Moving away from Victorian style hospitals

Ireland, like the UK, had its fair share of asylum-style mental health hospitals built during the Victoria era. Many were closed during the de-institutionalisation movement of the 20th century and, like in the UK, many patients were 'discharged' to the community without structured support.

One survivor of this movement was the Central Mental Hospital in Dublin's leafy suburb of Dundrum. It served as the Country's forensic hospital, but now its time is nigh. A new forensic mental health hospital is to open in Ireland soon. It's large, and will house high secure, medium secure, and forensic CAMHS patients. It will also house those with intellectual disability, female patients, and those requiring intensive care.

In a welcome move, the facility is moving from a Victorian era asylum style campus, albeit, to the grounds of another. The new hospital is built on the grounds of the Victorian era, St Ita's Hospital, on the outskirts of Dublin City. The Health Service Executive says that this new 'facility' is state-of-the-art. St Ita's Hospital, built in 1903 for the same purpose and with the same good intention, was also considered state of the art.

The recent BBC Panorama documentary, exploring the abuse of the patients at the Edenfield Centre on the grounds of Prestwich Hospital, also originally a Victorian asylum, shows that treatment has not changed much either. Every few years, there seems to be an exposé of failed treatment and institutional abuse. This year, the reporter Alan Haslam, chronicles his three months working at the forensic unit. He highlights the lack of psychotherapists and psychiatrists, and the lack of simple care as fundamental issues. He shares with viewers the harrowing experience of restraining patients, the use of seclusion rooms, and staff attitudes toward those who are in most need of care.

There will be the usual probes and investigations into what has happened at Edenfield. But how is it that mental health care is still stuck in the 1900s? The same asylum buildings, the same treatments, and the same disregard and contempt for vulnerable patients.

As the adage goes, the more things change, the more they stay the same.

What do we need to do when training nurses, psychologists, and psychiatrists to ensure a sense of criticality in their practice? Mental health professionals have a responsibility to treat, but also to vouch for their patients and improve the system for them.

Luke Quane,
University of East London