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Under the Clock Towers – an overview of remaining 19

th century public

psychiatric hospitals due for closure

INTRODUCTION Fifteen public psychiatric hospitals built two centuries ago remained in service between 2007 and 2011. Thirteen continued to be in service at the end of 2011 and were registered with the Mental Health Commission as approved centres under the Mental Health Act 2001. St. Dympna’s Hospital, Carlow, closed as an approved centre in October 2011. By the end of 2011 the original 19

th century

buildings in St. Brigid’s Hospital, Ballinasloe, St. Otteran’s Hospital, Waterford, St. Davnet’s Hospital, Monaghan, St. Brendan’s Hospital, Dublin, and St. Ita’s Hospital, Portrane, no longer accommodated residents. Included in this overview is St. Joseph ’s Intellectual Disability Services as, although a new purpose-built streetscape development was opened in 2011, many residents continued to live in premises that were not fit for purpose and one ward, Ashlea Ward, remained in the original building. The fifteen hospitals listed here cannot be all termed “Victorian-era hospitals” as six of them predate the British monarch’s ascension to the throne in 1837. All have reduced their bed numbers with the exception of St. Fintan’s Hospital, Portlaoise, which increased its bed capacity from 27 in 2008 to 39 in 2011 and has declared 40 beds in its self-assessment received by the Inspectorate in February 2012. The descriptions of the approved centres below, with the exception of St. Conal’s Hospital, Letterkenny, which closed as an approved centre in 2010, have been taken from the 2011 approved centre inspection reports and edited. The physical environment of some approved centres in which residents, staff and visitors continued to endure, had reached such low levels that the Mental Health Commission imposed conditions upon their continued registration as approved centres. In one approved centre in particular, St. Finan’s Hospital in Killarney, it was not only the age of the building that was of concern to the Inspector ate of Mental Health Services but also the custodial nature of practices and the culture that was maintained within the walls of the building. The 2011 inspection reports of all of the approved centres in this overview can be accessed on the Mental Health Commission’s website www.mhcirl.ie

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HSE Dublin North East

St Brendan’s Hospital, Dublin, built in 1814

2007 2008 2009 2010 2011

Number of Wards

7 5 5 5 4

Number of beds

113 84 82 82 57

Acute admission beds

Yes Yes Yes No* -

* Acute admissions to the approved centre ceased in September 2010.

DESCRIPTION

St Brendan’s Hospital occupied a large site in north Dublin city. Over the preceding years, the number of

beds had been reduced and at the time of inspection in 2011, there were 57 beds in four wards. Since the

inspection of 2010, acute patients were no longer admitted to the approved centre, and the service now

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provided continuing care, rehabilitation and acute care for seriously ill residents on transfer only. Wards

3A and 3B were situated in a two-storey building which was not part of the original building, whilst wards

O and 8A were in a different building on the grounds. Plans for the construction of a new building to

replace the existing hospital were well advanced, and the service was awaiting the appointment of a

contractor.

Units 3A and 3B: The condition of these wards was good. The wards were bright and spacious. Toilet and

bathroom areas were clean and well-maintained.

Unit O: This unit was very small with only one living space for residents. It had no quiet area. It was

unsuitable for the care of residents with challenging behaviour. The unit was clean and efforts had been

made by staff to brighten the area.

Unit 8A: This unit was old fashioned and unsuitable for the care of residents with challenging behavior.

The day room was drab and institutional. The unit was clean.

The Mental Health Commission attached two conditions to the registration of the approved centre as

follows:

Condition 1: The Mental Health Commission prohibited the admission of residents to Unit 3A and Unit 3B

of the Approved Centre other than for the purposes of rehabilitation/respite as part of a resident’s

individual care and treatment plan.

Condition 2: The Mental Health Commission prohibited the admission of residents to Unit 8A and Unit O

of the Approved Centre other than for the purposes of accepting the transfer of patients under sections 20

and 21 of the Mental Health Act 2001.

