In July 2014 councillors in Wokingham, Berkshire, were handed a report on a piece of local infrastructure most residents had learned to live beside. Thirteen warning sirens stood within seven miles of Broadmoor Hospital. They were tested every week. The tests had exposed a number of failures, the copper telephone lines that linked the sirens were no longer supported by BT, and an independent review had judged the system no longer fit for purpose. The report was careful to say what the sirens were not: they were a warning to the neighborhood, not a security measure. The first of them had gone up in 1952, after one patient got out. The patient was John Straffen.
The sirens are the visible edge of an argument about what to do with people who kill and are also ill. The argument runs through the cases of men and women who were sent to Broadmoor, Rampton, Ashworth and their equivalents abroad. Some arrived in hospital instead of prison, ruled unfit to plead or insane. Some were convicted and then moved. One was released and killed again. One has spent three decades in a Brazilian forensic institution that his country has decided to close, and one has been in a Kazakh psychiatric hospital since 1991. Ten of those cases follow, with the hospitals and the arguments about who belongs in one.
John Thomas Straffen was born in 1930 at Bordon, in Hampshire. As a young man in Bath he confessed to killing two girls. In 1951 he was ruled unfit to plead, Reuters reported at his death, and was committed to Broadmoor. A finding of unfitness to plead is not a verdict on whether a person committed the act charged. It is a decision that he cannot follow the proceedings well enough to take part in a trial. Straffen was never convicted of either death. The Court of Criminal Appeal, reviewing his case the following year, recorded that he had been arrested for the murders of young girls, found unfit to plead and committed to Broadmoor. The Australian Law Reform Commission, writing decades later, described those earlier killings as not in dispute and said it had been established that he had killed the two girls. No jury ever heard the evidence.
In 1952 he escaped from Broadmoor. He was not at liberty for long, but while he was out a five-year-old girl was killed. This time he stood trial. He was convicted of murder and sentenced to death.
His appeal turned on what the jury had been allowed to hear. The prosecution had put in statements he made at Broadmoor, and evidence about the Bath deaths. The Court of Criminal Appeal held in R v Straffen, [1952] 2 QB 911, that the Judges' Rules were designed to govern statements made to the police, not statements made elsewhere, so what he had said at the hospital could be used. On the Bath deaths, the general rule of English law kept out evidence showing only that a defendant tended to commit crimes of the kind charged. The court allowed it here. As a digest of the ruling summarizes it, Straffen had admitted the earlier killings while denying the later one, and that made the evidence relevant. The Australian commission listed the three strands that identified him: evidence that he had been near the place, that he had escaped from a nearby institution, and that he had been detained for killing two young girls "in precisely the same circumstances." The commission’s summary calls the institution a prison. It was a hospital. The ruling became a leading English authority on when evidence of earlier crimes may go before a jury.
The Home Secretary commuted the death sentence to life imprisonment, citing Straffen’s mental state, according to Reuters. The Farnham Herald said he escaped execution because he was considered feeble minded. The hospital had failed to hold him; prison would, for the rest of his life. In 2001 his solicitors asked for the case to be reopened, arguing that he should never have been tried at all because he had a mental age of about nine and a half. He was not released.
John Straffen died on Monday, November 19, 2007, in the health care center at HM Prison Frankland in County Durham. He was 77 and had spent 55 years in custody, longer than any other prisoner in Britain. The Ministry of Justice confirmed the death; it was believed to be from natural causes, and the prison service said it was unsure whether he had any next of kin.
What he left in Berkshire was the sirens. Reuters reported that a siren system was installed after the escape to warn people living nearby whenever a patient got out. The 2014 report to Wokingham Borough Council’s Overview and Scrutiny Management Committee gave the history: the first sirens went in during 1952, and more were added in the 1960s. By 2014 there were 13 siren sites within a seven-mile radius, still tested weekly, still the visible residue of an escape 62 years earlier.
Graham Young was 14 when he stood in the Central Criminal Court in July 1962. He was convicted on three counts of causing grievous bodily harm. The court found him to be suffering from psychopathic disorder and made two orders under the Mental Health Act 1959: one for his detention in Broadmoor, the other a restriction order providing that he could not be discharged without the Home Secretary’s consent for 15 years. The restriction order ran to 1977. Under it the hospital could not release him on its own authority.
A decade later, in the House of Commons, the Home Secretary, Reginald Maudling, said that had Young been dealt with as a sane offender, his offenses would have carried a prison sentence of about seven or eight years. In the House of Lords, Baroness Bacon asked why there had been nowhere other than Broadmoor to send a boy of 14, and called for separate arrangements for young offenders.
