New Central Mental Hospital 'will be full within a couple of years'

Picture: Courtpix

The long-awaited and enlarged new Central Mental Hospital will be full within a couple of years, its director has warned.

The €170m hospital, located in Portrane, north Co Dublin, will have 170 beds, a 66% increase on its 102 beds in the current Central Mental Hospital (CMH), located in Dundrum.

The CMH, which takes people with severe psychiatric illnesses from the courts, prisons and the community, has been experiencing a growing waiting list in recent years.

With increasing numbers of not guilty by reason of insanity (NGRI) cases in the courts referred to it, the CMH has had fewer beds available to take severely mentally ill people from prisons.

“Portrane will ease the waiting list for a limited time, but new patients found NGRI will overtake the additional capacity within a few years,” said Harry Kennedy, CMH executive clinical director and head of the National Forensic Mental Health Service.

The Portrane hospital, which had a construction budget of €170m , is described by the HSE as the “largest single mental health project ever” in the country.

It was due to be completed in quarter four of 2019, but is now expected to be handed over in the final quarter of 2020, after which it will take up to three months to be fitted out before it is due to open in phases.

While welcoming the new facility, Prof Kennedy said it was crucial the investment was built on to keep pace with demand. 

“Yes, Portrane will improve things, and we will clap ourselves on the back, but we will need to ensure that we sustain the improvement over the next five to 10 years." 

He said the rise in NGRI cases, and the length of time these people were staying in the hospital - on average around seven years - meant there were fewer beds to meet the constant demand from the prison system.

“The biggest problem is there are extremely mentally ill people in prison waiting when there’s almost no chance of getting admitted [to the CMH] before the end of their short sentences; that’s the real problem.”

He told the Irish Examiner that while the number of committals from the courts to prisons had dropped dramatically (down 41% between 2016 and 2019), the number of patient reviews CMH in-reach teams have conducted in prisons was up significantly, by 30%.

The in-reach teams received 887 new referrals in 2019, representing 10% of all committals that year.

The biggest CMH clinic is in Cloverhill Remand Prison, where people have been charged and are awaiting trial. It saw 315 new referrals in 2019.

“Cloverhill remand prison is the trolley system for psychiatry, but it doesn’t generate the outrage that people on trolleys in A&E does.”

He said the in-reach teams, which also comprise psychologists and social workers, do what they can, but added: “At the end of the day, prison is a toxic place. Prisons are prisons, they are not a hospital.” 

Official HSE statistics on admissions into, and discharges from, the CMH starkly illustrate the pressures on the hospital:

• In the period 2009 to 2014, between 52 and 74 people were admitted into the CMH each year – but in the years 2016 to 2019, this number more than halved, to between 23 and 30 each year;
• In the period 2009 to 2014, between 52 and 76 people were discharged each year – but in the years 2016 to 2019, this collapsed, to between 18 and 21 each year.

Prof Kennedy said for “legacy reasons”, the National Forensic Mental Health Service has two secure forensic beds per 100,000 population. Most modern European states have in excess of 10 per 100,000 – five times as many.

He said even when the full 170 beds become operational, Ireland’s ratio of forensic beds increases to around 3.5 per 100,000 people – still a third of the average in modern European states.