Psychiatric wards are "like pool halls...riddled with illicit drug use, bullying, and sometimes sexual intimidation". Nick Bowles, Bradford University School of Health Studies (Brindle, 2001).

"A 74-year-old was forced to have sex...in the mental health unit at Yardley Green Hospital, Birmingham...A male nurse...was charged with rape and sexual assault...but cleared of both charges. Prosecution and defence admitted the woman had been raped -but there was not enough evidence for a conviction. She died shortly afterwards." (Craven, N, and Merrick, J, 2006).

"The National Patient Safety Agency said there were at least 19 rapes of mental health patients in England, and more than 100 other improper sexual incidents in psychiatric units over the last two years...Eleven of the rapes were alleged to been by NHS staff, but the agency did not disclose whether staff were also involved in 20 cases of consensual sex, three unwanted pregnancies, and allegations of exposure, sexual advances and touching". (Carvel, J, Hall, S and Boseley, S, 2006).

"Patients were slapped, hit, stamped on, starved, kicked and taunted, a hospital trust admits" (Camber 2004).

"Essentially, if you are a mental patient, staff have a licence to assault you, and you have no protection whatsoever" (Justin Horton 2001).

"Low in the pecking order, it is tempting for nurses to vent frustrations on those even lower" (Nursing Times 1997).

"Institutions give inadequate people what they want - power ...many...people are inadequate and unfulfilled and they lust for power and control" (John Vaizey 1959).

"Both male and female bullies are drawn to the caring professions because of the opportunities for power and control over vulnerable clients" Tim Field (Feinmann, 2001).

"Patients detained in psychiatric hospitals are being denied basic human rights...according to the independent watchdog for mental health services" (Guardian 2001).

"Mind-melting drugs are still routinely administered to meet the needs of staff..." Christopher Barber, RCN Ethics Forum (Carvel, 2002).

"...drugs have become used more widely for sedating 'troublesome' residents..." (Matthew Akid 2002).

"...half of the cases of restraints in mental health are carried out in order to enforce medication..." (Mulholland, 2004).

"...up to 22,233 elderly nursing home residents are being given powerful anti-psychotics without medical grounds." (BBC 2003).

"...research found...an estimated 200 psychiatric patients died suddenly and unexpectedly each year in England...causes include... inappropriate restraint methods and high doses of medication" (Community Care 2000).

"There are so many rapes in children's and residential homes and psychiatric institutions because rapists know they can get away with it there" Harriet Wistrich -Solicitor (Taylor, 2001).

DESPITE THE REALITY...

Despite the reality that killings by the mentally ill are infrequent and may be decreasing (Muijen, 1999; Taylor and Gunn, 1999 et al.) the press has often commented as follows: "...every few weeks...some wretched ex-patient...runs amok with knife or gun, killing and wounding at random...The arguments against the old hospitals - that they were cruel and used brutal methods - simply do not apply any longer" (Daily Express, 1996).

Claims that psychiatric institutions are now benign and enlightened frequently follow criticisms of community care. Unfortunately, human nature has not changed and psychiatric hospitals - like other custodial institutions - can still be unpleasant or dangerous. (Boseley, 1998; Brindle, 2001; Camber, 2004; Community Care, 1995; Community Care, 2000; Gould, 1985; Guardian, 2001; Inquest, 2002; Johnstone, 2001; Mihill, 1994; Muijen 2000; Womack, 2004).

As Guardian correspondent David Brindle rightly reported: "Many people with mental health problems dread being admitted to hospital" while Nick Bowles, of Bradford University School of Health Studies, commented that psychiatric wards are "like pool halls, riddled with illicit drug use, bullying, and sometimes sexual intimidation" (Brindle, 2001).

Although the more gross barbarities are no longer routinely practised, psychiatric patients remain particularly vulnerable to abuse - and there is no reliable way of screening out abusers (Sines, 1994; Stark, 1997).

Worse, abusers know that complainants stigmatised with psychiatric diagnoses (or associated handicaps) are unlikely to be taken seriously (Hill, 2001; Wainwright, 2000b). As one commentator observed: "Just like children in care they are easy targets because nobody will listen to them" (Boseley, 1998).

NOT BELIEVED

Unfortunately - due perhaps to media demonisation of psychiatric patients as dangerous - society seems reluctant to take them seriously as victims. While we now know about the vast amount of abuse in children's homes (Bennetto 2001, D'Arcy and Gosling, 1998) and are just beginning to realise the - probably - huge scale of cruelty perpetrated against the elderly (Akid, 2002; BBC, 2003; Camber, 2004; Carrell, 2000; Nursing Times, 1996; Hill, 2001; Meikle, 2001); the violent, sexual, or emotional abuse of psychiatric patients remains largely under-reported.

This may be because many psychiatric institutions have become so well-practised at scandal suppression (Beardshaw, 1981; Martin, 1984) or possibly because such patients' allegations tend to be discounted (Boseley, 1998; Rogers, 2003; Taylor, 2001). Convicted psychiatrist Michael Haslam cunningly prepared possible defences against patients' allegations, writing "copious notes about the 'manipulative' personalities of his patients" (Rogers 2003).

