Original subtitles

NARRATOR: Deep in the Berkshire countryside

sits one of Britain's most feared institutions...

My first impression was, "This is a prison."

..Broadmoor Hospital.

It's notorious because of who's there.

A place where dangerous men are sent...

..when there's nowhere else for them to go.

You are dealing with people

who carry substantial risk of harm to the public.

There's always that risk that violence might erupt.

This is the inside story

told by those who've worked behind its walls...

One patient suddenly turned on me and said,

"The trouble with you is that you won't let me be mad."

..those once detained here...

..and by the most notorious of all.

He called me Bob, and I called him Peter.

PHONE RINGS

AUTOMATED MESSAGE:

Secretly recorded and speaking from beyond the grave.

Some will never leave.

You're there until it's deemed fit that you could be released.

This is the story of how to get out of Broadmoor.

People have escaped from high secure units.

It does happen, and it happened while I was there.

NARRATOR: Broadmoor Hospital

is one of the most secure institutions in Britain,

home to over 200 men with mental illness

or personality disorders.

It is surrounded by dense woodland, 22ft-high walls

and cutting-edge CCTV cameras.

But despite all the security,

there's still one sound synonymous with Broadmoor.

SIREN BLARES

The escape siren. SIREN BLARES

If there was an escape...

..these sirens would wail, warning the local citizens

that someone dangerous had left Broadmoor.

They were tested every Monday morning at 10am

and, I think, sent terrible waves

through the community and the local area,

making it very aware that Broadmoor was there.

Break-outs from Broadmoor are incredibly rare -

but escape is not impossible.

People have escaped from high-secure units.

It does happen, and it happened while I was there.

In July 1991,

one of Broadmoor's most dangerous and depraved patients

managed to escape.

SIREN BLARES

It was in the morning, and I heard this noise, and I thought...

"..Oh, that's the siren."

I remember that siren.

It was a wailing...

whirring god-awful noise.

As the escaped patient vanished into the woods,

the surrounding village of Crowthorne went into lockdown.

Everybody locally were told to lock their doors.

The kids, the doors all closed at the schools.

REPORTER: Schools in the area were closed,

and parents were told to keep their children off the streets.

With a violent offender on the run,

staff members were expected to drop everything

and report for duty.

Got in the car. Drove to Broadmoor quite fast.

Went straight to where the reception's all set up.

So, maps came out from behind the ward

so that the police and everybody knew the areas.

Masses and masses of telephones, maps, everything.

It was like a huge war room, if you like, and there must have been

60 police cars in there from all over.

Police roadblocks, helicopters - the lot.

The whole jamboree.

Nurses and police were sent out to search for the runaway patient.

And we were all put in teams,

and you paired up with the police, and off you went.

But the search teams had their work cut out.

The man on the loose was no ordinary patient.

He was convicted child rapist James Saunders,

also known as the "Wolfman"

because he'd lived in the wild whilst being hunted by police.

They called him the Wolfman

because he went on the run

and decided to live rough in the Wiltshire countryside.

So, you have this man who's been on the run.

It creates a storm nationally

and earned him the nickname of the Wolfman.

After five years and seven months in Broadmoor for violent rape,

Saunders was on the run once again.

Staff scrambled to work out how on earth he'd got away.

Evidence of Saunders' cleverness is that to distract attention

from the fact that he was planning to escape,

he helped to organise a pizza-making competition

which involved the chef and the staff in Broadmoor.

Neil Wheatcroft was Broadmoor's head chef at the time.

He was a wiry muscly patient, who...

When I first met him,

he said, "Would I be prepared to do a demonstration of pizza making?"

This was the initial meeting with him, and I said, "Yes, we can."

But the pizza party was just a diversion.

With the staff preoccupied, Saunders made his escape.

And it's during this he used the time to slip away

and exit through the shower room window.

He'd stolen a hacksaw blade from the workshop.

And he sawed through three window bars.

He's also tied bed sheets together

so that he could go down to the ground.

And he would have dropped to the deck,

ran across an open courtyard...

..to the next wall

and then over into the woods and gone. Very clever.

I mean, it was extraordinary ability.

I'm not saying for a moment

that he shouldn't be incarcerated, of course,

but my goodness me, that was some achievement.

Saunders was strong, fast and easily able to hide in the wild.

REPORTER: Hunting him is no easy matter.

