Rampton high-security hospital in Nottinghamshire was built in 1912. Everything about the bleak, remote facility for mentally ill people is forbidding, says Jan Neate. “I get really upset going there,” she says. “Even though I really want to see Jake, visiting is an ordeal.”
Jake, 45, is Neate’s son. He has been held at Rampton for eight years. In 2017, many years after being diagnosed with paranoid schizophrenia, he killed his partner, Suzanne Brown, and was deemed mentally unfit to stand trial.
When Neate visits him, her fingerprints and biometrics are taken before she is escorted in. Jake is searched when he is brought into the room and searched again when he leaves. Mother and son are permitted a hug, which is often distressing. “Both of us usually cry when we hug,” says Neate. “It reminds me of what our lives were like before and I think it reminds Jake of that, too.”
England has three high-security hospitals – Rampton, Ashworth in Merseyside and Broadmoor in Berkshire. According to the NHS trust that manages Rampton, secure hospitals are for people with severe mental health disorders who pose grave or immediate danger to themselves or to the public. They have accommodated some of the country’s most abhorred criminals, including Peter Sutcliffe, Ronnie Kray, Ian Brady, Ian Huntley and Beverley Allitt. Valdo Calocane, who was convicted of killing three people in 2023 and diagnosed with paranoid schizophrenia, has spent time in Rampton.
These high-security hospitals have been in the spotlight this year, after it was reported that Axel Rudakubana – who murdered three young girls at a dance class in Southport in 2024 – had been moved from Belmarsh, a category A high-security prison, to Broadmoor, which has security equivalent to a category B prison. Officials said the move was due to the deterioration of his mental health and the fact he could no longer be safely managed in prison. The plan is to return Rudakubana to Belmarsh after treatment.
Throughout its history, Broadmoor has had a reputation for being tough, even menacing, given the notoriety of various people housed within its walls. Nonetheless, some saw this move as the start of a “cushier” life for Rudakubana and an attempt by him to manipulate the system. Mark Fairhurst, the chair of the Prison Officers’ Association, said the move would afford him freedoms not available in a high-security prison.
Relatives of those incarcerated in high-security hospitals are usually unwilling to speak out because of the understandable stigma attached to the violent acts committed by those inside. But while Jake did something terrible, Neate is keen for people to understand the reality of this form of incarceration.
What happens inside high-security hospitals raises important questions about how we treat people who have committed extreme violence but who are also vulnerable themselves. These are difficult, emotive questions about mental health, retribution and rehabilitation.
Jake is sometimes placed in a form of segregation known as seclusion; Neate knows of at least two periods of seclusion so far this year. In both cases, she believes the seclusion lasted several days. She is given very little information about what happens to him during these periods, which she says is terrifying: “I dread the phone ringing one day and staff telling me that something terrible has happened to him.”
If Jake refuses his medication, his doctors have permission to administer it via injection.
He has been having seizures and injuring himself. “On one occasion, he fell and injured his shoulder when he was having a seizure,” says Neate. “On another occasion, also when he was thought to be having a seizure, he fell and injured his head.”
Jake was taken to an ordinary hospital after receiving these injuries, but Neate wasn’t given any information about where he was. Whenever she calls Rampton, to see how Jake is, she gets the briefest of replies – confirmation that he is eating, drinking and sleeping, but nothing else. “Anyone who thinks Rampton is an easy option for someone like Jake really doesn’t understand how things are,” she says.
Inspections of Rampton carried out by the Care Quality Commission (CQC) between July 2019 and June 2023 identified a number of failings, including a shortage of staff. Some therapy staff were used on wards to plug the gaps, leading to a reduction in patients’ therapeutic programmes. Concerns were also raised about overnight lock-ups in patients’ rooms being extended due to staff shortages, along with periods of “confinement” during the day. Poor medicine management was identified and there were repeated issues with the safeguarding of patients.
A focused review of Rampton by the CQC in March 2024 said staffing levels had improved and the use of confinement had decreased, but there remained a “culture of relying on therapy and education staff to cover nursing gaps”. While medicine management had also improved, staff did not always follow the correct procedure, “which could constitute an assault and trespass against the person”. The review added: “While we observed staff providing person-centred care, we remain concerned that people in long-term segregation were not always treated with dignity, compassion and respect.”
In a May 2025 CQC report, the hospital had its rating upgraded from “inadequate” to “requires improvement”. It was found that the trust still had work to do to address staff shortages and to support staff.
As a boy, Jake was happy and playful, says Neate: “We went on loads of outings like swimming, football and visits to museums. He was a really nice boy.” When he was 17, he started to get ill. “He became paranoid and was admitted to hospital for two weeks as a voluntary patient. The doctors said if he stopped smoking skunk, he would recover.”
He went on to study geography at the University of Birmingham, but left when he was headhunted by a bank in Canary Wharf, London. Then, at 20, he was diagnosed with schizophrenia. He had to leave his job, but he built up a window-cleaning round where he lived in Essex and he was popular with his customers. To treat his schizophrenia, he was put on the drug clozapine and he gave up recreational drugs, living successfully in the community. At that point, says Neate, Jake had an illness, but he also had a life.
In 2007, Jake and Suzanne met at a disco in Harlow. “He was 26 and she was 23,” says Neate. Suzanne, who was known as Sue, worked as a nursery nurse. “Sue had such a sweet, kind nature. Whenever she came to my house, she would always bring a homemade cake with her. She really looked after Jake, made sure he took his medication and went to all his appointments with him. She was a very giving person. I miss her.”
