The hospital treatment of Moors Murderer Ian Brady may have been affected by his notoriety, his mental health tribunal has been told.
Staying in the same place and with the same care team for 30 years was "exceptional" and not a "healthy position", consultant psychologist David Glasgow told the hearing.
Brady, 75, has brought the tribunal, which is being held in public, because he believes he is not mentally ill and wants to be transferred to a prison from maximum security Ashworth Hospital in Merseyside.
The child killer, who has been on hunger strike since 1999, has said previously he will be able to starve himself to death in a jail - currently he is assessed as being chronically mentally ill and is fed through a tube in his nose.
Mr Glasgow, called by Brady's legal team, said he thought the current nursing care provided to Brady did not amount to treatment and the hospital's overall therapeutic approach did not appear to have any goals.
He said: "My concern is that his notoriety has affected his treatment. There is a compelling argument that the move in 1999 (from one ward to another) irretrievably compromised his relationship with that care team. I was very surprised to learn that he is exceptional in that he has stayed in the same place with the same team for 30 years. This is just not a healthy position to be in."
Mr Glasgow said it was his opinion that treatment and goals needed to be constantly changed, he said.
Brady was transferred to Ashworth in 1985 when his mental health deteriorated. His legal team says he has a severe narcissistic personality disorder but is not mentally ill and could be treated in prison rather than hospital. But Ashworth says Brady remains a paranoid schizophrenic who should stay at the hospital. The hearing is being relayed to the press and public on TV screens at Manchester Civil Justice Centre.
Brady was given life at Chester Assizes on May 6 1966 - the last time he spoke in public as he denied a series of child murders. Brady and his partner, Myra Hindley, were convicted of luring children and teenagers to their deaths, with their victims sexually tortured before being buried on Saddleworth Moor.
Brady was given life for the murders of John Kilbride, 12, Lesley Ann Downey, 10, and Edward Evans, 17. Hindley was convicted of killing Lesley Ann and Edward and shielding Brady after John's murder, and jailed for life. She died in hospital, still a prisoner, in November 2002 at the age of 60.