"Spanning a period of two centuries, the extensive Irish asylum/mental hospital system was spectacular in its duration and scale. During the 1950s, the level of mental hospital usage in Ireland was the highest internationally, with a rate of 710 beds per 100,000 of population, followed by the USSR at 617 and the US at 511."
"This mental hospital system was by far the largest form of institutional intervention ever to have existed in the Republic of Ireland. For example, while about 10,000 women were known to have entered Magdalene Laundries in their entire history, during the mid- 1950s there were in excess of 20,000 individuals resident within mental hospitals on a single night."
"However, unlike the church-run institutions such as Magdalene Laundries and mother-and-baby homes, the mental hospitals were fully state-controlled. While there has been justified public shock at the neglect and abuse experienced within church-run institutions, responsibility for state mental hospitals cannot be placed at the door of the church, or within the opaque space that exists between the State and church."
"The other avenue of moral avoidance, to blame the British, is equally indefensible; mental hospitals were not 'liberated' after independence, rather they were expanded. In reality, our mental hospital system is an institutional wrong that is firmly situated within Irish communities, families and professional groups, which may explain our reluctance to delve too closely into them."
"We cannot in conscience claim ignorance of the existence of these institutions or the conditions within them. Mental hospitals were an annual feature of public record in the reports of the Inspector of Mental Hospitals, they were intensively utilised and known about by local communities."
"The remarkable growth of mental hospitals had little or nothing to do with the mental state of the individuals who were institutionalised. There was no epidemic of 'mental illness' in Ireland, rather this institutional confinement occurred in response to social forces such as poverty and family dynamics along with the actions of the individuals and professional groups who directly carried out the act of committal."
"A host of social problems were 'managed' in these institutions, with many individuals living out a large portion of their lives in these harsh places of confinement. The diagnostic criteria for admission changed over time and were loosely applied. One report for 1879 sets out reasons for admission under four headings: 'Moral Causes, Physical Causes, Hereditary and Not Known'. Moral causes included 'poverty, reverse of fortune', 'grief, fear and anxiety', 'religious excitement', 'domestic quarrels', 'ill-treatment', 'pride', 'anger' and 'love, jealousy and seduction'."
"Individuals continued to be admitted for a range of social reasons including family disputes, poverty, addiction and homelessness. I do not dispute that there was (and still is) a small group of people who experience serious mental health issues that need professional intervention and care, however, in practice, Irish mental hospitals became a major repository for social problems."
"While the intended function of mental hospitals was to provide 'care' to those categorised as being 'mentally ill', these institutions developed into locations of substantive social and economic importance to the communities in which they were situated. Rather than being austere institutions on the margins of communities, mental hospitals were in fact closely intertwined with the fabric of Irish social life."
"They became a valuable source of direct employment, a large consumer of locally produced goods and a key location for the development of professional practice, all of which depended on a continued 'supply of patients'. The importance of these institutions to local economies made their closure politically impossible up until the height of the Celtic Tiger economy, when nearly full employment eroded the local political resistance to job losses."
"In 2006, a new policy, A Vision for Change, was set out by the Department of Health and Children, which called for the final closure and sale of mental hospitals. However, in reality, they had been in decline since 1956, being practically empty by 2006. Vision for Change also set out the new provisions for the delivery of community-based mental health services. When industrial schools, Magdalene Laundries and mother-and-baby homes were eventually closed, the religious orders running them were not placed in charge of child welfare and sexual health programmes. In contrast, the very professional bodies who directly oversaw and enacted the most enduring and wide-scale Irish programme of institutionalisation within mental hospitals have now secured the most prominent positions of control within contemporary Irish mental health services."
"It is good that the large mental hospitals are almost a thing of the past. However, it would be unwise to assume that Irish communities have become more sensitive and tolerant to individuals who 'challenge' social expectations. The tenfold decrease in mental hospital residency since 1950 has been mirrored by a tenfold increase in the prison population."
"An inquiry into the excessive use of mental hospitals in Ireland will happen at some point. It is my hope that this review will start soon, as many of those who have been damaged by these institutions are now elderly. Their stories will be central in helping us understand how as a society we became so efficient at incarcerating our family members and neighbours in such great numbers."
Dr Damien Brennan trained and worked as a psychiatric nurse and is Assistant Professor at the School of Nursing and Midwifery, Trinity College Dublin. He recently published 'Irish Insanity 1800-2000' (2014 Routledge)
Originally published in the Irish Independent on June 28th 2014
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