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St Davnet’s Hospital, Monaghan, built in 1869

2007 2008 2009 2010 2011

Number of Wards

3 3 3 3 1

Number of beds

48 36 35 33 33

Acute admission beds

Yes Yes Yes Yes No*

* The acute admissions ward closed on 12 December 2011

DESCRIPTION

St. Davnet’s Hospital consisted of a number of buildings on an elevated site in Monaghan town. It had two

units: an admission unit and Blackwater House which had 22 beds for continuing care residents. Many of

these residents required full nursing care. Blackwater House was the amalgamation of two wards which

had been refurbished but retained many of the features of the old hospital such as large day rooms and

long dormitories. The admission unit (Ward 15) closed on 12 December 2011 and all acute admissions for

the Cavan/Monaghan area were directed to the Acute Psychiatric Unit, Cavan General Hospital.

The premises were clean, maintained in good structural and decorative condition. It was disappointing

that the new Blackwater House had retained the old-type long dormitories. The premises were heated

and adequately lit.

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St Ita’s Hospital, Portrane, built 1896-1901

2007 2008 2009 2010 2011

Number of Wards

7 7 7 7 2

Number of beds

138 139 125 122 26

Acute admission beds

Yes Yes Yes Yes No*

* The acute admissions wards closed on 31 August 2011.

DESCRIPTION

St Ita’s Hospital was a large red brick hospital situated in extensive grounds in north county Dublin. Some

of the units were still located in the old building whilst the admission units and one rehabilitation unit were

located in more recently constructed buildings. Since the inspection in 2010, one unit had been closed

and the total number of beds in the hospital had been reduced from 122 to 106 in 2011. On the day of

inspection there were 88 residents, some of whom had been resident in the hospital for a considerable

length of time. The hospital was in a state of transition with the expected move from the old building of all

the residents under the care of the psychiatry of old age team to modern facilities in Fairview and

Bloomfield by 31 March 2011. Following this move, there was a plan to relocate the admission wards to

different facilities within the complex of St. Ita’s Hospital pending the construction of a new unit in

Beaumont Hospital.

The male and female admission wards were clean and bathroom areas had been refurbished, but the

layout was out-dated and very institutional. In Willbrook, the toilet areas were dirty, very stained and had a

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very unpleasant odour. The windows from the toilet area opened directly onto the smoking area which

was actually enclosed. There was one two-bedded room where windows had blinds which could only be

operated mechanically from the nursing office. Willbrook was a locked unit. Each of the admission wards

had access to an enclosed garden, but these were poorly maintained and very unimaginative in design.

By way of contrast, the garden in Unit 8 was a very pleasant area and very well maintained.

When walking from one ward to another in the older building, one passed along corridors where peeling

paint, very damp and flaking plaster on walls and missing ceiling tiles presented an extremely unsightly

and potentially hazardous journey.

The overwhelming impression of the approved centre was of old, poorly maintained buildings and limited

facilities. Even in areas of the hospital which were not part of the original building, these were institutional

and outdated. The Inspectorate welcomed the plans to relocate the admission wards to meet the

condition relating to these wards imposed by the Mental Health Commission. The dates for the

completion of some of the conditions attached to the registration of the approved centre had been

extended.

The Mental Health Commission attached conditions to the registration of the approved centre as follows:

Condition 1: The Mental Health Commission prohibits the admission of residents who are children to St.

Ita’s Hospital-Mental Health Services.

Condition 2: The Mental Health Commission requires the permanent closure of Acute Unit Male and Acute

Unit Female in St. Ita’s Hospital-Mental Health Services by no later than 31 August 2011. (These units had

now closed and residents were now admitted to a new facility in St. Vincent’s Hospital, Fairview.)

Condition 3: The Mental Health Commission requires the permanent closure of Unit 1 – Male and Unit 1 –

Female in St. Ita’s Hospital-Mental Health Services by no later than 31 March 2011.

Condition 4: The Mental Health Commission requires the permanent closure of Unit 8 – Male in St. Ita’s

Hospital-Mental Health Services by no later than 31 March 2011.

