ITS NAME has unique power to conjure up diabolical images of psychopaths and their unspeakable deeds. Carstairs - the State Hospital - is probably the nation’s most feared and least understood institution.
Hidden away to all but train passengers on a remote and windswept south Lanarkshire moor, Carstairs is seen as the place where deranged murderers, rapists and child killers judged too dangerous for a ‘normal’ high-security prison are kept sedated and locked away behind a razor-wire fence.
Even those who dare visit are stripped of their mobile phones amid airport-style security.
So it may come as a surprise that the person in charge of this supposedly fearsome place is a 5ft-tall woman with an easy manner and a laugh to match. Andreana Adamson, dressed in a business suit and stylish court shoes, walks the hospital grounds and mingles with patients without fear for her safety.
The 46-year-old, Belfast-born chief executive is giving her first full interview since taking up the post in November 2002 and she is trying to shine light on the misunderstood world of mental illness.
Adamson believes that if there is anything ‘horrendous’ about Carstairs it is the conditions her 240 patients are living in.
She told Scotland on Sunday: "It looks like a gulag. It looks very hard from the outside. When first I came here to be shown around before I took the job I had no idea. They showed me the pet therapy rabbits. They just showed me the nice bits.
"When I came here for real I was horrified. The state of the wards was horrendous. Just one big room with people sitting round watching television. The conditions are really poor, and that does not help improve their mental health and it doesn’t help the staff. That’s why there is an overwhelming need to develop the hospital."
She added: "People have a perception of the patients here. Mental illness is quite scary for some people and there is a stigma around serious mental illness. For this particular group of people I think it’s even more stigmatised. I would like to remove that stigma.
"When you look at the work of the hospital it’s very therapeutic. It’s not like a prison. We have excellent, high-quality staff. But the facilities are inadequate. We are going to do something about it."
Adamson revealed her ambitious plan to have the 1920s institution demolished and replaced with a state of the art 50m facility.
She has prepared a business plan for a new building, which she hopes will soon be approved by the Scottish Executive. If it accepts her argument that the hospital is in urgent need of an overhaul she will seek planning permission to have it pulled down and rebuilt on site. She thinks the number of beds should be slashed to cut down on the number of people sent to high-security wards.
"I am open to the idea of private finance," she said. "But I don’t know how well that would go down with others."
Before taking the post at Carstairs she was director of planning at Lothian Primary Care Trust.
As well as improving hospital facilities for patients, her involvement culminated in the prestigious sale of the former Gogarburn Hospital to the Royal Bank of Scotland which will use the site as its world headquarters.
In her first year as chief at Carstairs, Adamson has fought a constant battle against its stigma. She points out that only a proportion of its patients have been ordered there by a court after committing an offence through mental derangement.
The State Hospital has 550 staff - two for each patient - including a broad range of psychiatrists and doctors. In time that will be cut to 100 patients with more being sent to medium security units, including all women.
Currently at Carstairs only the most violent patients are locked up. Those who are responding to treatment are allowed free access to the hospital’s gardens, where they rub shoulders with staff.
"I walk freely around," Adamson says. "It has a campus feel. The gardens are very popular as a place for patients to get fresh air. They can go for walks or do some gardening. Lots of the patients would never have had any opportunity to do gardening before. But one of the problems with the patients is that they don’t get enough exercise. Many of them are overweight. The anti-psychotic drugs they take can make them put on weight and they don’t get enough exercise to burn it off."
Despite the fact many of her patients have been demonised because of the horrific nature of the crimes they committed, the chief executive says this does not affect how she deals with them.
"I honestly don’t judge people. And for me the purpose of the hospital is rehabilitation, regardless of the nature of the crime. I don’t have a problem with it."
Refusing to focus on the roll-call of criminals, Adamson instead insists that the hospital’s treatment programme is very successful.
"We have pet therapy with small caged rabbits. We have arts and crafts and we have education programmes because most of the people who end up here have come from poor social and emotional backgrounds and their education has often been neglected.
"They can do courses and Open University degrees here. They also do anger management, problem solving and sexual offending programmes where necessary."
Adamson is reluctant to discuss her personal life except to say she is married to a doctor and has a 13-year-old daughter. She used to take her daughter into Gogarburn Hospital when it held open days in the summer. "Children have no fear of mental health, not like adults," she says. She adds that her interest in mental health services comes from her conscience, not from any personal experiences of the problem.
"When I was younger I never thought I would end up working in a place like this. But I suppose it’s a social conscience thing. It’s about vulnerable people unable to reach their full potential, and the stigma that goes with mental health. I like being able to make something happen to change things for the better.
"I am not anti-hospital. Not everyone can come out of hospital. But I think they should be places of the highest quality and part of the whole spectrum of care. People who need to be there for a long time deserve privacy and respect. The vast majority can, and should, move on.
"The fact is, mental illness is part of the community. It’s understandable how people feel. We have always had these big institutions away from the community which means we don’t really have to think about it."