Maudling told the Commons that progress in Young’s treatment was slow at first. Christopher Mayhew, speaking in the same debate, said Broadmoor then had six consultant psychiatrists with about 50 years' experience between them. Lady Ruthven of Freeland told the Lords the hospital was also short of nurses. In the summer of 1970 the doctor responsible for Young reported that he had changed profoundly and was no longer a danger to others.
On that advice Young was conditionally discharged in February 1971, aged 23. A conditional discharge was not a full release. He had to live at an address approved for him, report to a probation officer, and attend a psychiatric outpatient clinic as directed. He remained liable to recall at any time until the restriction order expired. Mayhew told the Commons that he also kept in touch with the Broadmoor consultant who had treated him. He went first to the Government Training Centre at Slough, then to a job with a firm at Bovingdon, near Hemel Hempstead in Hertfordshire. The government’s statement said he complied with the conditions of his discharge and gave his supervisors no grounds for suspicion. It also said that his old obsession had resumed almost immediately after he left the hospital.
Two of his colleagues at the firm died in 1971. On June 29, 1972, a jury at St Albans Crown Court convicted him of murder and other offenses, and he was sentenced to life imprisonment. That same day Maudling went to the Commons. "The safety of the public must be the paramount consideration," he said, "and no patient is discharged unless it is considered safe to do so." He gave figures. More than 300 patients had been released from Broadmoor in the previous 12 years, and Young was the only one known to have committed a further homicide while under supervision. In the Lords, the Lord Chancellor put the number of patients discharged to the community on the Home Secretary’s authority since 1960 at 331, and said that apart from Young, two had later killed, both long after their supervision had ended.
Maudling announced changes already made. No restricted patient would be discharged from a special hospital until the responsible medical officer had a concurring recommendation from a second experienced consultant psychiatrist. Supervision, psychiatric supervision included, had been strengthened, and supervising officers were to keep in touch with employers, who were to be told enough to report anything that caused concern. He told the House that he accepted that the only way to guarantee absolute safety would have been to keep a young man in Broadmoor for the rest of his life. When members pressed for a public inquiry with power to summon witnesses, he answered: "We have nothing to conceal." Shirley Williams, Enoch Powell, David Steel and Harold Wilson were among those who questioned him. In the Lords, the Lord Chancellor said Young had been adequately supervised and had hidden his renewed obsession with considerable ingenuity; Henry Brooke, a former Home Secretary, spoke of how hard such release decisions were.
Two inquiries followed. The first was a review of how patients under special restrictions were discharged and supervised. Its members were Sir Carl Aarvold, the Recorder of London; Professor Sir Denis Hill of the Institute of Psychiatry; and G. P. Newton, director of social services for Wiltshire. In October 1972 Shirley Williams asked when it would report, and the new Home Secretary, Robert Carr, said within weeks. It was published as a Command paper on January 23, 1973, and Carr told the Commons that the government accepted its recommendations in principle. Among them was an independent board to advise the Home Secretary on discharging or transferring patients from special hospitals in cases that needed special care. A working party was to define which cases those were. The second inquiry, a committee under Lord Butler of Saffron Walden, examined how the criminal law dealt with mentally disordered offenders and reported in 1975.
The effects reached past the two reports. H. R. Rollin of Horton Hospital, Epsom, writing in the Journal of Medical Ethics in 1976, noted that the Aarvold committee had reported swiftly and had concentrated on tightening the existing provisions. G. Robertson, writing in the Psychiatric Bulletin, traced a change in the use of restriction orders. The number of restricted patients admitted to ordinary local psychiatric hospitals had been fairly steady for 12 years before 1973, he wrote, and then fell quickly, to fewer than 30 orders by 1977. Robertson thought this might be linked to the publicity around the former Broadmoor patient, though he wrote that a direct link could not be established.
Between 1973 and 1979 eleven house fires in and around Hull, in northern England, killed 26 people. All but one were recorded at the time as accidents. In 1980 a young man who called himself Bruce Lee confessed to the one fire that had plainly been set deliberately, a December 1979 blaze that killed three brothers, and then, over the following weeks, to ten others. At Leeds Crown Court on January 20, 1981, he pleaded guilty to 26 counts of manslaughter on the ground of diminished responsibility and to 11 counts of arson. He was ordered to be detained without limit of time at Park Lane Hospital in Liverpool under the Mental Health Act 1959. Murder charges were not pursued.
