Ireland’s mental hospitals: the last gap in our history of 'coercive confinement'?

At the age of 19, Hanna Greally was admitted to St Loman's Psychiatric Hospital in Mullingar. It was the mid-1940s and she had just returned home from London, where she had witnessed the horrors of the blitz.

She thought she was being admitted to the hospital for “a rest”.

Despite several escape attempts and pleading letters to relatives to sign her out, she remained there for the best part of 20 years.

Bird's Nest Soup, her book published in the 1970s, captured in haunting detail the lives of others stripped of their human rights – social outcasts, the unloved, the incurably embittered and the dispirited.

“The patients inside, expectant, waited for the letters and the visits, until finally, one day, they would find themselves rejects, outcasts, and no explanation given. Sometimes a crushed spirit breaks, from mental agony and anguish, when she understands at last she is captive in a free society.”

At the time there were more than 20,000 patients confined behind mental hospital walls across the State, or 0.7 per cent of the general population.

In fact, Ireland led the world locking people up in institutions, with inpatient admission rates that were multiples of other countries – even ahead of the old Soviet Union.

“The high rate had nothing to do with mental illness,” says Dr Eoin O’Sullivan, associate professor in social policy at Trinity College Dublin. “They were used to dispose of people who society didn’t want . . . They were the single biggest part of our system of coercive confinement.”

As the Government prepares to establish a commission of inquiry into the operation of mother and baby homes, some mental health campaigners now say it is also time to shine a light on another gap in our social history – what happened behind the high walls of our mental hospitals.

These institutions share – at least on the face of it – many issues that have been flagged in mother and baby homes.

Mortality rates were high, with more than 11,000 deaths every decade between the 1920s and 1960s.

Discredited procedures

Experimental but now discredited medical procedures were also commonplace, including lobotomies – which involved removing parts of the brain – and insulin coma therapy, where patients were repeatedly injected with insulin to induce a coma.

There is also evidence of controversial burial practices – such as mass, unmarked graves – and the wrongful incarceration of people who had fallen foul of families or authorities.

But there are also some crucial differences.

These were institutions operated by the State, which were subject to inspection and, in some case, were closely integrated in the community.

"They were asylums in the old meaning of the world," says Dick Bennett, a former staff nurse who worked in St Brendan's Hospital in Dublin from the 1970s. "There was a sense of community there. The standard of care was excellent. You had people who lived into their 80s or 90s."

But the number of deaths was considerable earlier in the century. Eoin O'Sullivan and Ian O'Donnell's Coercive Confinement in Ireland found that one in 20 patients died annually between 1927 and 1963 – or 40,000 people – mostly from tuberculosis and other diseases, with a very small number taking their own lives or killing others," according to the book.

“Occasionally patients perished because they had been given the wrong medication, or tried to escape but fell into a river, or lost their lives in ways that are unexplained, but seemed to involve neglect or deliberate harm. Only in exceptional circumstances were staff called to account for such deaths.”

Death rates remained higher in psychiatric hospitals than in the wider community as the century progressed, though age began to play a bigger role.

"A certain number of deaths were to be expected in the asylums, especially as the asylum population aged, and fewer long-stay patients were created as the 1900s progressed," says Prof Brendan Kelly, a consultant psychiatrist who has researched the history of psychiatry. He points out that between 1965 and 2002, some 28,000 patients died in Irish psychiatric hospitals, of whom 68 per cent were over age 65 at death.

While some mental health campaigners have pointed to the similarities between psychiatric care and mother and baby homes, they were different in some key respects.

Prof Kelly points out that there was a system of inspection by state inspectors with reports made public.

“The meetings of the committee of management of the Ballinasloe Mental Hospital were held in public and reported in newspapers, and often poor practice was exposed at such meetings and remedied,” he says.

“That’s not to suggest this system or these safeguards worked all the time, especially as the asylums still grew too large and custodial, but there measures were, at least, in place, and had certain direct and indirect effects.”

Prof Kelly and Dr O’Sullivan also point out that the hospitals were often closely integrated with the community.

In Ballinasloe, for example, the town had a population of almost 5,600 in the early 1950s. Some 2,000 were patients in the mental hospital. This meant almost half the town’s population were patients, while the other half had close links in the form of employment or supplying the facility.

While there may be little appetite to examine in detail this gap in our social history, Dr O’Sullivan says there is merit in examining this wider landscape of how the State and wider society uses this institutions to confine and regulate unwanted people.”

‘Barbaric treatment’

Dr

Ivor Browne

, former chief psychiatrist with the Eastern Health Board, says he recalls with shame an era of “barbaric treatment”, but feels there is little to be gained in digging up the past. Instead, he says, we should focus on issues such as the overuse of drugs to treat mental health problems. While they have a role in treatment, he says, they are being overused. “There’s far too much focus on biochemistry, rather than examining what’s going wrong – or has gone wrong – in a person’s life,” he says.

“I spend most of my time taking people off drugs, but it can be a slow, painful process, combined with dealing with life problems.”