Mental health services – time for change


Sir, – Your editorial draws welcome attention to mental health services (“Shortcomings in mental healthcare: facts that shame”, July 26th).

The 50th anniversary of the 1966 Commission of Inquiry on Mental Illness passed relatively unnoticed two years ago. This ground-breaking report noted that “too many” psychiatric establishments had “inadequate facilities and services” and lacked the required “therapeutic atmosphere”.

There were unfulfilled needs for “treatment in the home or in surroundings akin to the patient’s normal mode of living” and for “adequate community services”.

The 1966 commission recommended a move away from “barrack-like structures characterised by large wards, gloomy corridors and stone stairways”, and provision of enhanced community services, more multidisciplinary care and better services for children.

All statements of mental health policy since 1966 have essentially reiterated the 1966 report with some amendments and updates.

This is not a bad thing: inpatient numbers have fallen from 18,084 in 1966 to 2,408 in 2016. Ireland’s rate of involuntary admission is now less than half of that in England, although some people pay a high price for this shift, ending up homeless or in prison.

This week, the Mental Health Commission called for “major transformational change”, with particular emphasis on community residences and services for children.

Over 50 years ago, the 1966 commission made a similar call for “radical and widespread changes”.

These changes need to occur not just in the area of health but across all government departments, all State services, and all parts of society. This is a whole-of-society issue, requiring a whole-of-society response. It’s time. – Yours, etc,


Professor of Psychiatry,

Trinity College Dublin,

Dublin 2.