Broadmoor is bordered by dense, thick pine forests.

All day, helicopters have been scouring the area,

flying at treetop height

whilst men on foot searched the undergrowth beneath.

A day and a half passed with no sign of Saunders.

I've done nine-hour stints on the road, searching cars.

And then a breakthrough.

Around 40 hours after the alarm was raised,

a member of the public

spotted a man acting strangely in the woods

outside the Somerset village of Croscombe,

almost 90 miles from Broadmoor.

They called the police.

A neighbour apparently said something to a policeman,

and then they sent the truck down to fetch him.

And he didn't put up a fight, particularly.

He just acknowledged it and said, "Well, you've got me,"

and went back to Broadmoor.

Although Saunders had been recaptured,

questions were raised

as to how he had managed to saw through the window bars.

One of the things that we used to do for security purposes

was we used to go into patients' rooms,

and we would rattle our keys along the bars.

And if you heard a different sound from one of the bars,

that was an indicator that it had been sawn through.

It's very complicated to escape from Broadmoor.

It's a lot of locks to go through,

a lot of guards to pass, a lot of security.

At Broadmoor, a patient escape is known as a "Never Event",

something that under no circumstances

should be allowed to happen.

So what happened next was doubly damaging.

And, so, a couple of years later, in 1993,

the Wolfman decides to escape again.

He just took off like a roadrunner.

Off he went. And over the wall - gone.

NARRATOR: Broadmoor had been rocked

by the escape of child rapist James Saunders.

The 40-hour manhunt caused a national scandal.

It was deeply wounding to Broadmoor

that such a dangerous man should be allowed to escape.

But although he had been recaptured,

the patient known as the Wolfman was undeterred.

Saunders wasn't content to remain in Broadmoor,

and so a couple of years later,

in 1993, the Wolfman decides to escape again.

This time, Saunders seized a chance opportunity.

He was escorted off the unit to go to a work area.

So, there was actually staff there,

and he just took off like a roadrunner.

And he ran just full tilt and then up a lamp

and jumped from the lamp onto the 22ft wall down the other side.

Off he went and over the wall - gone.

Remarkable, and worthy of the circus.

My friend said, "Bloody hell, he just got over the wall.

"God, he's done it again."

SIREN BLARES Yet again.

The siren sounded yet again.

It proved that you could escape from Broadmoor

if you were determined and if you were lucky.

But on this occasion, luck wasn't on his side.

When he landed on the other side, he did his ankle in.

Saunders was recaptured.

But that was the last time

those sirens were sounded in anger at Broadmoor.

There was never another escape.

Things tightened up. They got more security.

A lot more cameras were being installed outside.

The reality is it's very hard to escape from Broadmoor, indeed.

As Saunders discovered, the only guaranteed way

out of Broadmoor Hospital is to get officially discharged...

..and many patients do get out the right way,

like former patient Joshua, who made progress with his recovery

and was allowed to leave after seven years.

After making a series of violent threats,

Joshua was sectioned and sent to Broadmoor Hospital in 2004.

At Broadmoor, Joshua received much-needed treatment.

Joshua was discharged from Broadmoor

after a long programme of treatment, therapy and reflection.

Though Broadmoor might look like a prison...

..it is in fact a secure hospital

treating some of the country's most dangerous mental health patients.

We work, as anyone else in psychiatry would work,

with all the most modern treatments.

It's just that we have security as well,

so it's a proper modern hospital but with security.

At Broadmoor, patients who have committed a crime

are detained with a hospital order,

a legal declaration that detains those criminals

whose mental health makes them a risk to themselves or others.

Unlike a prison sentence,

a hospital order has no set end date,

so patients must remain in Broadmoor

for as long as doctors deem it necessary.

One of the extraordinary things about Broadmoor is that

you aren't really sent for a determined term.

You're there until it's deemed fit that you could be released.

This means that if you want to get discharged from Broadmoor,

you'll have to follow a rigorous process of treatment and therapy.

The first stage in all of this

is to get the mental illness under control,

and so the person is without the symptoms

that caused the problem in the first place.

On top of that, you then want to make sure the person has insight

into the past difficulties that they had...

..and that they have an understanding of some of the ways

of dealing with the illness in the future if it were to return.

So, within Broadmoor,

there are different levels of security on the wards,

and you want to see

someone progressing to the lowest level of supervision.