Journalist Sara Boseley reported on the case a young woman patient who was raped by a male psychiatric nurse. As in other cases of psychiatric patients being subjected to emotional, violent or sexual abuse by carers, it looked as if this incident would swept under the carpet. Fortunately, on this occasion, the patient was believed - but only because she could produce her semen-stained clothing (Boseley, 1998).

Liz Sayce, the then policy director of Mind, said that this case should not be considered exceptional: "We've heard a lot of cases of women, and to a lesser extent, men, who have been sexually assaulted or in some cases raped in psychiatric units, sometimes by staff, sometimes by visitors...and sometimes by other patients...In some cases it doesn't get to court. It may not even get to the Police" (Boseley, 1998).

Too often, offences against psychiatric patients - or people with learning difficulties - are not investigated or even - officially - reported. Jean Collins, writing in Community Care, rightly asked: "Why is there such reluctance to report alleged crimes against people with learning difficulties to the police?" (Collins, 1997). Although learning difficulty is not a mental illness, Jean's comments apply equally well to abuses in some psychiatric institutions: "Instead of concern focusing on the distress and suffering caused to the victim, it focuses on the need to preserve the system's good name...People deny that the incident constitutes a crime at all, seek to neutralise it through a series of internal enquiries, and absolve it form real meaning by understating and de-emphasizing its effects on the victim" (Collins, 1997).

Refering to convicted consultant psychiatrist Michael Haslam the Sunday Times noted: "Every complainant encountered a reluctance among senior NHS executives to take their concerns seriously" (Rogers, 2003).

Harriet Wistrich, a solicitor who advises women about complaints relating to rape investigations, remarked that: "There are so many rapes in children's and residential homes and psychiatric institutions because rapists know they can get away with it there" (Taylor, 2001).

PERFECT VICTIMS

The lack of credibility accorded to anyone having a psychiatric diagnosis makes them particularly vulnerable; as Ginny Jenkin, director of Action on Elder Abuse, commented: "...someone suffering some mental and physical frailty is the perfect victim... if they're able to communicate they're probably not believed. What more could any abuser want?" (Hill, 2001).

We have considerable anecdotal evidence of abusers gloatingly informing victims that they will not be believed. This seems to be common among abusive personnel in the psychiatric sector. For instance, before placing a former consultant psychiatrist on the sex-offenders register, a court heard that he'd explicitly told his victims that no-one would believe them. Apparently, for years, this prediction proved correct: "their complaints were disregarded by their GPs as hysterical over-reactions by unstable women..." (Wainwright, 2000b).

Earlier, Paul Worsley Q.C., prosecuting, told the court that this psychiatrist "...frightened his patients into silence...by telling them that they were mental patients whose word would never be believed against his" adding: "They were vulnerable...they trusted him...and in his room they did as he demanded. Afterwards they felt unclean, ashamed, humiliated..." (Wainwright, 2000a).

Sentencing another consultant psychiatrist to prison, Judge Leonard Gerber told him: "The victim was suffering from depression, anxiety and grief. You knew her vulnerability, her weakness and, regrettably, you exploited it for your own bizarre sexual pleasure" (Essex Chronicle, 2002).

Convicted psychiatrist Michael Haslam was sentenced in December 2003 for offences against patients (Wainwright, 2003). One of his victims told the court "It is hard for people to understand how vulnerable you are once you have been labelled a mental patient" (Rogers 2003).

A victim of a senior psychologist convicted of several serious sexual assaults on women said: "You have to trust these people to help you get better...I was only a patient and was a psychologist -the head of the psychology department at a hospital. What could I say?" (Wainright, 2004).

NOT ALWAYS ANGELS...

While we know that many health care staff are wonderful people, there is now such a wealth of data showing how nasty they can be towards their union-protected colleagues - though bullying, racism, and discrimination against those with disabilities (Akid, 2001; Akid 2001b; Baxter, 2002; Bater, 2001; Carver, 2004b; Coker, 2001; Caan, 2000; Johnson, 2001; Nursing Times, 2001a; Nursing Times, 2001d; Persaud, 2001; Quine, 1999; et al.) - no one should be surprised that patients are ill-treated.

The Nursing Times has commented: "Low in the pecking order, it is tempting for nurses to vent frustrations on those even lower. How many nurses can say truthfully, that they have never wanted to harm a patient?" (Nursing Times, 1997, p.3).

ROUGH HANDLING BY POWER-CRAZED STAFF

As Rachel Perkins and Julie Repper pointed out: "...it is often argued that [psychiatric] hospitals offer a place of safety, yet many people who have been admitted to hospital have been threatened, attacked and/or robbed whilst there, and sexual harassment and assault are all too common" (Perkins and Repper, 1996).

Vanessa Lloyd-Jones' experience accords with what we have heard from huge numbers of people: "My...admittance to hospital was devastating...some staff showed great kindness and patience. However, they were in the minority and I suffered and witnessed some truly dreadful treatment from so-called professional health-care staff...." She saw patients being "...roughly handled "sometimes by "power-crazed staff laying down the 'law'" (Lloyd-Jones, 2001). Former occupational therapist Kay Sheldon was also shocked by her experiences as a psychiatric patient; she found that: [nursing staff] "... did not respect me...they did not value my point of view" (Sheldon, 1997).

