Ireland has a long history of confining the intellectually disabled to psychiatric facilities. A member of the Royal Commission on the Poorer Classes in Ireland (1833) condemned the construction of a district asylum in Ballinasloe, East Galway, and dismissed plans to provide even more accommodation for the country’s ‘slavering and worthless idiots’. While ‘idiocy admissions’ to the Victorian ‘mental hospital’ have been well documented, it is perhaps less well known that the practice has persisted throughout the twentieth and into the twenty-first century.
In 2004, the United Nations Committee on Economic, Social and Cultural Rights conducted a periodic review of Ireland’s engagement with vulnerable groups. Among its concerns was the fact that ‘a large number of persons with mental disabilities whose state of health would allow them to live in the community are still accommodated in psychiatric hospitals together with persons suffering from psychiatric illnesses or problems.’
This practice was never kept secret. In 1982, the Irish state broadcaster RTÉ sent the reporter Hilary Orpen to visit the Ballinasloe District Mental Hospital. ‘To enter here is like a descent into hell’, she narrated. ‘The dark and squalid accommodation reeks of excrement. There is no activity, no communication. The Mentally Handicapped sit and rack and moan. They are forgotten people, abandoned here for life.’
At the time of Orpen’s report, there were 2,170 psychiatric inpatients with a primary diagnosis of intellectual disability, representing 15.5% of the total psychiatric hospital population. Faced with these statistics, an obvious historical question presents itself: why did psychiatric hospitals continue to function as repositories for the intellectually disabled throughout the twentieth century?
A key reason is a simple lack of alternatives. In contrast to the UK, where the post-war period saw the construction of a varied range of institutional and community supports for the disabled, options in Ireland were limited to institutional centres operated by Catholic religious orders. From a policy perspective, the use of religious orders was an obvious choice. They had hardworking staff and, perhaps more importantly, they were cheap. When a religious brother or sister left an institution, centres had to hire at least two lay staff to complete a comparable level of work. Members of religious orders routinely worked more than seventy hours a week to maintain their institutions in extremely trying circumstances. Nevertheless, this network of services remained drastically oversubscribed throughout the century, with biannual waiting lists that equalled the total capacity of the entire institutional network. With institutional places for the intellectually disabled so scarce, the psychiatric hospital presented a viable alternative.
Medical professionals were acutely aware of this issue. During a 1965 visit to St. Finan’s hospital in Killarney, the hospital’s management committee was informed that the institution’s 804 patients represented ‘the lowest population figure in the hospital for over 10 years’. Despite this reduction in the overall inpatient population, the hospital’s Resident Medical Superintendent, Dr J. J. O’Connor, expressed concern that ‘they were still getting Mentally Handicapped people into the hospital, both children and adults,’ because of a lack of local alternatives.
As the twentieth century progressed, the psychiatric hospital network became an increasingly viable option for families of the disabled. As outpatient treatment of psychiatric illnesses increased, driven by the new availability of psychopharmacological tools for managing conditions like depression, the numbers of institutionalised patients in Ireland’s psychiatric hospitals fell. Between 1963 and 1981, there was a 48% fall in inpatients with ‘manic-psychosis’ and a 41% drop among schizophrenics. In their absence, the excess institutional beds did not disappear; they were increasingly filled by groups like the elderly or the intellectually disabled.
It is only ever possible to gain a fragmentary glimpse of what life was like in these institutions, as statutory oversight by the Inspector of Mental Hospitals was patchy during the late-twentieth century. Nevertheless, the records we do have show institutions failing even basic standards of hygiene, and residents seemingly left with little substantive care.
The psychiatric facility which housed the largest population of ‘mentally handicapped patients’ was Portrane (St. Ita’s) in North Dublin. In 1977, there were approximately 500 ‘handicapped’ patients (42%) among the hospital’s total population of 1,190. Clare Kelly, from the Association of Parents and Friends of St. Ita’s, visited the hospital’s ‘handicap wards’ in February 1981, and her report was notable for its graphic descriptions of the physically degrading conditions within the hospital. In the Number 7 East Ward for young ‘handicapped’ males, she described an overwhelming ‘stench of urine’ across a ward with soiled walls. Patients’ clothes were ‘ill fitting and dirty’, and at night they slept under ‘rag-like’ blankets on bed-sheets that were heavily stained. Perhaps most shocking was Kelly’s lengthy description of the ward’s bathroom:
Scandalous. Two toilets. Behind those toilets there is a channel. Over on the right hand side looking in at the channel it is filled with a sludge-like matter. The shore is at the end of the channel, it is blocked and uncovered. It overflows all over the floor and patients must walk in this mess to use the toilets …. Nurses and other staff say nothing is ever done about this.
While it may be comforting to assume these conditions existed in a distant past, contemporary journalists have provided numerous examples of similar failings in Ireland’s present arrangements for the intellectually disabled. The lack of available beds for the disabled in psychiatric institutions led a High Court judge to house a disabled man within a Garda (Police) detention cell overnight in November 2017. In January 2018, the psychiatric system was again used to house a vulnerable disabled man, described by the President of the High Court, Justice Peter Kelly, as ‘seriously underweight, incontinent and at risk of sepsis’. Ireland’s national network of Victorian era institutions are a tenacious remnant of an earlier model of institutional care. Once space became available, the imposing wards of ‘Mental Hospitals’ were filled with needy residents who had nowhere else to go, including the intellectually disabled. This is a long-established pattern that can be observed across more than two centuries. Breaking it will require fundamentally new solutions to resolve what the Department of Health termed its 1960 White Paper: ‘The Problem of the Mentally Handicapped’.