At this stage, “Jake had dreams and ambitions and he loved Sue to pieces”, says Neate. “His schizophrenia then was nothing like it is now. He was never violent. I don’t think he and Sue even argued with each other.” When they bought their first flat together, in Braintree, they had a new kitchen fitted and were full of plans for the future.
Jake had received excellent care and support from the NHS mental health trust in Harlow, but their move meant Jake’s care was transferred to a new trust. For 10 years, clozapine had kept him stable. But in 2017, after he started to experience physical side-effects – severe constipation, urine retention and an inability to eat or sleep – the drug was stopped suddenly.
Withdrawal from clozapine is supposed to be closely monitored, but Jake, Sue and Neate were unaware of this. “None of us had any idea what could happen as a result of him being taken off clozapine,” says Neate. “Sue and Jake really trusted their clinical team. I thought that the worst that might happen would be that Jake might have a row with Sue. I had no concept of the gravity and severity of it all. It’s a heavy-duty drug and taking him off it should have been treated as a medical emergency.”
Jake began to experience psychosis and repeatedly tried to seek help, but little was forthcoming. Jake wrote to his doctors, listing the symptoms he was experiencing after being taken off clozapine, but he didn’t receive a response. Neate says she made dozens of phone calls and sent numerous emails during this period, trying to get help for Jake, but this didn’t result in any interventions. She believes that, had there been effective responses to the pleas she, Sue and Jake were making, the horror that followed could have been avoided.
In texts to his mother in this period, Jake said he had been researching private hospitals. “I feel a bit angry that no one told me of the implications of going on to this drug,” he wrote. “I would like to be an inpatient to deal with all the issues.”
His condition worsened. On 15 December 2017, a mental health worker visited the couple’s flat and said telephone support would be put in place and a home visit organised for the following week. That evening, Neate received a call from Sue, “screaming and hysterical”. She said Jake was hurting her. Neate told her to get out of the flat and immediately called the police.
Three hours after that call, police officers arrived at the flat. By then, it was far too late. Jake had stabbed Suzanne 173 times.
Neate says she didn’t understand the severity of what was happening until the police called her and said: “‘We’ve taken the dead woman from the flat.’ All I could say was: ‘Oh my God, what do you mean?’ … I am always asking myself if I could have prevented this happening if I had been close by.”
Jake was initially charged with murder, but was found to be unfit to stand trial. He said he had been hearing voices coming out of the TV urging him to kill Sue and was having terrible thoughts about God, the devil and the battle between good and evil.
When a person is deemed mentally unfit to stand trial, a trial of the facts takes place. Rather than deciding on a defendant’s criminal guilt or innocence, this determines whether the defendant carried out the alleged acts. The trial found that Jake had killed Sue. The jury heard that Sue was devoted to Jake and that she had looked after him when he was unwell with “the patience of a saint”.
“I miss Sue so much,” says Neate. “I miss her lovely sunny nature … We used to go on outings together, to spas and to the cinema. I feel so lonely. I don’t have Jake as he was and I don’t have Sue. Jake was a perpetrator, but I believe he was also a victim of the system.”
A report on mental health services after Sue’s killing identified eight failings and made seven recommendations for change. It found that an up-to-date risk assessment was not carried out after the sudden cessation of clozapine and that there was neither appropriate professional monitoring nor guidance for Jake and his family. It also found that clinical information was not communicated consistently within and between teams.
An investigation for the Independent Office for Police Conduct (IOPC) found that the police response was delayed because it was initially miscategorised by the call handler. The IOPC did not identify any misconduct, but found that two members of staff in the control room “had not met expected standards”.
When Jake was sent to Rampton, it was supposed to be temporary. Neate was told that when he was more stable he could be moved to a medium-security unit with a less restrictive regime. Jake is held at Rampton on what is known as a section 37 order; the Home Office has to give permission for the release of those held under this type of indefinite hospital order.
In a letter to Neate on 28 July 2026, Jake’s doctor at Rampton wrote: “In recent years we have seen several episodes of decline in his condition, but overall he is making progress.” He also described Jake as having a serious mental health disorder that is “very resistant to treatment”.
A spokesperson for Nottinghamshire Healthcare NHS foundation trust said: “While we cannot comment on the care of individual patients, we fully understand that families want the very best for their loved ones and we recognise how difficult it can be when progress feels slow. We always welcome families raising concerns with us and are committed to working with them openly.
“Decisions about moving a patient to a lower level of security are made carefully, taking account of their recovery and wellbeing alongside wider safety considerations. For many patients at Rampton these decisions also involve the Ministry of Justice and the receiving service, which can mean the process takes time.”
Neate firmly believes Jake is deteriorating at Rampton. “Jake says he is fighting a battle between good and evil and says he has to rescue Sue,” she says. “He isn’t the same person he used to be … I don’t think he’s always treated as a human being, as a person. Everything is so clinical there. They talk about his presentation, as if he’s a thing, rather than a human with a heart.
“I feel like I’m banging my head against a wall trying to help him. All I want for Jake is a life that’s reasonable, with some hope in it. People who are mentally ill are entitled to a bit of care. But I don’t believe Jake’s getting that. It’s not at all cushy or luxurious for him in Rampton, very far from it.”