Condition 5: The Mental Health Commission requires a skill mix and complement of staff appropriate to

the needs of the residents and the size and layout of the service.

Following compliance by the approved centre, Condition 1, 2, 3 and 4 were removed by the Mental Health

Commission on 6 October 2011.

Effective from 12 December 2011 the following three Conditions were imposed by the Mental Health

Commission:

Condition A: The Mental Health Commission requires that refurbishment works on Willbrook Unit be

completed by no later than 30th June 2012.

Condition B: The Mental Health Commission requires the permanent closure of Willbrook Unit by no later

than 31 December 2012.

Condition C: The Mental Health Commission requires quarterly reports on the full decommissioning of

Rehabilitation Services in St. Ita’s Hospital.

By the end of 2011 all wards in the main building had closed.

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St Joseph’s Intellectual Disability Service, Portrane, built 1896-1901

2007 2008 2009 2010 2011

Number of Wards

15 13 13 13 19

Number of beds

177 172 165 155 163

Acute admission beds

N/A N/A N/A N/A N/A

DESCRIPTION

St. Joseph’s Intellectual Disability Services comprised 19 wards, nine of which were dotted around the St.

Ita’s Hospital campus and constructed around the time of the main hospital and accommodated 95

residents*. Dun Haven had been closed at the time of inspection. Dun Na Ri Unit was closed for

refurbishment. The design and layout of St. Fiacra’s was not suited to the provision of care of residents.

Ashlea Ward was situated in the main hospital building towards the rear.

In addition to the nine wards on campus, the approved centre had opened the Knockamann streetscape

development, which was situated on high ground overlooking the sea, beaches and Lambay Island. The

construction of Knockamann resulted in an increase of beds form 155 in 2010 to 163 in 2011.

Knockamann was an excellent development catering for up to 60 residents and comprised ten 6-bed

houses and Knockamann Resource Centre laid out in a streetscape design. Residents had moved into

Knockamann in mid-December 2010 and all but one house was now occupied. The design features of the

houses provided a homely environment with single rooms, domestic style dining, kitchen and living

rooms, and access to landscaped gardens and patios. The design incorporated flexible features to

accommodate the range of care needs of the residents. The Knockamann Resource Centre incorporated

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administrative and clinical offices interspersed with activity rooms. This arrangement fostered integration

of residents and staff.

*Based on service’s self-assessment for compliance with Approved Centres Regulations, Rules and Codes of

Practice completed on 11 February 2011

HSE Dublin Mid Leinster

St. Fintan’s Hospital, Portlaoise, built in 1832

2007 2008 2009 2010 2011

Number of Wards

2 2 2 2 2

Number of beds

29 27 30 31 39

Acute admission beds

No No No No No

DESCRIPTION

St. Fintan’s Hospital was located on the outskirts of Portlaoise opposite the Midlands Prison. Two wards

remained open. Residents were mostly elderly and had been in the approved centre for many years. It

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was planned to close the hospital. Plans to achieve this had progressed at an interminable pace. Despite

these plans, the number of beds in the approved centre had risen from 27 in 2008 to 39 in 2011.

The building was not suited to mental healthcare delivery. Staff had made valiant efforts to render the

rooms bright, clean and decorative but the fabric of the building was poor with ever visible patches of

damp and peeling plaster. Accommodation was largely in dormitories. The partitioned dormitories on the

rehabilitation ward were warren-like and in stark contrast to the couple of refurbished bedrooms. The

current layout of the wards did not provide a flow in living space for residents and for observation of

residents.

Refurbishment had been carried out in several bathrooms and they were bright, clean and modern. There

was only one shower on Ward 6 which catered for up to 22 older residents, most of whom required

assistance with self-care. The female lavatory in the rehabilitation ward was malodorous and had damp

and flaking plaster on the walls. Another lavatory in this ward had a hole in the wall caused by banging of

a door handle. None of the lavatory doors were lockable. The sitting room area of the Rehabilitation Ward

had been upgraded with new floor covering, painting and new television. Other areas also had floor

covering replaced. There were plans to open a new two-bed female area and a new four-bed male area

with accompanying sitting room in March 2011.