To be fair to mental health workers, it seems that the temptation to hurt or humiliate patients also proves irresistible to other types of carers (Akid, 2002; Carell, 2000; Carter, 1999; Hill, 2001; Macaskill, 2000; McDonald, 2000; Mihill, 1997). Surveys suggest that as many as 800 people with learning difficulties are sexually abused annually; in perhaps as many as a third of cases, their abusers are professional 'carers' (Brindle, 1998).

Although people with learning disabilities are not mentally ill, they often experience similar abuses from both medical professionals and the public; encountering the same attitudes of disrespect and disdain so familiar to psychiatric patients. MENCAP researchers found widespread abuse and that "around 90 per cent of people with a learning disorder were bullied in the past year" (Duckworth, 2001).

Angela Beardshaw commented that it is remarkable how the same - or similar - abuses occur in different types of custodial institutions: "Malpractice within mental illness and mental handicap hospitals is strikingly similar" (Beardshaw 1981, p1).

While we now know about the horrendous cruelties in children's homes, the full extent of the emotional, violent and sexual abuse of psychiatric patients and the elderly is another scandal awaiting exposure. Ginny Jenkin, former Director of Action on Elder Abuse, said: "Anyone who bothers to look into it cannot fail to realise that the sexual abuse of elderly people in care homes is horribly prevalent" (Hill, 2001).

Action on Elder Abuse believes elder abuse affects around 1 in 10 of older people, and that almost one in three abusers are professional personnel paid to look after them (Nursing Times, 1996). Another survey - of 1,400 carers of Alzheimer's disease sufferers - found that 1 in 10 (carers) said that their relatives had been mistreated in residential or nursing homes (Mihill, 1997).

Social services directors Mike Boyle and Mike Leadbetter estimated that up to a third of cases of abuse of vulnerable people - including female psychiatric patients - are perpetrated by paid carers (Brindle, 1998). As Ginny Jenkins remarked: "Elderly patients are regularly assaulted, abused and neglected, but only the worst cases ever come to public light" (Carrell, 2000).

In 2002 Nursing Times revealed:: "Care home staff admitted during a series of seminars that older patients are locked up, drugged, imprisioned at night by bed rails..." and "drugs have become used more widely for sedating 'troublesome' residents..." (Akid, 2002).

Oddly, it seems that health care professionals who mistreat mentally 'abnormal' clients rarely receive penalties commensurate with their offences; often they are not even dismissed. For example, Community Care (2001b) reported the case of two carers at a council-run residential home who "assaulted a women with severe learning difficulties". Astonishingly, the assailants "remain...in employment". The victim, who was "blind, has partial hearing, virtually no speech and severe learning difficulties...sustained many injuries" (including a fractured skull).

Many Mancunians were outraged at the decision not to prosecute staff at a Manchester hospital who tortured and humiliated patients. The hospital actually admitted that staff engaged in "...slapping, hitting with a hairbrush, stamping on feet, flicking ears, squeezing lips and kicking, taunting and winding-up patients, or mocking [and] deliberate withholding of food as punishment" (Camber, 2004).

Typically, "None of the medical staff involved" in the death of David 'Rocky' Bennett "have been disciplined. Some have been relocated, or retrained, and a number have been on extended sick leave" (Womack, 2004).

HUMAN, ALL TOO HUMAN

While exploring this curiously neglected problem of the abuse of power in psychiatric institutions (and the corresponding importance of community care) we do not wish to demonise any particular professional group: our sole objective is to show that institutional personnel are only human and therefore capable of exhibiting the full range of human behaviour; i.e. they can be as narrow, nasty, petty, scheming, unscrupulous, cruel and sadistic as any other type of people. This is why vulnerable individuals are usually safer in the community.

THE BANALITY OF EVIL

The vast scale of institutional abuse revealed during the past few decades - and the huge numbers of people involved - suggests that abusers do not need to be 'monsters' (although that might help): all that is required for abuse to take place is the typical institutional setting e.g. one where average-to-mediocre individuals have power over others.

Hannah Ardent - referring to Holocaust perpetrator Adolph Eichmann - remarked that: "the trouble with Eichmann was precisely that so many were like him, and that the many were neither perverted, nor sadistic, that they were...terribly and terrifyingly normal" (Ardent, 1964).

Consultant psychiatrist Dr Donald Dick, quoted in Angela Beardshaw's - muted - Social Audit report 'Conscientious Objectors at Work', thought that abuse may stem simply from staff's opportunities to be abusive. He commented: "When staff begin to enact the relationship of staff to patient this is quite a test of their own character - once you're given total power over somebody else you behave towards them in a different way to the one you adopt if they're your customer and you are providing a service...It's true of any institution in which the roles are clearly those of bossing and bossed" (Beardshaw, 1981; p.16).

