have really been closely related to his offending behaviour.
30:55I'm surfing the urge because, like, internally, I want to scream and shout.
31:04That's, like, part of Borderline, you know?
31:06It's, like, unjust.
31:07It's like, but I'll just have to just ride, ride with it, you know what I mean, yeah?
31:12You're like a pressure cooker and this could be the slightest little thing that sets you off
31:18and you're sort of really unrushed, you know?
31:23It's like taking a dummy off a baby, you know what I mean, yeah?
31:26I could just throw a wobbler, and I don't want that setback, you know what I mean, yeah?
31:31So I've just got to reframe myself and just stay calm
31:34and just think whatever comes, whatever comes, comes, innit?
31:37I'll deal with it.
31:41You know, life's passing me by, mate, you know what I mean, yeah?
31:44I'm anxious to sort of just get some formal normality, normal life.
31:48I'm like a dog at the lead at the moment, trying to, you know, gnaw it off, mate.
31:52I want to get out there and sort myself out,
31:54even though I've got a lot of anxiety problems,
31:56but I just want to get out there and get my life back on track, mate, you know?
32:14What's up, Tony?
32:17I'm miserable.
32:20I've got the hump, I'm pissed off,
32:23and my hormones are playing up.
32:28It's against my religion, which I don't have a religion,
32:33but I'm Church of England.
32:36I was bored.
32:38I want to get a move on, you know?
32:41Make a start of things.
32:48Common misunderstanding is that it's an easier option,
32:51being forensic psychiatric care, compared to them being in prison.
32:58I would argue that, in fact, this is the tougher option.
33:02When you go to prison, you have an end to the sentence.
33:06The sections that the majority are on here are indefinite.
33:12They will go on as long as necessary.
33:16Some have been in the Secure Psychiatric Care for decades,
33:21and there is no end point.
33:23Oh, mate.
33:29I've got to come out of here, mate.
33:31As far as I'm concerned, they're...
33:33I don't even know what I'm doing here, mate.
33:37I ain't done me no favours, mate.
33:39And that's why I'm losing my temper.
33:42I want to get out of here, mate.
33:44I've got a life to live.
33:45I've got a daughter to look after.
33:47This is like being in a cemetery.
33:49This is like being in a funeral pile,
33:51sitting here laying,
33:53and they're all looking at you thinking,
33:54fucking hell, what's wrong with this div?
33:56They want me sent back to prison.
33:58They don't want to see me go out there,
34:00because they know what I'm like outside.
34:02I'm laying on this bed.
34:03I'm laying on this bed holding me head together,
34:06holding all my body together.
34:08You know what I mean?
34:10I'm suffocating...
34:11I'm suffocating in the building.
34:13How much more do they want from me, mate?
34:15I can't do...
34:16I can't do nothing more, can I?
34:23But I'm all right.
34:25I'll get through it.
34:26I've got me...
34:27I've got me daughter there,
34:28so I'll just look at the photo every day
34:29and just think to myself,
34:30babes, I'll be out one day.
34:32I'll be out.
34:33Not to worry, I'll get out of this.
34:35I just want to get my life together, mate.
34:37I wish I could walk right now, you know?
34:53I wish I could walk.
34:55He was 18 years old and it was coming up to Christmas
35:10and Tony was going to a party.
35:14He went to the party
35:16and then it was about two, three days after he'd been to the party.
35:23He was acting very strange.
35:25He kept saying all weird things that was happening.
35:32I thought, this ain't right.
35:34This ain't right.
35:35It's something.
35:36He's took something.
35:37He has definitely took something.
35:38And he said all he kept, it was help me mum, help me.
35:42And he just went down on the floor.
35:44Help me mum.
35:45Help me mum.
35:46Sorry.
35:49I said that we need to come up to the hospital.
35:55The hospital.
35:56And so I took him up to the hospital
36:00and they sectioned him there and then for six weeks.
36:04And I lost him.
36:06I'd lost him.
36:07Tony can be very scary.
36:14He is 4S's.
36:16Yeah.
36:17The 4S's tell him what to do.
36:19And he says he has to do it.
36:22See, I don't want to hurt no one.
36:24But they tell me what I've got to do.
36:31I had to cut Tony off for his own good.
36:34For his own benefit.
36:36And that is very hard as a mum.
36:39When you've got to shut a door on your son.
36:44Cut his heart.
36:46No.
36:47There's nothing you can do.
36:49You've tried.
36:50And you've tried.
36:51And you've tried.
36:52And you can't.
36:54And you can't do no more.
36:56He's took the fight from me.
36:58The fight has gone from me.
37:00You expect your children or your kids or whatever to do well.
37:06But it never happened in his case, did it?
37:10Did it?
37:25Shall we make a cup of tea?
37:27Keep it up, yeah?
37:28Get some pills.
37:30Get some pills waking up.
37:32We'll be all right.
37:33We'll be all right.
37:47James has finally got a decision.
37:49His escorted leave to the local town has been approved.
38:02He hasn't been allowed outside an institution in this way.
38:06Yeah.
38:07Since he was arrested for robbery 17 years ago.
38:15Yes.
38:19How are you feeling?
38:20That's all right.
38:21No problem.
38:24No stress.
38:25Eight weeks of non-smoking.
38:26You know what I mean, yeah?
38:27He's about to just go down the pan.