The case has never rested quietly. The prosecution relied mainly on his confessions, with no identification or forensic evidence tying him to any fire, according to the Criminal Cases Review Commission (CCRC) and the arguments reported from his 2021 appeal. In 1983 the Court of Appeal quashed the eleven manslaughter convictions for a fire at a care facility for elderly men in Hessle, and one count of arson, and let the others stand; the hospital order continued. On October 24, 2019, the CCRC referred the remaining convictions back to the Court of Appeal, saying new evidence raised a real possibility they would be quashed. It cited psychological and forensic linguistic evidence on the reliability of his confessions, a document examiner’s evidence on the written statements, failures to follow the rules governing police interviews, and expert evidence on the causes of the fires.
The Court of Appeal ruled on February 8, 2022. It heard four kinds of fresh evidence: a forensic linguist, a document examiner, two psychologists who described him as vulnerable, suggestible and compliant, and fire experts for each side who, for most of the fires, could not exclude an accident. The court weighed all of it and quashed two arson convictions and three manslaughter convictions, for fires in 1976 and April 1977. It upheld the remaining eight arson and twelve manslaughter convictions as safe, and left the hospital order undisturbed. His 1981 guilty pleas, entered in open court with legal advice, weighed heavily. Cartwright King said it was disappointed, ITV News reported.
He had been first held at Park Lane, one of the high-security hospitals of the period, and was later moved to Rampton Secure Hospital in Nottinghamshire, ITV News reported in February 2022. He was 61 at the time of the ruling. He has used several names: Peter Dinsdale at birth, Bruce George Peter Lee by 1980, and later Peter Mawson and Peter Tredget. The record of his case shows how a hospital order can outlast the certainty of the convictions behind it: three fires' worth of findings fell away over four decades, and the order stayed.
Peter Sutcliffe was convicted of murdering 13 women and of trying to kill seven others in West Yorkshire and Manchester between July 1975 and November 1980. He was a married truck driver from Bradford, and during the years of the inquiry West Yorkshire Police interviewed him nine times. He was arrested in Sheffield on January 2, 1981, after officers checked the number plates on his car, and confessed two days later.
The question at the Old Bailey in May 1981 was where he would go. Sutcliffe admitted the killings but said he was not guilty of murder because God had told him to kill. The Attorney General, Sir Michael Havers, told the court that the Crown accepted the doctors' diagnosis and would accept pleas of manslaughter. The trial judge, Mr. Justice Boreham, refused. He said he had "grave anxieties" about the pleas, since the medical opinions rested on what Sutcliffe had told the doctors, which was not what he had told the police. Whether he was guilty of murder was a matter for a jury. A manslaughter verdict would have sent Sutcliffe to a secure hospital, the Press Association noted later; a murder conviction carried a mandatory life sentence. Havers told the jury that Sutcliffe might be feigning madness to be sent to a hospital rather than prison, and that he had told his wife he expected 30 years in jail if convicted of murder but perhaps ten in a mental hospital if people believed he was mad.
On May 22, 1981, the jury convicted him of all 13 murders by a majority of ten to two, the Yorkshire Post reported, after nearly six hours of deliberation. Mr. Justice Boreham passed 20 concurrent life sentences, 13 for murder and seven for attempted murder, recommended that he serve at least 30 years, and said he hoped Sutcliffe would never be released.
He began his sentence in the prison system and spent about three years at Parkhurst on the Isle of Wight. In 1984, after prison doctors diagnosed paranoid schizophrenia, he was transferred to Broadmoor. He remained there for 32 years. The hospital that took him was the destination that a manslaughter verdict would have given him in 1981.
Because no minimum term had ever been set, the Secretary of State for Justice referred the case to the High Court. On July 16, 2010, Mr. Justice Mitting gave judgment, and Sutcliffe, by then known as Peter Coonan, was told he would never be released.
On August 24, 2016, he was moved from Broadmoor to HMP Frankland in County Durham, ITV News reported. He died on November 13, 2020, at the University Hospital of North Durham of COVID-19 pneumonia, with diabetes and heart disease contributing, according to the Prisons and Probation Ombudsman’s later investigation. He was 74. On the day he died, the chief constable of West Yorkshire apologized to the families for the language and terminology used about the women by the original investigators.
Ian Brady was convicted at Chester Assizes on May 6, 1966, of murdering three young people: two children, aged 12 and 10, and a 17-year-old. His partner, Myra Hindley, was convicted with him of two of the murders and of being an accessory to the third. More than 20 years later, both admitted to two further killings, of a 16-year-old and a 12-year-old. Neither was ever tried for those deaths. The case has been known ever since as the Moors murders.