Professor Ervin Staub speculated that: "The freedom to completely control others' lives and bodies might give some people a dizzying sense of power or perhaps the experience of both abandonment and strength as in an intense sexual experience" (Staub, 1992; p139); However, it seems that many institutional abusers are often simply banal or average individuals who take advantage of their considerable powers over vulnerable people.

Some violent staff may merely be obtuse or limited individuals, implementing their peculiar concept of order and discipline. As J.P. Martin discovered: "Many ward staff came from family backgrounds where the normal reaction to unruliness or disobedience was a 'clip round the ear' (Martin, 1984; p102). Others may also use retalitory violence; clinical psychologist Dr Lucy Johnstone observed that: [psychiatric] "patients [may be] persecuted if they show anger or resentment" (Johnstone, 1989: p120).

Maybe abuse arises from the predominantly custodial role of staff involved in institutional psychiatry. The historian, Tacitus, commented that people despise those they oppress. Perhaps this phenomenon was best expressed by Noam Chomsky: "If you are sitting with your boot on somebody's neck, you are going to hate him because that's the only way you can justify what you're doing" (Chomsky, 1992).

Whatever their make-up or motives, the widespread, well-documented, incidence of bullying, (Akid 2001; Johnson, 2001; Mitchell, 1996; Persaud, 2001); racism, (Akid, 20001b; Baxter, 2002; Bater, 2001; Carvel, 2004b; Coker, 2001; Fernando, 1995; Mullings, 1998); and discrimination against colleagues with disabilities (Caan, 2001) reveals that despite their angelic image, health service personnel are only human: all too human...

BULLYING

It seems that bullying is so rife in the NHS generally (but particularly, perhaps, in the psychiatric sector) it may be contributing to the current nursing shortage. (Akid 2001; Johnson, 2001; Persaud, 2001). A Royal College of Nursing survey found that "One in six nurses has been bullied by a member of staff in their workplace over the past 12 months" (Akid, 2001a); while according to the MSF union: "Bullying and harassment are at epidemic levels in NHS" (NHS News, Sept. 1999. Issue 4).

"Research and publicity often focus on the anger encountered from patients. But what about anger from other colleagues?" asked Jackie Cosh in Nursing Anger. "Fighting between staff who are unable to vent their anger at those in power occurs increasingly in health care settings. Backstabbing, bickering and gossiping are symptoms of this". (Cosh, 2006).

Anti-bullying expert Tim Field (2001) found that of the 1 in 6 bullied nurses: "a third of those are planning to leave the profession". He also found that "nurses with a disability fared worse (41%) followed by ethnic minorities (33%) [and that] more than one third said no action had been taken in their case".

RACISM

As if the appallingly high incidence of bullying was not enough, it seems that some NHS staff also have to endure racial discrimination from their colleagues (Akid, 2002; Akid, 2001b; Baxter, 2002; Baxter, 2001; Carvel, 2004b; Coker, 2001). For example, Professor of Nursing Carol Baxter, revealed that: "One morning, some years ago, I entered my office to find that several parcels of excrement had been placed among my files" (Baxter, 2002; p.24).

The RCN found: "The figures on appropriate pay and grading are bleaker for nurses from ethinic minorities" (Carvel, 2004).

In his article 'Staff Fight to Cure Racism in the NHS', Andrew Mullings reported on the case of psychiatric nurse Kai Sumana, 54, who said that the entire course of his career has been shaped by his battles against racism. He experienced: "Discrimination...in terms of promotion (and) in terms of allocation of responsibility" adding: "We had to go all the way to ACAS to get the grade I really deserve" (Mullings 1998).

Although more than 9% of nurses are from black or ethnic minority groups, just over 1% of these are directors of nursing (Baxter, 2002); also, well over a third of nurse-victims of bullying in the RCN study were members of ethnic minorities.

"For years, ministers have been aware of the discrimination suffered by patients and staff from black and minority ethnic communities" (Carvel, 2004b). A leaked draft report into the hospital death of David 'Rocky' Bennet also reportedly criticised the treatment of black and ethnic miniority psychiatric patients (Frean and Fresco, 2004).

DISABILITY DISCRIMINATION

One may have assumed that health service personnel would have more sophisticated attitudes than the general public towards people with mental health difficulties, but this does not always accord with experience.

Woody Caan, in his British Medical Journal article 'Nurses are also Punished for having Mental Health Problems' referred to a study carried out with the help of the Nursing Standard (Caan, 2001). It found that: "Sixty nurses...reported...that they had to endure not only unsympathetic treatment from colleagues but also hostile responses from their managers if they disclosed mental health problems". (See the Nusing Standard 2000; 15 (2); pp22-23).

More than 40 per cent of nurses (in the RCN survey) - who were victims of bullying by their colleagues - had disabilities.

STRUCK OFF

Another indication that staff are not always angels comes from a professional body, the UK Central Council for Nursing, Midwifery and Health Visiting. In its report of March 2001, the UKCC revealed that record numbers of nurses had been struck off the register for professional misconduct in the previous year (Carvel, 2001; Laurance, 2001; Metro, 2001).