St. Loman’s Hospital, Mullingar, built in 1847

2007 2008 2009 2010 2011

Number of Wards

7 7 6 5 5

Number of beds

154 121 115 108 95

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Acute admission beds

Yes Yes Yes Yes Yes

DESCRIPTION

St. Loman’s Hospital, Mullingar, consisted of five wards spread over three buildings in extensive grounds.

St. Edna’s Ward was situated in the original building which was opened in 1847; St. Brigid’s Ward and St.

Marie Goretti Ward were situated in a separate building to the rear of the original building, which was

opened in 1938 and the two admissions wards were situated in a stand-alone building opened in the

1940s.

Male admission: The toilets were not in good condition and there was an open drain in one toilet.

Female admission: This unit was in good decorative order and was well-maintained.

St. Brigid’s ward: The condition of the toilets, bathrooms and showers was very poor. There was no proper

disabled toilet. One of the toilets was used as a storage area. Staff had made efforts to make the ward

homely.

St. Marie Goretti ward: This ward was unsuitable as accommodation for residents. The condition of the

toilets, shower and bathrooms was poor. There was no proper disabled access to the toilet. Tiles were

falling off the walls and paint was peeling in the shower. There was paint peeling in the dining room.

St. Edna’s ward: This ward was unsuitable as accommodation for residents. The bedrooms were cell-like

and stuffy. The toilets were in very poor state with open drains and the floor was stained and marked. The

shower was in poor condition. There was insufficient storage space and clean laundry was stored in open

trolleys in the corridor.

Plans to close the continuing care wards and restructure the admission wards were outlined to inspectors

during the inspection.

The Mental Health Commission attached amended conditions to the registration of the approved centre

on 6 October 2011:

Condition 1(a): The Mental Health Commission requires the permanent closure of Marie Goretti’s Ward

and St. Brigid’s Ward in St. Loman’s Hospital, Mullingar, by no later than 31st March 2012.

Condition 1(b): The Mental Health Commission requires the permanent closure of St. Enda’s Ward in St.

Loman’s Hospital, Mullingar, by no later than 30th November 2012.

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Central Mental Hospital, built in 1850

2007 2008 2009 2010 2011

Number of Wards

7 7 8 8 8

Number of beds

87 84 93 93 94

Acute admission beds

Yes

Yes Yes Yes Yes

DESCRIPTION

The in-patient facility for the National Forensic Service remained at the Central Mental Hospital in

Dundrum, Dublin, in 2011, despite the extremely poor condition of the building. At the time of inspection,

no plans were in evidence that alternative accommodation was in train.

The main building was Victorian and housed two medium secure units (Units 2 and 3), an acute unit (Unit

4) and the women’s unit (Unit 1). Two buildings on the campus that were more modern, contained a

rehabilitation and recovery unit (Unit A) and the male acute unit (Unit B). It also contained a gym and

swimming pool and administrative section. There was a rehabilitation and recovery unit (Unit 7) attached

to the main building and a low secure house (Laurel Lodge) which housed 10 residents preparing for

discharge. Female patients were now facilitated in Unit 1, in an old part of the hospital which was totally

unsuitable for the provision of a women’s forensic service. They had been moved from the smaller Unit A

to Unit 1 in order to provide more space, a high observation area, and to reduce the use of seclusion. In

Unit 1 the high observation area consisted of a grim narrow corridor with cell-like rooms to each side. The

seclusion rooms were unsafe due to blind spots in the rooms. There was no living area in the high

observation area and patients had to sit in the corridor to watch television. The grill of an extractor fan in

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this corridor was extremely dirty; photographic evidence was taken. Overall, the high observation corridor

was grim and totally unsuited to the therapeutic care of women.