Brady was taken to Durham Prison after the trial. The 2013 mental health tribunal that reviewed his history set out his later moves: to Albany on the Isle of Wight on August 28, 1971; to Wormwood Scrubs in London from June 11, 1974, to March 31, 1982; to Parkhurst the same day; and to Gartree in Leicestershire on April 22, 1983. In 1985 he was diagnosed with paranoid schizophrenia and moved from the prison system to a high-security psychiatric hospital. He was admitted to Ashworth, near Maghull on Merseyside, on November 29, 1985, and never left. Years later the tribunal examined that diagnosis closely and rejected his claim that he had not been ill in 1985. The symptoms, it found, had been too severe to have been feigned.
On September 30, 1999, Brady was moved from one ward at Ashworth to another. He stopped eating that day. In October clinicians drew up a plan to feed him against his will, and he was fed through a tube passed through his nose into his stomach. He went to court. In R v Collins and Ashworth Hospital Authority, ex parte Brady, decided in the High Court on March 10, 2000, Mr. Justice Maurice Kay considered whether the feeding counted as treatment for his mental disorder, which under the Mental Health Act could be given without his consent. A later case summarizing the decision records that the judge ruled the force-feeding lawful. The hunger strike, in name, went on until his death. The coroner later described it as intermittent. He took some meals from staff he chose, and the 2013 hearing was told that he regularly ate toast and soup. Brady himself said he wanted to be allowed to die.
From Ashworth he wrote. He corresponded for many years with the writer Colin Wilson, and in 2001 the Los Angeles publisher Feral House brought out his own book, The Gates of Janus: Serial Killing and Its Analysis, with an introduction by Wilson. In it Brady discussed a series of killers, among them John Wayne Gacy, Henry Lee Lucas and Peter Sutcliffe, and claimed that killers understood the criminal mind better than psychiatrists, reporters or police. Publishers Weekly called the argument unremarkable and the chapters on individual killers gratuitous. The criminologist James Sheptycki of Durham University, reviewing the book in Criminal Justice Matters in 2003, quoted Brady’s line from a letter to Wilson, "My life is over, so I can afford honesty of expression," and read the book as a final statement.
In 2013 Brady asked a mental health tribunal to find that he no longer needed hospital treatment, so that he could be moved back to prison. His lawyers argued that he had a severe narcissistic personality disorder but was not mentally ill. Brady had suggested that in prison he would be free to end his own life. The tribunal noted that there was no possibility of his release into the community; the only question was hospital or prison. At his request the hearing, a week long, was held in public, and he appeared by video link, his first public appearance since the 1980s. He called himself "a petty criminal." He described the killings as "recreational" and as "an existential experience," and said he had accepted "from day one" that he would be in prison for life.
On June 28, 2013, the tribunal, chaired by Judge Robert Atherton, ruled that Brady still had a mental disorder for which hospital treatment was appropriate and necessary for his health and safety and for the protection of others. In its written reasons, published later, it found that he had been correctly diagnosed with paranoid schizophrenia in 1985, that he still had residual symptoms, and that his account of having feigned the illness was unreliable. All the medical witnesses agreed that he also had a personality disorder with antisocial and narcissistic features. A relative of one victim called the hearing a waste of public money. A solicitor who had represented the mother of another victim said that hearing Brady call the murders recreational "beggars belief."
Brady died at Ashworth on May 15, 2017, aged 79. The inquest found natural causes.
Kenneth Erskine was convicted at the Central Criminal Court in London on January 29, 1988, of seven murders and one attempted murder. All the people involved were elderly. Over a few months in 1986, three women and four men were killed in England, and a man of 73 survived. The trial judge, Mr. Justice Rose, passed seven concurrent life sentences and recommended that he serve at least 40 years.
Erskine never accepted guilt at trial. He told the police and his lawyers that he was a burglar, not a killer, and he did not give evidence. Several psychiatrists who saw him in the months before the trial thought he had schizophrenia, and at least one doubted that he was fit to stand trial at all. Dr. Paul Bowden, a forensic psychiatrist instructed by the court, reported in 1987 that Erskine had a severe mental illness. Because Erskine denied the killings, Dr. Bowden did not think a defense of diminished responsibility could be put forward. The medical director of Broadmoor, Dr. John Hamilton, reported in January 1988 that he had schizophrenia and a psychopathic disorder, and noted that Erskine was suspicious of his own lawyers and afraid that if convicted he would be executed in South America. A third psychiatrist, Dr. James MacKeith, reported a severe personality disorder and schizophrenia, doubted whether Erskine was fit to stand trial, called him a serious danger, and recommended a special hospital if he was convicted. No diminished responsibility defense was run. His trial counsel said years later that Erskine would never have allowed it, because it would have undercut his main defense, that he had killed no one.
