Sir, – Eoin O'Sullivan and Ian O'Donnell draw welcome attention to the history of Ireland's psychiatric hospitals ("Time for inquiry into psychiatric patients' care", Opinion & Analysis, February 9th).
The magnitude, complexity and embeddedness of these State-run institutions is not to be underestimated.
In 1951, Ballinasloe had a population of 5,596, of whom 2,078 were patients in the “mental hospital”.
As a result, virtually everyone in the locality was a stakeholder in the institution in one way or other. Many people worked in it, including members of emerging mental health professions, keen for recognition and prestige. Others provided supplies or had family members admitted.
These were not “hidden institutions”, as is sometimes claimed. The mental hospitals were enormous, visible, and deeply embedded in their communities. It was not uncommon for families to remove relatives from the hospitals to work for them in the summer and return them in the winter (“wintering in”).
On some occasions, medical professionals sought to keep patients in the hospitals, but on other occasions they tried, unsuccessfully, to discharge them.
Many hospital archives contain letters from doctors urging families and governmental authorities to cooperate with discharge, often to little avail.
Some families were simply too poor to receive home a person with enduring mental illness or intellectual disability. Some argued that that person was better off in the mental hospital and should be kept there until death.
Ultimately, the end of the institutions was attributable only in part to advances in clinical psychiatry (such as antipsychotic medication) and was more substantively shaped by broader changes in Irish society, such as the opening up of Ireland to greater outside socio-political influences in the 1960s and 1970s, an increasingly free press, the growth of the language of human rights across Europe, and Ireland’s accession to the EEC in 1973.
Today, Ireland has the third-lowest number of psychiatry beds per capita in the EU.
While this shows long-overdue respect for the right to liberty, it also means that we have many mentally ill people in our prisons and homeless on our streets. Prison is toxic for the mentally ill. The streets can be fatal.
We need appropriate inpatient care for the severely ill, stronger community mental health care, and more rights-focused health and social services to get this balance right. – Yours, etc,
BRENDAN KELLY,
Professor of Psychiatry,
Trinity College Dublin,
Dublin 2.