Historically, there were a large number of patients in District Mental Hospitals. At the end of 1950s, over 20,000 inpatients were in mental hospitals throughout the country. These institutions were the successors of the lunatic asylums, and provided little in the way of care or treatment. District asylums had been established in the late 19th century and persons with mental health issues had been moved from workhouses and prisons to them.
Many of these institutions later became mental hospitals. Some were significant institutions, and many had their own firms.
The Mental Treatment Act 1945 replaced older legislation and sought to prevent inappropriate admissions into psychiatric hospitals. However, this was objective not achieved for a very many years. The Act provided for committal orders only on the basis of a doctor\’s medical assessment. Prior to that, peace commissions had power to commit persons to mental hospitals.
The 1945 legislation allowed for voluntary admissions. By the 1980s, three-quarters of all admissions were voluntary.
Many persons were admitted to psychiatric hospitals entirely inappropriately, including children, older and marginalised persons.
Historically, psychiatric hospitals were administered by a resident medical superintendent who was largely autonomous. The role of psychiatric nurse only developed gradually. Several highly controversial techniques are used for treatment, many of doubtful value and some caused significant harm. Drugs became a feature of “treatment” or management from the 1960s onwards.
The Commission of inquiry on Mental Illness, 1961-66 highlighted shortcomings and recommended the replacement with sychiatric units attached to general hospitals, community care by multi-disiciplinary teams and greater involvement for GPs. The report was published in 1966, but had no strategy for implementation. Some outpatient services developed. Some sanitaroria foremely used for treatment of TB became used for psychiatric services. There were number of private psychiatric hospitals (13 ).
In the early 1980s very little had changed. \’A Plan for the Future\’ 1984 was a major strategic document. It recommended community treatment, moving long-term patients to live in the community. Psychiatric service for old age, separate services for alcoholics in the community and services for drug treatment, together children\’s psychiatric services were recommended to be developed.
Localised services were set up in most areas, with psychiatric units being provided in general hospitals. The numbers in psychiatric institutions fell dramatically. By the beginning of the new millennium, community care was well established. Institutions moved towards temporary residence. The number of day places increased, and community residence increased.
18 general hospitals havef psychiatric units.Private psychiatric hospitals such as St. John of God\’s and St. Patrick\’s provide inpatient accommodation with treatments commonly supported by the VHI and other health insurers. The hospitals also provide services on a contract basis for the health authorities.
The Mental Health Act 1981 was, passed but never implemented. A new Mental Health Act was enacted in 2001 following a Green Paper and White Paper on Mental Health in 1992 and 1995.
The Mental Health Act established the Mental Health Commission and created a new inspectorate of mental hospitals. It introduced procedures to bring mental health law in conformity with the European Convention on Human Rights. See the separate sections on mental health legislation.
The Commission prepares codes of practice and procedures for certain treatment and interventions. There is a mental health inspector and an independent review system for review of detention. There is a legal aid scheme and Mental Health Tribunal to deal with involuntary detentions.
In 2006 The Vision for Change strategy was published. The expert group recommended that the remaining public psychiatric hospitals (15) be closed down over 10 years. Community services would be enhanced. Additional staff should be recruited. It proposed crisis houses for patients of approximately 12 for persons, in lieu of admission to psychiatric institutions.. Inpatient beds for children and adolescents with mental health difficulty should be increased. More use should be made of counselling and therapies.
The Central Mental Hospital in Dundrum has existed since the middle of the 19th century. Its role as a criminal detention centre was radically changed by Criminal Law (Insanity) Act 2006. See the separate section under criminal law.
The 2006 strategy document, \’A Vision for Change\’ promoted a strategy which would involve closure of all psychiatric hospitals and the development of community services. There would be a greater emphasis on counselling and recovery than on illness.
The Vision for Change recommended the establishment of a national mental health services directorate within the HSE recommended
- community mental health teams consisting of psychologists, psychiatrists, social workers, nurses, counsellors, occupational therapists and other support workers
- one acute inpatient unit of 50 beds and a one-day hospital services for each area with 300,000 persons.
It recommended the closure and sale of the remaining hospitals.
A monitoring group was established to monitor the implementation of the recommendations. The policy has been adopted by government, but the rate of progress is slow. A comprehensive community-based service has been lacking in most areas of the country.