So it's about a gradually reducing the level of surveillance

until you can reintroduce someone to the outside world.

If a patient has served out their criminal sentence

and can demonstrate that their symptoms are under control,

then even serial killers can be considered

for discharge to the outside world.

One such patient is Kenneth Erskine,

more commonly known as the Stockwell Strangler.

REPORTER: They were the sort of people

least able to defend themselves -

the elderly, the sick and the frightened.

They were the victims of a psychopath who roamed the streets

at night for nearly five months, looking for pensioners

who he strangled to death and sexually abused.

The period between April and July 1986,

we know for certain that Erskine killed seven times.

He deliberately targeted vulnerable old individuals.

He was 23. They were between 67 and 94.

They were people that he could exercise

a level of control and power over.

REPORTER: This morning, police repeated

their warning to elderly people

to keep all doors and windows locked at night.

He would climb into the house, through the window

and attack the old person, often sexually.

He would strangle them. He would sodomise them.

It's impossible to imagine

what that must have felt like to his victims. Out of nowhere.

Fred Prentice was asleep in bed in an old folks home

when a man climbed in through a window and tried to strangle him.

He was just out of control.

He wouldn't stop, indeed, until he was stopped.

REPORTER: When eventually caught and tried,

24-year-old Erskine was sentenced to 40 years,

at the time, the longest ever jail term handed down in Britain.

Sentenced in 1988,

Erskine was initially sent to a high security prison.

Shortly after his conviction,

he was sectioned under the Mental Health Act.

During the trial,

Erskine is reported to have behaved really quite inappropriately.

Whilst in the dock, he was seen to be giggling and laughing

and speaking to himself, and there was also a point

where he was observed to be masturbating within the dock.

That behaviour really is telling

of somebody who is experiencing a mental illness.

Erskine was diagnosed with a personality disorder

as well as his chronic schizophrenia and goes to Broadmoor.

On arrival at Broadmoor, Erskine's symptoms were assessed.

Erskine would have been in quite an acute state of mental illness,

so he would be extremely destabilised, really quite paranoid,

mistrusting of the people around him.

He talked about experiencing what's called command hallucinations

that commanded him to undertake certain actions,

to do certain things.

I think the key thing with his experience of psychosis

is that he was completely out of touch with reality.

So I think he would have presented as being quite challenging.

At Broadmoor, Erskine received therapeutic treatment.

Doctors will generally utilise evidence-based interventions,

such as cognitive behavioural therapy, schema therapy,

dialectical behaviour therapy, and these are evidence-based therapies

that we know that will impact mental illness.

Erskine's mental illness was also treated with medication.

In general, schizophrenia is responsive to medication.

These are not just tranquillisers, they are very specific

antipsychotic, anti-schizophrenic medications.

And in 90% of cases of schizophrenia,

they're going to produce an improvement,

often a very dramatic improvement.

Certainly my experience,

if you remove from the picture the acute mental illness,

give them some medication, basically,

the risk practically disappears.

You can't believe when they first came in, how they presented,

how destructive, how aggressive, to turn out...

where you think, "My gosh,

"they've gone through all that therapy and medication,

"and look at them now."

It's just unbelievable, really.

And that's what keeps you going as a nurse.

In order to be considered eligible for discharge from Broadmoor,

a patient's entire clinical team has to be in agreement.

Everybody that's had input with that patient would have their say,

a long, long process.

And then once everybody in that team are satisfied,

they go to a tribunal.

Introduced in 1983,

a mental health tribunal is an independent panel of experts

who meet in a special tribunal suite to assess patients at Broadmoor.

All patients, including Erskine, have the legal right

for their detention under the Mental Health Act to be considered

at a tribunal hearing once a year.

It's essentially a small court of law

which considers whether the criteria for detention are still met.

There's a judge, a medical member and a lay member.

The Mental Health Review Tribunal either says,

"Yes, we're gonna lift the hospital order

"and leave the restrictions in place."

Or, "No, we don't agree that this person is ready."

For Joshua, regular dialogues with his clinical team

helped him keep his recovery on track.

But every release from Broadmoor Hospital has its risks.

And when things go wrong, the results can be deadly.

He games the system. He is indeed duly released from Broadmoor.

Then he embarks on what can only be called a killing spree.