In August 1988, a few months after the conviction, Erskine was admitted to Broadmoor under section 47 of the Mental Health Act 1983, which allows a prisoner to be transferred to hospital for treatment, with a restriction without limit of time. He had refused treatment in prison. Within months Broadmoor reported that he remained a danger and advised against placing him in dormitory accommodation. Staff recorded that he lived, to all intents and purposes, in a world of his own. In 1995 he began to admit responsibility for the killings.
He applied for leave to appeal almost 20 years after the time limit had passed. His case was heard with an unrelated appeal, because both raised the same question: when should the Court of Appeal receive fresh psychiatric evidence of diminished responsibility that was not put to the jury at trial? A psychiatrist, Dr. Horne, reported in 2007 that Erskine’s responsibility had been substantially impaired, and in 2008 that his belief he would be executed had been a delusion held with great conviction, and that his lack of insight, itself a product of the illness, would have stopped him from pleading diminished responsibility. On July 14, 2009, the Court of Appeal ruled that there had been "unequivocal contemporaneous evidence" at the time of the trial that his responsibility was substantially impaired, and replaced the seven murder convictions with manslaughter on the ground of diminished responsibility. The attempted murder conviction stood.
The court rejected the argument that such a conviction should normally lead to a hospital order, since some people whose plea succeeds remain dangerous and a life sentence can still be right. In Erskine’s case, though, he had been in a maximum-security hospital for about 20 years, and the medical evidence pointed toward a hospital order. Subject to oral evidence, it said it would make a hospital order under section 37 of the Mental Health Act with a restriction under section 41 without limit of time, in the interests of public safety. The life sentences would in effect be replaced. He had been in Broadmoor since 1988; the court was, in practice, giving a name to where he already was.
Beverley Allitt was an enrolled nurse aged 22 when 13 children on Ward 4, the children’s ward of Grantham and Kesteven General Hospital in Lincolnshire, were harmed over about two months in the spring of 1991. Four of the children died: three babies and an 11-year-old boy. Nine survived, some with lasting harm. In May 1993 a jury at Nottingham Crown Court convicted her of four counts of murder, three of attempted murder and six of causing grievous bodily harm with intent, and on May 28, 1993, Mr. Justice Latham gave her 13 life sentences, one for each child.
The children had been admitted with minor ailments, the Press Association reported. Between February and April 1991 they began to collapse on the ward. Seven were transferred to the Queen’s Medical Centre in Nottingham. David Blunkett, then Labour’s health spokesman, told the Commons in 1994 that he counted 26 incidents involving 13 children over 61 days. Local reports have given the period as 59 days. In each case, as the Press Association later summarized the investigation, the same nurse was on duty.
At the trial, two medical specialists told the court that she was psychologically disturbed and suffered from Munchausen’s syndrome by proxy, a condition in which a person harms another, often a child in their care, to draw attention to themselves, UPI reported. By the time of sentence she had been treated at Rampton for severe anorexia nervosa. "You are cunning and manipulative and you have shown no remorse for the trail of destruction you have left behind you," the judge told her. "There is no real prospect that a time will come when you can safely be released." UPI reported that whether she would serve her sentences in a hospital or a prison was left for the Home Secretary to decide. The press called her the Angel of Death, VICE noted; the name has followed her since.
She has been detained in hospital rather than prison. Rampton, in Nottinghamshire, is a high-security psychiatric hospital, and she was reported there in 2023. Her minimum term of 30 years expired in November 2021, but a patient held in hospital cannot be considered by the Parole Board. On October 3, 2023, Allitt went before a mental health assessment panel to ask to be transferred to a mainstream prison, the Grantham Journal reported, because a move would have allowed her to apply for parole. LBC reported that she was 54. A spokeswoman for Nottinghamshire Healthcare NHS Foundation Trust told LBC she could not comment because of patient confidentiality. The father of one survivor told LBC: "She should never be released." No independent outlet has reported a decision on the application.
Her case was recalled when a neonatal nurse, Lucy Letby, was convicted in August 2023 of murdering babies at the Countess of Chester Hospital; the Press Association, listing earlier cases of health workers who killed patients, placed Allitt first and said she was then held at Rampton. At the public inquiry into the Letby case, chaired by Lady Justice Thirlwall, counsel Rachel Langdale KC told the opening hearing in September 2024 that the Allitt case had formed part of Letby’s student training at the University of Chester. About 25 years after the Clothier inquiry, Ms. Langdale said, "another nurse working in another hospital killed and harmed babies in her care."
