More people before courts due to shortage of psychiatric beds

The shortage of beds for people with psychiatric illnesses means that a lot more severely unwell people are appearing before the courts charged with serious crimes, a conference in Dublin heard on Saturday.

Such is the shortage of beds for people who have mental illnesses and are in need of secure care, that the only way they can access beds now is through the courts, Professor Harry Kennedy of the Central Mental Hospital in Dundrum, told the annual national prosecutors' conference, organised by the Director of Public Prosecutions.

“The day will come when a person is found not guilty [by the courts] by way of insanity and I’m not going to have a bed.”

The Central Mental Hospital, which is run by the National Forensic Mental Health Service, is the only secure mental health institution in the State. It has 82 beds.

Professor Kennedy, in an address entitled Dangerousness - a Dangerous Concept?, said psychotic illness is associated with recidivist homicide.

He presented statistics to the conference showing the number of secure forensic beds for mentally ill people in different countries as a percentage of the population. “This is how we care for dangerous patients.”

While England and Wales had 7.5 beds per 100,000 of population, and Germany had 10, the figure for Ireland was two.

Unlike most other countries, the move to community care and the reduction in the number of general psychiatric beds in Ireland over recent decades, has not been matched by an increase in secure forensic beds.

While Ireland in 1990 had more general psychiatric beds that most other countries in the world, the ratio fell very steeply in the period since, to approximately 2 per 100,000 today. In the UK the equivalent figure is 20.

Internationally, the fall-off in the number of general beds reached its lowest around 2004, after which it began to rise again. However the trend has not turned upwards again in Ireland.

Professor Kennedy said dangerous people with mental illnesses cannot be put into general psychiatric hospitals.

A lot more severely unwell people are ending up before the courts, and the range of mental illnesses they are suffering from is expanding. Dementia, Alzheimer’s, and autistic spectrum disorders were featuring in the courts, which was not the case until five or six years ago. This was in part due to people living longer, as well as the issue of historical offences coming before the courts.

The Dundrum hospital, which is an 1850s building, is being replaced by a new hospital in Portrane, Co Dublin, but there is to be only a small increase in the number of beds, he said.

“How dangerous does a problem have to be before it is addressed?”, he asked.