Women patients not in high observation had more living space but their bedrooms were extremely small

and cell-like, poorly ventilated with limited storage space. All female patients were locked in their

bedrooms at night regardless of their assessed risk. This meant that they had to ring for nurses to take

them to the toilet at night. Beds consisted of mattresses on hard wooden platforms. The floor of one

bedroom which was unoccupied was dirty. Unit A had toilet facilities in bedrooms. There was no step-

down facility and no community supervised accommodation for women. Access to garden space was

limited despite the construction of a fenced area.

Unit 4: There was evidence of grime and dirt on the floor of two bedrooms and there was a bad odour in

one of the bedrooms.

Unit B: There was paint peeling and patches of damp and mould inside and outside one of the bedrooms.

Unit 2: One bedroom was dirty with bodily fluids on the walls. Another bedroom had peeling paint around

the inside of the window. Dirt and fluids were engrained in the toilet floors and walls. The walls in the day

room and the stairwell used by patients had peeling paint. The ceiling in the shower area had mould

growing on it. Photographic evidence was taken.

Unit B: There was obvious damp in the bedroom corridor that had spread into one of the bedrooms. The

unit was clean but small with insufficient living space.

The provision of forensic mental health services for both men and women in such an unsuitable

environment was unacceptable.

Plans for the construction of a new Central Mental Hospital in the grounds of St. Ita’s Hospital, Portrane,

have been initiated.

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HSE South

St. Dympna’s Hospital, Carlow, built in 1831

2007 2008 2009 2010 2011

Number of Wards

4 3 2 1 1

Number of beds

69 55 36 15 15

Acute admission beds

No No No No Approved centre closed in October 2011

DESCRIPTION

St. Dympna’s Hospital had one ward remaining, St. Patrick’s Ward, which was a 15-bed ward, which was

due to close within a few months of the inspection. Areas of the walls on the unit had paint peeling. The

ward was in need of redecoration and was clean, adequately lit and heated. Staff reported that they were

actively pursuing the development of discharge plans for those residents who would be suitable for

community living. The rehabilitation team was actively involved in discharge planning. Families and

nursing home managers had been involved in case conferences. Residents deemed not suitable for

discharge, were to be transferred to a refurbished unit elsewhere in the same building. St. Dympna’s

Hospital closed as an approved centre on 1 October 2011.

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St. Finan’s Hospital, Killarney, built in 1849

2007 2008 2009 2010 2011

Number of Wards

6 6 5 5 4

Number of beds

60 60 58 52 52

Acute admission beds*

No No No No No

* Residents with acute mental illness continued to be transferred to St. Finan’s Hospital from the Acute

Mental Health Admission Unit in Kerry General Hospital. There were also direct admissions from the

community to the long stay wards.

DESCRIPTION

St. Finan’s Hospital was a large Victorian building situated on the outskirts of Killarney. It had four wards.

Despite the closure of St. Paul’s ward earlier in 2011, the number of residents, 52, remained the same as

in 2010. The closure of this ward had resulted in an unsatisfactory mix of residents with widely differing

care needs in the O’Connor units which were built between 1974 and 1975 and opened in 1976. St

Martin’s ward and St. Peter’s ward were extremely institutionalised and the physical and psychosocial

environment was impoverished. All residents in the hospital were under the care of the Rehabilitation and

Recovery Team.

O’Connor Unit West: The unit was clean. It needed to be repainted and redecorated.

O’Connor Unit East: The unit was clean. It needed to be repainted and redecorated.

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St. Peter’s ward: This male ward was drab, bare and impoverished with paint peeling and plaster falling

from the walls which had mould in some areas. There was a hole in the wall of one bedroom. The

dayroom had minimal decoration. The dining room was furnished with plastic garden tables and chairs.

The ward was clean but had a strong smell of urine. The ward relied on plug-in oil filled heaters to

augment the outdated heating system in this old stone building.

St Martin’s ward: This female ward was also drab, bare and impoverished and had paint peeling and

plaster falling from the walls with mould in some areas. The bedrooms were small, cell-like and stuffy, and

had insufficient storage space. The bedrooms afforded no privacy for residents who slept with an

uncovered window in the door and a convex mirror in the room, which meant that passers-by could see

every part of the bedrooms and the residents at any time of the day or night. There was a smell of damp.