Edmund Emil Kemper III was convicted on November 8, 1973, of eight counts of first-degree murder in Santa Cruz County, California. Six of the people he killed were young women and girls, between May 1972 and February 1973. The last two were his mother, Clarnell Strandberg, and her friend Sara "Sally" Hallett, in April 1973. He then drove east to Pueblo, Colorado, and telephoned the Santa Cruz police to say what he had done. He had pleaded not guilty by reason of insanity. Court-appointed psychiatrists found him sane, UPI reported in 1985.
He had killed before. In 1964, at 15, he killed his paternal grandparents. Because he was 15, the case went through juvenile court and not an adult prosecution; some later accounts call the outcome a conviction, but the record describes a juvenile proceeding and a commitment. He was sent to Atascadero State Hospital, the maximum-security psychiatric facility in San Luis Obispo County, and was released to his mother’s care. Lookout Santa Cruz reported in 2024 that this happened on his 21st birthday; a 1973 television report said he had been paroled in 1970, and accounts differ. After his arrest, a reporter for the San Francisco station KPIX noted that Kemper had bought a gun despite his history of psychiatric treatment, and asked what that might mean for California’s gun laws.
At 6 feet 9 inches and about 280 pounds, according to UPI in 1985, he was known as Big Ed. Santa Cruz County District Attorney Jeff Rosell told a 2024 parole panel that he remained a high risk. The panel denied parole on July 9, 2024, for seven years, and Kemper, then 75, remained in the California Medical Facility at Vacaville. The hospital in his story is the one that released him: a juvenile commitment to the state’s maximum-security psychiatric facility, a release to his mother’s care, and eight murder convictions that followed in 1973.
Marcelo Costa de Andrade confessed to killing 14 boys in and around Niteroi, the city across Guanabara Bay from Rio de Janeiro, between April and December 1991. The boys were between about 5 and 13 years old, according to Correio Braziliense. He justified the killings in religious terms, believing that children who died went to heaven, Folha do Leste reported.
He never stood trial. Brazilian courts ruled him inimputavel, the legal term for a person who cannot be held criminally responsible because of mental illness or impaired mental development. Instead of a prison sentence he received a medida de seguranca, a security measure that commits a person to a forensic psychiatric hospital for treatment and custody. Enfoco, a Niteroi news site, wrote in March 2024 that because of his mental illness he could not be tried. Correio Braziliense wrote in 2021 that he was judged to have an intellectual disability and placed in a psychiatric hospital. AIB News reported in April 2023 that the finding came in 1992 and that the measure had no fixed end, with periodic examinations to decide whether he had recovered. Folha do Leste and Enfoco both date his internment under the measure from 1993. In 2023, after 30 years, his lawyer asked the court to end it.
The question of where he could be held came to a head through a national policy. Brazil’s National Council of Justice adopted an anti-asylum policy for the judiciary that limited psychiatric internment to cases of clinical need and barred institutions of an asylum type, including the custodial psychiatric hospitals. Folha do Leste reported in February 2024 that the council had ordered the closure of the Henrique Roxo custodial hospital in Niteroi and of the Roberto Medeiros penal psychiatric hospital in Rio’s Gericino prison complex, by about the middle of 2024. The paper said 71 patients held in the two institutions were to be released. By early 2024 he was the only patient left at Henrique Roxo, which was due to be shut down by May.
In 2023 a judge of the Vara de Execucoes Penais, the court that supervises the execution of criminal sentences and measures, ordered him moved to the Jurujuba psychiatric hospital, in Niteroi’s South Zone, by March 18, 2024. The State Health Secretariat had suggested the hospital. The order met resistance from the city. Its Municipal Health Secretariat told Enfoco in February 2024 that Jurujuba no longer offered long-term inpatient care and concentrated on emergencies, and that it could not meet the needs of the patient in question. Under the anti-asylum model, the city said, a patient once stabilized would be treated through outpatient services such as psychosocial care centers and therapeutic residences. The city said no one had contacted it before the ruling, and its attorney’s office filed a legal challenge. Folha do Leste reported that Jurujuba lies near schools, and residents of the surrounding community spoke out publicly against the transfer. On February 23, 2024, a patient who had escaped from a psychiatric unit killed a school doorman in the Icarai district of Niteroi; O Sao Goncalo and Terra reported that the patient had escaped from the Jurujuba unit, and Terra reported that the escape weighed in the court’s thinking. His own lawyer, Mantovani, told Enfoco that the defense and prosecution had at first agreed with the judge’s plan only because they did not know the hospital, and that having seen it he found it lacked the structure for the case.
On March 5, 2024, the court reconsidered. He stayed, for the time being, at Henrique Roxo, and Jurujuba would not receive him, O Sao Goncalo, Enfoco and Terra reported. He was still reported in Niteroi in October 2024. The closure of the asylums had left a country with a single patient, a building due to shut, and no agreement on where he could be held.