As human nature has not recently undergone any noticeable changes, it seems that increased misconduct is not the explanation. The council believes the increase to be due more to "the public's greater willingness to complain rather than by any deterioration of professional standards." A spokesperson said: "We can see no reason why there should be more misconduct now than there was 10 or 15 years' ago" (Carvel, 2001).

WHISTLEBLOWERS

Of course, many health service personnel are decent, ethical people, appalled by abuses: unfortunately those brave enough to speak out are liable to experience severe ostracism - or worse. (Nursing Times, 2001a; Nursing Times, 2001d; Steele, 2001). As Prof. Staub remarks: "Even in a society that fosters individual moral responsibility, there is no guarantee that individual's will oppose the group. Resisting is extremely difficult: it requires courage and strong motivation arising from moral values or empathic caring" (Staub 992; p.149).

Professor John Martin's study 'Hospitals in Trouble' (referring to whistleblowers) found that their..."public spiritedness tended to be rewarded with threats, dismissal or ostracism. It has not been an edifying part of the story." (Martin, 1984; p.86).

Jonathan Coe, Chief Executive of Witness: Against abuse by health and care workers, has commented: "Time and again, enquiries have revealed the same systematic lack of respect for basic dignities alongside cultures which appear immune to monitoring...Rather than seeing the reporting of concern as "whistleblowing", not reporting should itself lead to disciplinary action." (Coe, 2006).

PLUS ÇA CHANGE...

NHS whistleblowers have always been persecuted (although particularly, perhaps, in the psychiatric sector). As Alice Mahon, MP, rightly remarked: "...there is savage treatment meted out to whistleblowers" (White, 1997, p23). This should surprise no-one familiar with the canteen culture which still prevails in some psychiatric institutions: at the Royal College of Nursing's 2001 annual congress in Harrogate, one mental health nurse revealed that whistleblowing is widely regarded as a "grassing up" of colleagues. He added: "You can kiss your career goodbye" (BBC, 2001).

As Community Care commented: "Sacking staff for blowing the whistle may have been outlawed, but the outdated attitudes among employers which allowed this thing to happen have not been eradicated. In some localities the culture of victimisation is alive and well" (Community Care, 2001a).

Clinical psychologist Dr David Pilgrim once observed that: "Anonymous threats of death and sexual violence are to be expected in hospitals that contain rapists and murderers. What may come as a surprise is the issuing of such threats not by patients but by nurses to clinical psychologists" (Pilgrim, 1997).

Referring to her own experience of whistleblowing, mental-health nurse Mandy Leaman, told the Royal College of Nursing 2001 Conference that: "I wouldn't do it again...I survived, but others haven't". Another delegate to the conference, Stephen Moore, said he had heard "reports of appalling persecution of nurse whistleblowers, including some who had had to remove their children from school and drive unmarked cars" (Nursing Times, 2001a).

In response to a letter asking "How do I speak up about bad practise?" The Nursing Times Helpdesk (Nursing Times, 2001b) replied: "The UKCC knows how difficult this can be. Practitioners are often at best ignored, at worst victimised, for having the courage to speak out".

"Staff who want to report the abuse of vulnerable clients...fear repercussions and victimisation if they do so" according to Rebecca Calcraft of the Ann Craft Trust (Sale, 2004).

Notwithstanding the dangers, some mental health workers have been courageous enough to express their dissatisfaction at being associated with a system in which vulnerable people are ill-treated: referring to a relative's experiences as a psychiatric in-patient, one mental health nursing student, writing in the Nursing Times, provides an insight into the sometimes vast difference between what students may hear in lectures and the harrowing reality of the wards.

He wrote: "We are lectured on the importance of treating our clients with respect, but in practice...a dark subculture exists". His relative was "...regularly restrained and forcibly drugged. On several occasions she was mobbed by six or more people and lifted kicking and screaming...before being drugged into unconsciousness". In common with many survivors of custodial 'care' she still has nightmares about how she was treated (Colmach, 2001).

EVEN THE BEST...

Hospital, care home, and other institutional abusers probably don't need to be particularly sadistic or perverse: institutions seem to bring out the worst in the best of people. This may stem from some primitive instincts, rooted in the human psyche (Staub, 1992) or possibly derives from a 'canteen culture' which de-values client-groups as sub-human (Beardshaw, 1981; Martin, 1984). Whatever the reasons, it seems that custodial care and cruelty are probably both inseparable and inevitable: this is just one good reason why a well-resourced programme of care in the community is so important for vulnerable groups such as (non-offending) sufferers from mental illness.

The tendency of institutional staff to become abusive was dramatically demonstrated in a classic study carried out in the 1970s by Stanford University psychologist Philip Zimbardo. The correct interpretation of the Zimbardo study has been widely debated; nevertheless, what it apparently revealed about human nature made it one the most notorious psychological experiments of the Twentieth Century.

Prof. Zimbardo constructed a simulated prison in the basement of the Psychology Department at Stanford University and randomly allocated a number of male volunteers to the roles of prisoner or guard. Although the study was originally intended to run for a fortnight, it had to be halted after just six days as many of the 'guards' - apparently intoxicated with power - became increasingly domineering and sadistic. For instance, although instructed never to use physical force, they quickly developed a culture which legitimated (staff-initiated) violence.