The dining room was completely bare apart from tables and chairs. The walls were devoid of any pictures

or decoration. The ward was clean. This ward also relied on plug-in oil filled heaters to augment the

outdated heating system of the old stone building.

Of great concern to the Inspectorate was that service users who were acutely unwell continued to be

transferred to totally unsuitable care in St. Finan’s Hospital. Of even more concern was that there were

direct admissions to St. Finan’s Hospital. The Mental Health Commission was immediately informed of the

Inspectorate’s concern regarding transfers and admissions to St. Finan’s Hospital and the poor conditions

within the hospital.

The following conditions were attached by the Mental Health Commission with effect from 12th December

2011:

Condition 1: The Mental Health Commission requires the cessation of the direct admission of residents to

St.Finan’s Hospital with effect from 12th December 2011.

Condition 2: The Mental Health Commission requires the permanent closure of St. Martin’s Ward in St.

Finan’s Hospital by no later than 31st January 2012.

Condition 3: The Mental Health Commission requires the cessation of the transfer of residents form Acute

Mental Health Admission Unit, Kerry General Hospital to St. Peter’s Ward in St. Finan’s Hospital by no

later than 31st January 2012.

The approved centre confirmed in writing on 22 February 2012 that:

St. Martin’s Ward had closed in advance of the 31 January 2012 deadline.

The last direct admission of a resident occurred in December 2011 and no such admission would

occur in the future.

The transfer of residents from the Acute Mental Health Admission Unit, Kerry General Hospital,

to St. Finan’s Hospital had ceased.

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St. Luke’s Hospital, Clonmel, built in 1829

2007 2008 2009 2010 2011

Number of Wards

7 5 5 4 3

Number of beds

131 106 102 71 52

Acute admission beds

No No No No No

DESCRIPTION

St. Luke’s Hospital was situated adjacent to the South Tipperary General Hospital in Clonmel. Over the

last few years, the bed numbers had been gradually reduced with a view to closing the hospital. Another

ward had been closed since the inspection of 2010 and there were now three wards open, only one of

which was in the original building. Building was well under way on a new unit in the grounds of the

general hospital and it was expected that the remaining residents from St. Luke’s Hospital would be

relocated there by 2012.

Most of the ward areas were very clean, apart from one bathroom in St. Paul’s ward where there were a

number of cobwebs. There was a large patch of plasterwork missing from one wall in this ward. St. Mary’s

ward had been redecorated last year and was well maintained.

St. Teresa’s ward was unsuitable as a rehabilitation unit as it was spread over two buildings separated by

a courtyard. There were a number of maintenance issues such as peeling paint, plaster fallen off the wall

and missing tiles. The ward was clean. There were plans to move St.Teresa’s ward to a purpose built unit

in the near future.

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The Mental Health Commission attached three conditions to the registration of the approved centre as

follows:

Condition 1: The Mental Health Commission prohibits the admission of residents for the purpose of

relieving bed shortages in another approved centre.

Condition 2: The Mental Health Commission requires the provision of occupational therapy for the

residents in St. Paul’s ward.

Condition 3: The Mental Health Commission requires evidence of full compliance with Article 22

(Premises) of the Mental Health Act 2001 (Approved Centres) Regulations 2006 by no later than 31 May

2011.

St. Otteran’s Hospital, Waterford, built in 1835

2007 2008 2009 2010 2011

Number of Wards

5 4 4 4 3

Number of beds

132 115 78 70 70

Acute admission beds

No No No No No

DESCRIPTION

St. Otteran’s Hospital was located on the south side of Waterford City and provided continuing care and

treatment to elderly persons in St. Aidan’s Ward and rehabilitation to residents of St. Monica’s Ward and

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Grangemore. All three wards were in separate premises on the campus of St. Otteran’s Hospital and

residents were now no longer living in the original building. Grangemore, originally a lodge to the left of

the entrance to the grounds of St. Otteran’s Hospital, had been refurbished and extended in 2009 to a

very high standard. St. Aidan’s ward had also been refurbished to a very high standard. St. Monica’s ward

was an old building which needed refurbishment; the living and working environment was poor and the

building, in its present state, was not fit for purpose.

