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Carstairs Hospital becomes world leader in treatment of violent schizophrenics


Scotland’s high security psychiatric hospital has become a world leader in the treatment of violent schizophrenics.

Clinicians at State Hospital Carstairs have developed new approaches in forensic mental health.

The success has been followed by medics around the world and now psychiatrists and legal experts in Pakistan have asked for help to create a similar system.

About a quarter of the 110 male patients at Carstairs have killed – and been sent to the hospital as they were not fit to stand trial or be in the general prison population.

The majority have schizophrenia and are among the most challenging patients in the world. In the past, the focus has always been on intensive one-to-one sessions with specialist forensic psychiatrists and other intensive treatment techniques.

Now experts at Carstairs use specialist group sessions to encourage rehabilitation.

Violence and aggression levels have been dramatically reduced at the facility and more patients than ever are being moved into lower security specialist centres.

The new approach recognises that, in many cases, the NHS has invested in too much medicine instead of more structured care.

Forensic consultant psychiatrist Dr Gordon Skilling leads the Realistic Medicine programme.

He said: “Our approach is much more about recognising the challenges to patients and to staff, and to the development of care and understanding.

“Our staff volunteer to take part in group sessions with patients and get to know them in a way no one else has.

“It’s about empowering these groups to be innovative, creative and practical.” Changes like improved menus and getting access to gym equipment have contributed to its success.

Consultant forensic psychiatrist Dr Khuram Khan leads Project Pakistan under a Global Citizen programme designed to support Scotland’s international reputation as an exporter of humanitarian knowledge and expertise.

He said: “Last year, Pakistan changed law to end capital punishment for blasphemy … a common reason for psychiatric patients to be locked up.

“Now, the next steps are being taken to develop the system to give those patients proper care rather than being treated as criminals.”

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