Broadmoor Hospital houses some of Britain's most violent criminals.

So it's no surprise that

many patient discharges come under intense scrutiny.

Whenever somebody is discharged from hospital,

it is on the balance of risks, really.

You can never be certain of what's going to happen in the future.

There is a risk that...

that violence might erupt again.

I think there's pressure in Broadmoor to make sure

that any patient they discharge was completely safe.

But human behaviour is so unpredictable.

If you release someone

on the theory that they have been cured or rehabilitated,

and they proceed to kill again,

then you are hanged by public opinion and by the media.

And the most notable example of that, of course, is Graham Young.

In 1962, Graham Young was convicted of poisoning members of his family

by slipping the dangerous chemical thallium into their tea.

After being diagnosed with psychopathic traits,

the Teacup Poisoner was sent to Broadmoor.

He was just 14 years old.

He had taken a fascination with chemistry,

and he started off by killing his stepmother

and trying to kill his father and sister.

In Broadmoor, he was rather a weird, creepy man. Sort of remote figure.

Sort of on the periphery of everything.

Nobody drank any tea that he'd prepared.

After just two years in Broadmoor, Young set his sights on freedom.

He was determined not to spend any longer

in Broadmoor than he can help it.

So he games the system.

He was very, very capable of saying the right things,

appealing to the authorities in the correct manner.

I believe that he was thinking to himself,

"I can groom Broadmoor to my advantage.

"Convince the authorities that I am actually rehabilitated,

"regardless of what is in my mind."

In the 1960s, there were no mental health tribunals.

Young only had to convince his psychiatrist that he was reformed.

The psychiatrist petitions the Home Secretary on his behalf,

saying he's given up his mischievous interest in poisons and violence.

The truth was rather different.

I think he wrote a letter to his sister at one point,

saying, "Your friendly local Frankenstein

"is about to be released again."

That is Graham Young... in a nutshell,

"your friendly local Frankenstein".

In 1971, just nine years after his arrest,

Young's wish was granted, and he was allowed to leave Broadmoor Hospital.

It appears that he was discharged prematurely

by persuading his psychiatrist and the Broadmoor authorities

that he was fully reformed.

He was only a young man. So he was discharged.

They helped him to get a job in a photo development shop.

He has access to poisons, including thallium.

Within just weeks, Young began poisoning his colleagues

in his trademark manner by lacing their tea with thallium.

He embarks on what can only be called a killing spree.

Not only tried to kill his own family,

but now he's killing random people he works with.

One by one, Young's colleagues began to fall ill.

Many were hospitalised.

The police began an investigation,

and the Teacup Poisoner couldn't resist the limelight.

He took great delight in going to the police press conferences

about the number of people who were becoming sick in his workplace.

And he showed an abnormal interest,

so much so that the police picked up on him quite quickly.

And then when they checked on his background,

they found out that he'd been in Broadmoor for poisoning

and had recently been released.

By the time Young was caught, two of his colleagues were dead

and several more were critically ill.

When Young is re-arrested in November 1971,

he's attempted to poison no fewer than 70 people.

He has thallium in his pocket.

He has a diary which notes exactly what dose is given to whom.

So, of course he was arrested and convicted and returned to prison.

The revelations about Young caused a national outcry.

I think Broadmoor was hugely damaged by Graham Young's release.

He's incarcerated for one set of crimes,

is released and then does exactly the same thing all over again.

The Graham Young discharge led to public inquiry

as to how he could be released and then kill again.

I don't think any country in the world could produce a better record

than our doctors in Broadmoor,

but the best doctor in the world can occasionally make a mistake.

That's where the tribunal can come in handy, really.

Because if there's a serious difference of opinion,

a judge, an independent doctor and a social worker

can take a look at both sides and decide.

The Young inquiry led

to the reform of the psychiatric hospital system nationally

and eventually the introduction

of high, medium and low secure psychiatric units.

Today, these units form

a vital part of the discharge process for every patient.

No-one goes straight from Broadmoor to the outside world.

Young was probably the most chilling

and the most compulsive serial killer

we've created in this country.

I don't think he could stop poisoning.

I think he would have gone on as long as he could get away with it.

Graham Young's psychopathy meant that he was able to come across

as calm, sane and rational.

This helped him fool his Broadmoor psychiatrist.

Psychopaths don't appear, on the face of it,

to be mentally unwell.