St. Monica’s ward: This ward was located at the back of the hospital in an old stand alone building. It was

in very poor condition and required substantial upgrading in the immediate future. The ward was unfit for

purpose. The ward was divided into male and female. The female area was one large open area which

contained both the day sitting area with television and the residents’ beds in an open dormitory style,

typical of old institutions. There was damp in the store room, the male bathrooms had a strong odour of

urine despite the efforts of staff and there was a strong odour emitting from the smoking room into the

main sitting area for male residents. Paint was peeling from the walls and the ward areas appeared

cluttered and hazardous for residents. Requests for routine maintenance of the ward were examined by

the Inspectorate and a number of maintenance requests were outstanding.

St. Aidan’s ward: This ward had been refurbished to a high standard, was clean and bright but still had an

open dormitory style to the bedrooms which limited the privacy for the residents. The Friends of St.

Aidan’s were very active in fundraising for equipment for the ward. There was large visitors’ room and

quiet room, easily accessible for wheelchairs.

Grangemore: This ward had been refurbished to a high standard and an extension added. The ward was

clean and bright and refurbished to a high standard.

St. Senan’s Hospital, Enniscorthy, Co. Wexford, built in 1870

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2007 2008 2009 2010 2011

Number of Wards

11 10 7 6 3

Number of beds

157 147 102 85 46

Acute admission beds

Yes Yes Yes Yes No*

*The admission wards closed on 4 April 2011.

DESCRIPTION

St. Senan’s Hospital was located at the edge of Enniscorthy on an imposing site overlooking the River

Slaney. It was unsuitable for the care and treatment of residents and was now in the process of closing

down with final closure set for January 2013.

The admission wards, St. Clare’s Ward and St. Anne’s Ward had closed permanently on 4 April 2011. On

the day of inspection 48 residents continued to be cared for and treated in an environment that was drab,

desolate and depressing. Documentation relating to fire inspections was obtained by the Inspectorate

pursuant to section 53 of the Mental Health Act 2001.

Four wards remained with 59 beds: there were two rehabilitation wards (Tús Nua and St. Enda’s wards),

one ward under the care of psychiatry of later life (St Elizabeth’s ward|) and one ward, which was for

residents with intellectual disability (St. Christopher’s ward). Although the approved centre was clean, and

this was a credit to household staff, the interior of the wards had paint peeling in places with old-fashioned

toilets and bathrooms not suitable for modern living.

St. Christopher’s Ward and St. Enda’s Ward were clean. The physical environment in both wards was

unsuitable for the care and treatment of residents.

Tús Nua ward was clean, but the layout was unsuitable. The nurse’s station, bedroom and sitting room

were semi-partitioned areas of one large room.

In St. Elizabeth’s Ward, there were two large deep holes in the walls of the eight-bed room and a hole in

the wall of the single room which had not been repaired despite requests from nursing staff to the

maintenance department to do so.

Two conditions of registration were imposed on the approved centre by the Mental Health Commission to

its current registration as an approved centre:

Condition 1: The Mental Health Commission requires the permanent closure of St. Clare’s Ward and St. Anne’s Ward in St. Senan’s Hospital by no later than 31 May 2011. Condition 2: The Mental Health Commission prohibits the admission to St. Senan’s Hospital of all residents who are children.

The Inspectorate was informed that Tús Nua Ward had closed on 7 November 2011, reducing the beds

further from 59 to 46.