Nikolai Dzhumagaliev has spent most of his adult life in psychiatric custody, and no court has ever convicted him of a killing. Between January 1979 and December 1980 a series of women were killed in and around Uzynagash, a large village west of Alma-Ata (now Almaty) in what was then the Kazakh Soviet Socialist Republic. Dzhumagaliev, a local firefighter, was arrested on December 19, 1980, and confessed; 360 reported that he confessed to seven of nine killings in the case. Kazakh news outlets credit him with ten victims. Information about the case was long kept from the public, NewTimes.kz wrote in 2025.
Earlier, in August 1979, a fellow firefighter had died; 360 reports that it was ruled an accident and that the outcome was compulsory psychiatric treatment, and that he was released in less than a year. After his arrest in 1980 he was sent to the Serbsky Institute in Moscow, the Soviet Union’s leading center for forensic psychiatry, where he was diagnosed with schizophrenia, Informburo and 360 reported.
On December 3, 1981, a court ruled him insane and ordered compulsory treatment in a closed special psychiatric hospital. Zakon.kz wrote in 2014 that he was tried in 1981 and sent to Tashkent, the capital of the Uzbek Soviet republic, and that he had been "found not subject to criminal punishment." Other descriptions differ. 360 writes that he was found guilty of nine killings but declared insane; Kursiv wrote in 2026 that his prison sentence was replaced with compulsory treatment; Tengrinews, in January 2016, said he had been "sentenced to life imprisonment," which no other account supports. Informburo, Zakon.kz and NewTimes.kz all describe a finding of insanity followed by compulsory treatment, not a prison term.
He spent about eight years in the special hospital. 360 says he attempted suicide there twice and that staff described him as polite. After about eight years, according to 360, doctors judged that his condition had improved and that he no longer posed a danger, and he was to be moved to an ordinary psychiatric hospital. On August 29, 1989, he escaped during that transfer; Informburo and 360 differ on where, 360 placing it at the airport in Frunze, now Bishkek, in Soviet Kyrgyzstan. The search was large. 360 reports that militia, soldiers and hang-glider pilots combed the mountains, and did not find him.
In 1991 he was detained in the Fergana region of Uzbekistan after stealing a sheep, Zakon.kz and 360 reported. 360 dates the arrest to the spring of 1991; Kursiv wrote that it was January. He gave a false identity and claimed to be Chinese, hoping, according to 360, for a light sentence as an escaped foreigner. 360 says his inability to explain how he had crossed the border gave him away. He was returned to psychiatric custody.
Since 1991 he has been held at the Republican psychiatric hospital of a special type in Aktas, a village in the Almaty region about 40 kilometers from central Almaty, Kursiv and Tengrinews reported. NewTimes.kz describes it as the only specialized institution of its kind in Kazakhstan, and the Ministry of Health has said that more than 80 percent of its patients committed serious or especially serious crimes against people. It is surrounded by a concrete wall and barbed wire; staff enter only with passes, and medical staff leave their phones at the gate, Tengrinews reported in January 2016. Informburo reported that he repaired small appliances there. Tengrinews reported in 2014 that he had attempted suicide several times and wrote regularly to the authorities asking to be executed.
His doctors have more than once considered whether he could be released. In September 2014 Zakon.kz quoted the clinic’s assessment that his "behavior is orderly" and that "the patient is calm," and reported that the question of his discharge was open; specialists who study serial killers strongly disagreed, it said. 360 writes that doctors at one point considered outpatient observation but that the security services blocked his release. In 2014 police in Aktobe also said he was linked to the 1990 killing of a female student there, while he was at large; Tengrinews and Zakon.kz reported a reopened case, and no verdict has been reported.
In January 2016 a rumor of another escape spread across Kazakhstan. On January 5, messages began spreading on WhatsApp and then Facebook claiming that he had escaped from the Aktas hospital on December 23. The next day the police of the Almaty region called the claims disinformation, and told Tengrinews that similar false rumors surfaced every year and that there was no search order for him. A Tengrinews reporter went to the hospital. The duty doctor confirmed he was there and being treated, refused to let him be seen, and said, "If he had escaped, we wouldn’t be standing here like this." On January 8 the Almaty city police reported that the criminal police had traced the message to a 21-year-old woman from Uzynagash, who confirmed that the story was invented; a pre-trial investigation was opened into knowingly spreading false information. Its outcome has not been made public.
In August 2023 Caravan published an interview with Akmaral Shegentaikyzy, the psychologist who has worked at Aktas since 2007. She called him the hospital’s "most exemplary patient," said his condition was stable and that he spoke little, and said he did not accept his diagnosis and believed he had been locked up on a fabricated case. She thought it unlikely that he would ever be released. As of August 9, 2026, NewTimes.kz reported, he was still held under compulsory treatment at Aktas. No court decision on his discharge has been reported.