They can plan, they can organise,

they can, you know... they can think rationally.

They display very charming behaviour

because they knew that that's what was required.

So they were able to manipulate particularly their psychiatrists

because that person held the key to them being discharged.

The challenge for Broadmoor's doctors becomes even more acute

when a patient has been convicted of violent, notorious crimes.

With the people who've committed

very serious and particularly high profile offences,

you are playing with quite high stakes in this.

And the stakes don't get much higher than with the Stockwell Strangler.

After 21 years at Broadmoor,

in 2009, Erskine appealed his conviction.

The Court of Appeals reduced the murder conviction

to manslaughter on the grounds of diminished responsibility.

Appeal judges heard new medical evidence proving

Erskine had been suffering from severe schizophrenia

at the time of the killings.

With his conviction reduced,

Erskine's future was now largely in the hands of his Broadmoor doctors.

But should a man guilty of seven killings ever be set free?

So, Erskine would have to really demonstrate compliance

with treatment and that medication.

He would have to demonstrate an insight into his violent offending

and the factors that led to that and contributed towards that.

Seven killings.

I mean, a man who clearly suffers from some kind of disease.

I think it's a very difficult thing to decide what you should do

with someone like Kenneth Erskine.

I hesitate to say lock them up and throw away the key,

but I am profoundly cautious about releasing someone like Erskine

so that they may soon taste freedom

because I fear that they may commit the same crimes again.

But Erskine has appeared to be making progress with his recovery.

In 2016, he was transferred from Broadmoor to Thornford Park,

a nearby medium-secure unit.

I think it can be difficult for people to understand sometimes

that somebody who has done something really horrendous

can ever be safely discharged into the community.

But once you give them some medication,

get the illness under control, you're often left with someone

who actually presents very little, if any, risk to anybody.

And it's very important to recognise that in those circumstances.

Now one of Britain's most prolific serial killers

is reportedly eligible for day release.

It's a very interesting arc

for this extraordinarily violent, vicious man

to go through a period of rehabilitation

with the help of Broadmoor.

I think the fact that Erskine is now in a lower security environment

is, to some extent, a reflection of Broadmoor's success.

Probably they regard it as a success.

I suppose it gives you hope.

It's important to know that there's always a chance,

no matter what they've done, it's really important.

There's always a chance that in the future,

they will be able to be released.

There will be freedom for them in the capacity that they can feel,

that actually, they can go the other side of the wall.

The mission of Broadmoor is to...

..exercise and practice therapy

so that people can get better.

The patient is going to be back out in society,

living with us as our neighbours.

Shouldn't we invest everything so that they are restored in some way,

so that we can continue to live in harmony?

That's a challenge,

to start looking at bringing somebody back out into society

because you're there to protect the society as well,

protect the public.

That's a duty of care.

But there's the crux of the debate.

The public want to be protected.

They do not see Broadmoor's role as rehabilitation.

They say we just simply don't want those dreadful, dangerous men

anywhere on the streets.

It's a conflict.

And Erskine precisely captures the conflict.

Whether Kenneth Erskine will ever be completely free remains to be seen,

but one of Broadmoor's most infamous residents

was content to stay there forever.

Ronnie Kray, in many ways,

Broadmoor was probably the ideal place for him.

He was content in Broadmoor.

He had everything he wanted.

I think one of the Krays once called it cushty.

NARRATOR: The majority of patients released from Broadmoor Hospital

pose little threat to the British public.

But no patient goes straight from Broadmoor to the outside world.

They are first sent to medium-secure units

outside the hospital.

Patients in medium security

are granted access to certain privileges.

The security is always there, but relaxed.

A lot more relaxed.

The move from Broadmoor to a medium-secure unit

can be a momentous day for both patients and staff.

I felt good about the ones I'd helped get to that stage,

and you get a shake of your hand and say,

"Thanks for looking after me."

And you think, "Yeah, OK, it's been worth it."

The best thing for myself personally as a nurse,

the fact that you do see a day coming

where somebody eventually gets transferred.

It just gives me so much joy to see somebody leaving.

And they've got a whole life out there to live.

But life after Broadmoor can be difficult.

After years inside, the outside world can be a disorientating place.

They haven't seen a car for ten years,

haven't been to the pub,

haven't been out for a meal or a walk in the park.