Zimbardo's conclusion included the observation that his study showed "the power of social, institutional forces to make good men engage in evil deeds" (Zimbardo, 1973).

Evidently human nature does not change: subsequent scandals in British psychiatric, mental handicap and other custodial institutions suggests that Zimbardo's study - and his conclusions - remains relevant and valid.

It is interesting to note that although Prof. Zimbardo's volunteers were selected from respondents to a newspaper advertisement, only those evaluated (by this distinguished psychologist and his colleagues) to be the most emotionally mature and stable were actually chosen to take part in the study. In fact they were overwhelming middle-class university students -and probably significantly more intelligent, sophisticated and emotionally-mature than personnel usually employed in present day British custodial institutions.

NO PROTECTION

The probably vast - if under-reported - prevalence of institutional abuse may have something to do with British psychiatric patients' almost total lack of power or meaningful (as opposed to nominal) protection. Particularly in British psychiatric hospitals, the whole system seems to rely on the staff's good nature not to engage in ill-treatment. As Justin Horton so rightly remarks: "Essentially, if you are a mental patient, staff have a licence to assault you, and you have no protection whatsoever" (Horton, 2001).

We should be cautious, however, about seeking legislative safeguards: the evidence and experience of the last 15 years or so (Akid, 2002; Bennetto, 2001; Beardshaw, 1981; Camber, 2004; Carrell 2000; Carter, 1999; Community Care, 2001b; Community Care, 1999; Daily Express, 2000; D'Arcy, and Gosling, 1998; Gorman, 1992; Gould, 1985; Gosling, 1998; Hill, 2001; Hunt, 1998; Macaskill, 2000: Martin, 1984; Sines, 1994; Smith, 1992; Taylor, 2001; Wainwright, 2000b; Womack, 2004) shows that custodial institutions tend to be dangerous and unpleasant places, whatever legislative protection is provided.

Most of the patients/victims involved in above scandals had the theoretical (if useless) protection of: The European Convention on Human Rights; The United Nations Declaration of Human Rights; The UKCC Code of Ethics; The International Code of Nursing Ethics; the hospital - or institution's - own code of conduct; the law of the land - and possibly a dozen or more impressive-sounding - but equally useless - charters, codes, laws, rules and regulations which have little or no effect wherever vulnerable people are in the power of personnel who do not regard them as fully human.

Whenever another scandal emerges - along with the routine reassurances that "lessons have been learned"; "staff will receive better training" etc - there usually follows promises of "better regulation"; however, after decades of abuses, cover-ups and scandals, it seems clear that the only real protection for vulnerable people is a properly-funded program of care in the community. Vulnerable people can never be safe in custodial institutions.

HOSPITAL BLUNDERS

Apart from the degradations and dangers which can accompany psychiatric hospitalisation e.g. "200 psychiatric patients die suddenly and unexpectedly each year" (Community Care, 2000); [psychiatric patients are] "subjected to rising levels of violence on the wards" (Community Care, 1995) it may be that hospitals in general are best avoided: Sir Brian Jarman, Professor of General Practice at Imperial College School of Medicine, estimated that "at least 30,000 people might be dying in hospital every year as a result of medical accidents that could have been prevented". This staggering figure, is "higher than the total number of deaths from all other accidents, including those on the road and in the home" (Laurance, 2000).

Sir Brian's estimate may have been an under-estimation (Vincent, 2001): later research by Professor Charles Vincent of the University of London indicates that: "One in ten hospital patients becomes a victim of a medical blunder or other 'adverse event' [and that] ...850,000 people a year in England and Wales suffer some form of avoidable mistake or complication while in hospital -and 68,000 will die partly as a result of an error by a doctor or nurse" (Yeo, 2001). While this huge number of fatalities may not be so astonishing given the overall numbers of patients treated, it clearly suggests that the doctor (or nurse) does not always know best.

(This fallibility was further underlined by a 2004 British hospital study of diagnostic reliability which compared post-mortem results with patients' records: of the 49 post-mortems checked "only 17 turned out to be completely correct" Day, 2004).

PROVOCATIVE BEHAVIOUR

'Care' staff sometimes provoke violence. This has been recorded by independent investigators; for instance, Clare Evans, a consultant for the National Institute of Social Work "surveyed service users for a...report on violence and abuse (against social workers) commissioned by the Department of Health." She reported that: "users described to her how they were made fun of; how staff deliberately wound them up...in one instance...care workers publicly commented on the size of a disabled person's penis as a source of amusement" (Community Care, 1999a). To cite just one, recent, example: a male psychiatric nurse snatched a five-pound note from a female patient and stuffed it down his underpants, inviting her to retrieve it.

The authorities admit that on a Manchester psychiatric unit "staff...punished patients by withholding...foods, and taunted and mocked them" (Batty, 2004).