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HSE West

St. Brigid’s Hospital, Ballinasloe, Co. Galway, built in 1833

2007 2008 2009 2010 2011

Number of Wards

8 8 6 5 3

Number of beds

133 106 94 77 53

Acute admission beds

Yes Yes Yes Yes Yes (main hospital campus closed in 2011)

DESCRIPTION

St. Brigid’s Hospital no longer had wards on the main campus that catered for residents in receipt of

mental health services. Since the inspection in 2010, Ward 17, Ward 21 and Our Lady’s Ward had closed

on the St. Brigid’s Hospital campus. Clonfert Community Nursing Unit (CNU) opened in newly-built

premises some two hundred metres from the building in which St. Dympna’s Ward and St. Luke’s Ward

were situated, which was on a separate site to the St. Brigid’s Hospital campus, across the main

Ballinasloe to Roscommon road.

St. Dympna’s Ward and St. Luke’s Ward were acute admission wards housed in a stand-alone facility

dating to the 1930s. Both wards were in need of refurbishment.

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Clonfert was a newly-built, bright unit for the care and treatment of residents under the Psychiatry of Old

Age team. Concerns were expressed by the Inspectorate about the small size of the day room, and the

fact that the dining room, which might provide a more spacious day area, was only used during mealtimes

for the purpose of dining only.

St. Conal’s Hospital, Letterkenny, Co. Donegal, built in 1866

2007 2008 2009 2010 2011

Number of Wards

2 2 2 1 -

Number of beds

39 32 27 2 -

Acute admission beds

No No No Approved centre Closed

-

DESCRIPTION

St. Conal’s Hospital closed as an approved centre in 2010.

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St. Joseph’s Hospital, Limerick, built in 1825

2007 2008 2009 2010 2011

Number of Wards

5 5 5 4 2

Number of beds

84 77 65 54 28

Acute admission beds

No No No No No

DESCRIPTION

St. Joseph’s Hospital was located in Limerick City. In 2010, there were 54 beds and four wards. Since

then two wards had been closed, St. Rita’s Ward in February 2011 and St. Brendan’s Ward in April 2011.

This had been achieved by discharging residents to nursing homes and supported accommodation in the

community. Two wards remained open, St Mary’s Ward and Aurora, providing a total of 28 beds. Both

wards were bright and clean, however, the male lavatories smelt strongly of urine owing to the fabric of

the building. Efforts had been made to upgrade furnishings and decor, however, the building was

unsuitable for the purpose of providing care and treatment to residents.

23

CONCLUSION

Over the past five years the physical conditions in all of the above hospitals have deteriorated. The above

hospitals were earmarked for closure since the publication of the Department of Health’s 1984 mental

health policy document Planning for the Future. Since the 2007 inspections by the Inspectorate of Mental

Health Services, there has been a steady decline in the number of beds in these hospitals with the

exception of St. Fintan’s Hospital, Portlaoise, where the bed capacity increased from 27 in 2008 to 39 in

2011. St. Conal’s Hospital, Letterkenny, Co. Donegal, inspected for the last time on 16 June 2010 when it

had two residents, finally closed its doors as an approved centre two days later. This was followed by St.

Dympna’s Hospital, Carlow, which closed as an approved centre in October 2011. The original 19th

century buildings in St. Brigid’s Hospital, Ballinasloe, St. Otteran’s Hospital, Waterford, St. Davnet’s

Hospital, Monaghan, and St. Brendan’s Hospital, Dublin, no longer accommodated residents. Included in

this overview is St. Joseph’s Intellectual Disability Services which is an approved centre under the Mental

Health Act 2001, where a new purpose-built streetscape development was opened in 2011.

The Mental Health Commission has imposed conditions of registration as approved centres on a number

of the above hospitals. The more detailed individual inspection reports of all of the above approved

centres and former approved centres are available on the Mental Health Commission’s website from 2008

onwards. These 19th century structures do not lend themselves well to the level of infrastructural

renovations required to bring the facilities to an adequate level and underlie the urgent need for

progression of hospital closure plans. Their continued existence only serves to give the impression to

anyone who enters them that the type of care and treatment being delivered to residents is institutional

focused rather than focussed on the progressive care and treatment one would expect in the 21st century.

At the end of 2011 there were no acute admissions to all of the above hospitals.

Recommendation

Closure of the above hospitals should include changing the name of new services that will be established

in their place.