When a violent offender is convicted and sentenced, it’s the end of the story as far as most of us are concerned. This lack of curiosity about what happens next is surprising given that the UK has one of the highest rates of incarceration in western Europe and a very high level of reoffending. Poor mental health is a huge problem, with 70 per cent of inmates believed to have at least two mental health issues. The demand for mental health care far exceeds capacity, which is bad news in terms of both protecting the public, given that most prisoners will eventually be released, and making life bearable in understaffed and often frightening institutions.
Dr Gwen Adshead has spent thirty years working with the prisoners most of us forget. Much of her work has been at Broadmoor, originally a secure hospital for both sexes but latterly an all-male establishment. Broadmoor has had some notorious inmates over the years, including the Yorkshire Ripper, Peter Sutcliffe, but the patients Adshead writes about are anonymised. And that’s the first problem with her book: her concern for confidentiality is understandable, but it is unsettling to be presented with ‘mosaic portraits’ of people she has treated without knowing what has been changed or left out.
All of them are very damaged, coming from dysfunctional families where they were themselves abused before going on to inflict terrible suffering on other people. Most of the patients she writes about are male, reflecting the fact that men commit many more crimes than women, but there is a fascinating