In an NHS psychiatric unit, Justin Horton observed patients being goaded to the point where staff could 'restrain' them. He writes: "...often, staff would pester a patient, who just wanted to be left alone, until the patient did lash out and 'had' to be restrained" (Horton, 2001). As Dr Lucy Johnstone commented: "Much [of psychiatric patients'] aggressive behaviour stems not from illness - but from the mental hospital regime" (Johnstone, 1989; p.120).

Paul Gosling has also reported on how abusers tormented and provoked children's home inmates: "Children were persistently provoked - by name calling, undermining, tickling and assault - until they threw temper tantrums. This, in turn, gave care workers the excuse to physically restrain children and, in some cases, to sexually abuse them" (Gosling, 1998).

Writing in the British Medical Journal, Dr Charles Essex, has called for NHS staff to be trained in techniques for preventing aggression. He wrote: "All readers have experienced behaviour by employees in public services (including the NHS)...that is rude, facetious, insulting, bullying, or provocative. If we are honest we have probably all been guilty of that at some time. It is easy to imagine that people with poor self-restraint or a low threshold for violence would quickly become aggressive when treated like that...NHS staff need to recognise, preferably before they become victims, that their words or manner can prevent or induce aggression or confrontation". (Essex, 2001).

BE ASSURED THAT BETTER TRAINING...

While applauding Dr Essex's insights and aspirations, experience shows that there are limits to how far training can compensate for fundamental character flaws; these tend to be resistant to training.

In an Autumn 2001, BBC news report about the grotesque institutional abuse of a 104 year-old woman by her 'carers', the following discussion focused mainly on the staff's alleged 'lack of training'. Speaker after speaker commented on the need for better training, and their major priority seemed to be providing more training for staff. Apparently no-one considered that if staff do not instinctively shrink from torturing an old lady, they are unlikely to benefit from additional training.

Unfortunately, kindness and compassion cannot be acquired in the classroom or the lecture theatre. All reason and experience is that custodial institutions tend to be places of abuse (Akid, 2002; Beardshaw, 1981; Camber, 2004; Carell, 2000; Comach, 2001; Community care, 1995; Gorman, 1992; Gould, 1985; Gossling, 1998; Hill, 2001; Horton, 2001; Hunt, 1998; Lloyd-Jones, 2001; Mackaskill, 2001; Martin, 1984; Rogers, 1998; Sines, 1994; Smith, 1992; Staub, 1992): this can never be eliminated by giving abusers additional training.

Nevertheless, promises of better training have routinely followed the numerous scandals and exposures of the past few decades. These post-enquiry reassurances appear so regularly that one wonders whether or not spokesmen are issued with a some kind of spin-doctors' handbook advising them to fob-off the public with this empty reassurance.

The fallacy that abuse can be eliminated by better training is shown by the fact that the many of the worst institutional abusers turn out to be people with adequate - or even exceptional - levels of training (Staub, 1992; p136). The most significant characteristic that highly-trained abusers share with lesser-trained colleagues is essentially the view that clients - the 'bennies', 'muppets', 'nut-cases' - or whatever - are somehow less than fully human.

Perhaps the ultimate antidote to the idea that institutional abuse can be reduced through better training is provided by the Auschwitz doctor, Josef Mengele. One of the worst institutional abusers of all time, Mengele was also one of the best trained and educated (in Mengele's case, a PhD. from Munich and an MD from Frankfurt). The majority of people who staff Britain's custodial institutions will never have anything like Mengele's level of education and training and if they had, it would be valueless should they share this suave, sane individual's lack of compassion and empathy for 'lower' life-forms.

Dr Mengele, incidentally, was not one of the 'unrepresentative rotten-apples' so-often cited by apologists for institutional abuse: according to research by the Simon Weistenthal Centre, Mengele was only one of tens of thousands of well-trained, highly-educated physicians, psychiatrists, scientists and academics who enthusiastically participated in the Holocaust project (Levy, 1993).

ABUSED, THEN ABUSED AGAIN...

Despite orthodox psychiatry's belief in a biological basis for most mental illnesses (Breggin, 1993; Nelson, 2001); it seems that substantial numbers of people who end up in psychiatric units have suffered emotional, violent, or sexual abuse in childhood (BBC, 2002; Community Care, 2002; Johnstone, 2001). Researcher Dr John Reed said: "It is time to break the silence about how frequently people with psychosis have been abused" (BBC, 2002).

Marjorie Orr of Accuracy About Abuse believes that: "Well over 50 per cent of psychiatric in-patients suffered sexual abuse in childhood...amongst the highly disturbed this rises to 80 per cent" (Orr, 1998).

Regrettably, the secure psychiatric wards of many NHS psychiatric hospitals - although officially deemed to be 'a place of safety' - are often hazardous places . Having been abused earlier in life, patients are particularly vulnerable to being abused again.

This abuse itself can result in mental health difficulties: according to a survey by POPAN - the Prevention of Professional Abuse Network - "Patients abused by social care workers or health staff are so traumatized by the breach of trust that many develop mental health problems" (Community Care, 1999).

IN DENIAL...