38:28Oh, gosh.
38:48Generally with leave, the concerns that you've got to take into account are the likelihood of
38:53the patient disappearing, absconding.
38:59With him in particular, that's less of a concern.
39:01The greater concern is just not really coping when he's out, wanting to return very quickly,
39:07panicking and becoming very emotionally aroused, and just losing his confidence.
39:13What a day!
39:15What a day for him!
39:16What a day!
39:30It's nice to be out with a bit of normality in that guy, yeah?
39:33Just seeing the world go by, you know what I mean, yeah?
39:36Away from the wars, you know what I mean, yeah?
39:38I love it coming up here, mate.
39:53Bundles.
39:54Yeah, it's just a different pace of life out here, isn't it, you know?
39:57At first when I come out, I was quite brick in it, you know?
39:59Felt really unusual.
40:00I'm on leave, I'm on tag, I'm on...
40:03All the different aspects to it, do you know what I mean, yeah?
40:06It's like...
40:07But you just... you gnaw it.
40:09At the end of the day, nobody don't know who I am, what I'm doing, you know?
40:13I'm just mingling in like normal people do.
40:15I am normal, you know what I mean, yeah?
40:17I've got personality disorders.
40:18It doesn't mean I'm a rave of lunzig, do you know what I mean?
40:22It's all good, mate.
40:23It's all good, mate.
40:30Hello, mate.
40:31Do you do any pork belly strips?
40:34Yeah, can I have a couple of them, please, yeah?
40:40Do you know what?
40:42I've only lost a lot.
40:44Yeah.
40:47Yeah, hang on a sec, mate.
40:49Yo!
40:50Get that bag, let me check that bag a sec.
40:54Oh, that's it.
40:57What is it you're looking for?
41:00Your wallet?
41:02Fuck!
41:04All my money, my cards, all my ID, all freshly done,
41:09and I thought I'd lost a lot and now I found it, you know what I mean, yeah?
41:12What a relief, mate.
41:14I feel like I'm going to pass out, mate.
41:16I felt really stressed to know that, I really did.
41:18Let me just get some bit of air, mate, cos I...
41:21I feel really...
41:24You know, stressed, mate.
41:25James left his wallet in the record shop he visited earlier in the day.
41:31Stress, Ed, stress, Ed!
41:34Oh, gosh!
41:36Do you know what?
41:37It was a test of all tests, cos internally I was screaming!
41:41Inside I was...
41:43I was just saying...
41:45Yeah.
41:50Oh, cheers, thanks so much, mate.
41:51Appreciate you, mate.
41:52No problem.
41:53Thank you, yeah.
41:54Cheers.
41:56Lifesaver!
41:57He's got a long way to go before I think he's ready for a more extensive community leave and even beginning to think about unescorted leave.
42:09I think that's a way off.
42:11He could be moving on in the next year to 18 months, but I think that would be best-case scenario and I think he sometimes underestimates how difficult it's going to be.
42:19Yeah, he's not high and dry.
42:25Yeah.
42:26I'm going back to the ward now.
42:28I'm depressed.
42:29I want to get back out there in my real world, get on with my life, mate.
42:32And yeah, cheers for today, mate, and thanks for your company. Cheers, mate.
42:47As the prospect of being discharged from the Bethlehem Royal becomes real, John has started to look for voluntary work.
42:53Subject.
42:54Volunteering.
42:55Yes, sir, madam.
42:56I'm currently an inpatient with Bethlehem Royal Hospital.
42:57I currently have extensive community leave and I'm currently looking, I currently, currently.
42:58I'd be grateful if you could let me know of any positions you have.
42:59Terrible. Terrible. Terrible.
43:00I'll feel sincerely sent.
43:29Judicial camp.
43:30Let me know of everyone as day well.
43:31Bye-bye.
43:32Yeah.
43:33Beautiful.
43:34Who's that?
43:35That's me as a kid.
43:36I reckon I'm 13.
43:47And with my bowl cut.
43:50But just, I think it's sad because of, you know, this kid, he's not smoking, he's not drinking,
43:58oh good to see you around how are you doing and where has life taken you see how do you
44:10answer that where do you even begin with that where do you even start
44:15hi mate i don't even know where to start i've been in the hospital recently mate i had a few
44:25sight problems that's for the last 35 years an email
44:35letter or two
44:39how do you explain 35 years
44:55doctors are about caring and i take pride in the fact that i'm working with a group of patients
45:05who are probably the most dispossessed sideline rejected in society
45:14shame and isolation for patient increases their risk if we tackle that effectively
45:21compassionately we reduce the risk significantly
45:27we've got two options as a society we either lock up offenders with personality disorder and they're
45:33just removed from society altogether or my position which is to try and get something positive out of
45:44these horrendous incidents
45:50these individuals didn't emerge from a vacuum they came from families who lived in streets and had
45:56neighbors and they very much are a product of society too and i do think we have a responsibility to think
46:05about how we support manage understand them to me the options of doing nothing just doesn't make any sense
46:13you've just got to hold in there tone i know i know all right yeah just told her in there yeah i'm all right
46:21but you're all right yeah
46:24huh when are you next gonna see when my next gonna see you tony you you know the rules it's once a month
46:30once a month yeah okay all right then and i'll speak to you soon all right love you all right love you
46:37bye bye