It's so different for them, you know.

Once transferred to a medium-secure unit,

escorted trips are an option, but they can be challenging.

Even fully discharged patients remain in contact

with Broadmoor staff,

staying in touch in case any problems arise.

People would be discharged,

and it would be part of my job to supervise them in the community.

They couldn't just go out to the shops,

they couldn't form normal social relationships

like the rest of us could.

You'd hear examples of people in their own flat

looking around for somebody to ask for permission to go to the toilet.

Really institutionalised and very, very difficult to adapt.

When I was at Broadmoor, one of the patients

who was being prepared for discharge

was taken out to Reading on a shopping trip on a train.

During the journey, he was very anxious and very agitated,

and at one point, he stood up on the train and fell over.

The train was moving so fast, he'd never been used to such speed.

For some patients, the prospect of living an independent life

outside Broadmoor is too much to handle.

There is a minority of people who don't have families

who looked upon us as part of the family.

There was one lady who was finally discharged,

and she was banging on the gates to come back in.

That says a lot, really, doesn't it?

Not all patients get discharged from Broadmoor.

In fact, not all patients want to be discharged.

Sometimes, patients and staff come to recognise

that Broadmoor is simply their final home.

GEOFFREY: Ronnie Kray, there's no question about it.

In many ways, Broadmoor was probably the ideal place for him.

Convicted of murder,

The East End gangster Ronnie Kray was sent to Broadmoor in 1979

after being diagnosed with paranoid schizophrenia.

Ronnie Kray was not entirely sane.

He was by far the most dangerous of the two twin brothers,

and he was very much a loose cannon.

Kray's friend, Maureen Flanagan, made regular visits to Broadmoor.

He had his black moods,

where he told me when he first woke up in the morning,

he knew it was gonna be a bad day.

He thought he was going down a tunnel,

and at the end of it was bloodshed.

Once hospitalised,

crazed schizophrenia was treated with medication.

He started freaking out, and he felt he wanted to attack.

And that's what had to be subdued in Broadmoor and regulated.

And it was.

He's been injected many times and sedated.

They call it the liquid cosh.

And sometimes, it takes him days to get over that.

Over time, the gangster's fearsome persona diminished.

Author Bernard O'Mahoney recalls meeting Kray in Broadmoor

for the first time.

I went into the visiting room.

I was looking for really big guy,

jet black hair and inky black eyes.

And this little guy

in his immaculate suit sort of waved at me, you know?

I thought, "That can't be him."

He was like a little old man, do you know what I mean? He...

He wasn't intimidating to me at all.

But, er, I think he was quite happy where he was, to be honest.

He knew. He knew exactly what was wrong with him,

and he knew he'd never come out.

When Maureen organised a petition

to try and get the Kray twins released,

Ronnie intervened.

He said, "Take my name off of the petition."

I went round to the East End. I got 10,000 signatures.

He said, "Take it off. I'm never gonna leave."

There is no doubt, too, that some of the criminal community

regarded Broadmoor as a holiday camp.

A soft option, a lovely place to go.

I think one of the Krays once called it cushty.

But Broadmoor was the one place, I think, that Kray felt comfortable.

He became more calm, more happy.

He was content in Broadmoor.

He had everything he wanted. Number one, his room.

His room became to look like his bedroom in his mother's house,

with the little desk there with these pictures

and the single bed here and the rug on the floor and the curtains.

He played his opera. He loved to listen to Maria Callas.

I think he felt, "I can make sense of this,

"and I can make a life for myself."

He was a very notorious gangster indeed.

But perhaps, at Broadmoor, he found an element of peace.

Peace, too, has descended on the Berkshire countryside.

The Broadmoor sirens have been decommissioned

and replaced with a high-tech text-alert system.

In 2019, the entire hospital was redeveloped,

transforming Broadmoor into an institution

fit for the 21st century.

PAUL DEACON: The new hospital that is built is now right beside

the old Broadmoor Hospital.

Very modern.

Lovely conditions inside. Activities.

Technology. Completely different.

All those things are very crucial to somebody

who's going through mental health problems.

Nobody chooses to have mental health issues.

Who on earth would choose that?

So I would say support them.

And take a minute, surely, just to stop

and talk to somebody who you can see they're troubled.

"Are you OK? Do you need a hand?"

Or, "You look upset. What can we do for you?"