We expect to receive protestations from custodial staff and psychiatric-system apologists claiming that we have exaggerated the scale and extent of abuses: despite the well-documented tendency of institutional staff to maltreat inmates (Akid, 2002; Beardshaw, 1981; Camber, 2004; Carrell, 2000; Comach, 2001; Community care, 1995; Community Care 1999; D'Arcy and Gosling,1998; Gorman, 1992; Gould, 1985; Gossling, 1998; Hill, 2001; Horton, 2001; Hunt, 1998; Lloyd-Jones, 2001; Mackaskill, 2001; Martin, 1984; Sines, 1994; Smith, 1992; Staub, 1992 et al.) institutional apologists routinely claim that allegations are false or exaggerated.

Perhaps the classic example was the senior social services spokeswoman who insisted that abuse allegations (in North Wales children's homes) were "wicked, stupid lies" (Hunt, 1998).

Holocaust historians also found ex-concentration camp personnel who denied that well-documented events took place; or claimed that prisoners were treated fairly - even kindly - while in their 'care'. In fact, it seems common for former custodial personnel to insist that - in their particular concentration camp, care home, gulag or psychiatric unit - conditions were good; inmates were well-treated - even cosseted - and that they, personally, never knew about - or participated in - abuses.

These denials have been made by former personnel from even the most notorious institutions: this is an extract from a post-war epistle penned by mass-murderer, Dr Mengele: "Terrible things happened at Auschwitz and I did my best to help. One could not do everything...I could only save so many. I never killed anyone or hurt anyone" (Levy, 1993 pp.216-7).

THE SEROTONIN SOLUTION...

If, as orthodox psychiatry believes, low-serotonin levels are implicated in major psychiatric illness (Breggin, 1993; James, 1997) and, as psychologist Oliver James, persuasively argues, brain serotonin levels are related to the individual's social status i.e. "More than anything, serotonin levels seem to reflect our ranking in hierarchies, or our perception of our ranking..." (James, 1997; p.34) then it follows that, for many people, residence in a British psychiatric hospital - with its threats, assaults, degradations and humiliations - may, for them, be one of the worst possible places.

ASYLUM SEEKERS...

People experiencing mental distress often desperately desire refuge - 'asylum' in the best sense. As Dr Matt Muijen, former director of the Sainsbury's Centre for Mental Health, pointed out: "[some] people with mental health problems have periods, sometimes long periods, of poor functioning, and may need intensive treatment and care. We need to produce services acceptable to people suffering from mental health problems..." (Muijen, 2001).

Unfortunately they will be lucky if they find it. Many mental health professionals (not 'rotten apples' but seemingly, rotten orchards) lack the emotional maturity and character to have power over other people. Unless human nature undergoes a radical transformation, vulnerable (non-offending) people should be kept out of custodial institutions.

Too many have had experiences similar to this: "I sought psychiatric help voluntarily in the belief that the treatment would be safe, effective and humane. Unfortuntely I was wrong...psychiatric hospital is not a therapeutic environment. I found it to be a bizarre and threatening place...as a result of my experiences I will never trust another psychiatrist or mental health nurse again" (Hartley, 2001).

psychologist Dorothy Rowe commented: "When we treat someone as a person we are treating that person as our equal, human like ourselves. When we treat someone as an object we are acting as a predator and seeing that person as prey. If we want to live in a world where people live peacefully together treating a person as an object must, without exception, be unacceptable" (Rowe, 2000; p.433).

As Jonathan Coe, Chief Executive of Witness: Against abuse by health and care workers, said: "Abuse by trusted professionals causes serious and long-lasting harm. As well as the clear physical effects, it dammages the fundamental trust that people rightly place in people there to support, help and treat them. We work with people who have never recovered; who never received the support they originally sought and who struggle to gain the health and care support that they need...perhaps policy makers need to look again at this area". (Coe, 2006).

USEFUL CONTACTS:

To contact WITNESS: Against abuse by health and care workers, write to:

WITNESS, Delta House, 175-177 Borough High Street, London, SE1 1HR

Email address: jcoe@witnessagainstabuse.org.uk

Their 'phone number is: 0845 4500 300 -or visit their website at: www.witnessagainstabuse.org.uk

To see the ACCURACY ABOUT ABUSE website, go to: www.accuracyaboutabuse.org

To contact ACTION ON ELDER ABUSE, write to them at Astral House, 1268 London Road, London, SW16 4ER

TEL: 0808 808 8141 (Helpline) or visit their website at: freespace.virgin.net/man.web/aea/

RESPOND - which provides counselling for people with learning disabilities who have been abused can be contacted on: 0845 606 1503 Their website is at: http://www.respond.org.uk

VOICE - which provides support for adults and children with learning disabilities who have been abused, can be contacted on: 01332 202555

To contact the ANDREA ADAMS TRUST set up to support victims of bullying. Tel: 01273 704900

To access TIM FIELD'S excellent ANTI-BULLYING WEBSITE go to http://www.successunlimited.co.uk/bully/nurses.htm

'TACKLING RACIAL HARRASSMENT: Good Practice Guidance' is available at:

www.doh.gov.uk/raceharassment/trhguide.htm

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