Set side by side, the ten cases do not point one way. Straffen and Dzhumagaliev each got out of a hospital that had been ordered to hold him, and each was caught and held again, Straffen in prison for the rest of his life. Young was discharged under supervision, and the rules were rewritten. Erskine’s hospital order began in 1988 as a prison transfer and was named as a hospital order twenty-one years later. Sutcliffe and Brady were convicted of murder, and then diagnosed; one returned to a prison cell after 32 years, the other asked to and was refused. Allitt sits in a hospital with a minimum term that has expired and a parole process she cannot enter. Lee’s order outlasted the convictions beneath it. Andrade’s lasts as long as the doctors decide, and the building was due to close before his case could be settled.
• 1951: John Straffen is ruled unfit to plead over the deaths of two girls in Bath and committed to Broadmoor.
• 1952: Straffen escapes from Broadmoor; a five-year-old girl is killed; he is convicted of murder and sentenced to death, later reprieved. Warning sirens are installed around the hospital. The Court of Criminal Appeal decides R v Straffen, [1952] 2 QB 911.
• July 1962: Graham Young, 14, is convicted at the Central Criminal Court of causing grievous bodily harm and sent to Broadmoor with a 15-year restriction on discharge.
• February 1971: Young is conditionally discharged, aged 23.
• 1971: two of Young’s colleagues at a firm in Bovingdon, Hertfordshire, die.
• June 29, 1972: Young is convicted at St Albans of murder and other offenses; Home Secretary Reginald Maudling makes a statement to the Commons and announces two inquiries.
• January 23, 1973: the Aarvold review is published as a Command paper.
• November 8, 1973: Edmund Kemper is convicted of eight counts of first-degree murder in Santa Cruz County, California, years after a 1964 juvenile commitment to Atascadero State Hospital.
• 1975: the Butler committee reports on mentally disordered offenders.
• 1977: Young’s restriction order would have expired.
• 1980: Nikolai Dzhumagaliev is arrested on December 19.
• January 20, 1981: Bruce Lee pleads guilty at Leeds to 26 counts of manslaughter on the ground of diminished responsibility and 11 of arson; ordered detained without limit of time at Park Lane Hospital.
• May 22, 1981: Peter Sutcliffe is convicted of 13 murders after the trial judge refuses manslaughter pleas.
• December 3, 1981: a Kazakh court rules Dzhumagaliev insane and orders compulsory treatment.
• 1983: the Court of Appeal quashes Lee’s Hessle convictions.
• 1984: Sutcliffe is transferred from Parkhurst to Broadmoor.
• November 29, 1985: Ian Brady is admitted to Ashworth Hospital.
• January 29, 1988: Kenneth Erskine is convicted of seven murders and one attempted murder; admitted to Broadmoor in August.
• August 29, 1989: Dzhumagaliev escapes during a hospital transfer; recaptured in Uzbekistan in 1991 and held at Aktas since.
• 1991: Marcelo Costa de Andrade is said, on his own confession, to have killed 14 boys around Niteroi between April and December.
• May 28, 1993: Beverley Allitt is sentenced to 13 life sentences.
• 1993: Andrade placed under a security measure (per Folha do Leste and Enfoco).
• September 30, 1999: Brady stops eating; tube feeding follows; High Court rules it lawful on March 10, 2000.
• July 14, 2009: the Court of Appeal substitutes manslaughter for Erskine’s murder convictions and signals a restricted hospital order.
• July 16, 2010: Sutcliffe is told he will never be released.
• June 28, 2013: a mental health tribunal refuses Brady’s bid to return to prison.
• July 2014: Wokingham councillors receive the report on the Broadmoor sirens.
• August 24, 2016: Sutcliffe moved to HMP Frankland.
• May 15, 2017: Brady dies at Ashworth.
• October 24, 2019: the CCRC refers Lee’s remaining convictions to the Court of Appeal.
• November 13, 2020: Sutcliffe dies.
• November 2021: Allitt’s minimum term expires.
• February 8, 2022: the Court of Appeal quashes five more of Lee’s convictions and upholds the rest.
• October 3, 2023: Allitt asks a mental health panel to move her to prison.
• February to March 2024: Brazil’s plan to close Henrique Roxo leaves Andrade its last patient; on March 5 the court keeps him there for the time being.
• July 9, 2024: Kemper is denied parole; next hearing in 2031.
• August 9, 2026: Dzhumagaliev is reported still held at Aktas.