FORENSIC MENTAL HEALTH
invited back to Ireland after the old Central Mental Hospital was inspected by the Committee for the Prevention of Torture, the inspection wing of the European Court of Human Rights, and the European Convention of Human Rights. The visiting party condemned the buildings – quite rightly, they were in a shocking state.” He continued: “The Irish Government took the CPT very seriously, and was proposing to build a new hospital. I took the job on the basis we would be in it within five years; in fact we didn’t move into a new facility until November 2022.” Prof. Kennedy explained that
The exterior of the Central Mental Hospital in Dublin – on its completion in 1850 one of Europe’s first forensic mental healthcare ‘asylums’.
still a medical student’. He said: “I also had several friends studying, or working in, psychiatry, and found we had a lot in common. I met Robert Murray, Dean of the Institute of Psychiatry at the Maudsley Hospital in Denmark Hill, who told me psychiatry really is a scientific subject, and open to people with a scientific frame of mind. In fact, there was an unexplored opportunity to do interesting and original science, because what was being done in psychiatry up to then was not very scientific.”
Major changes seen? I imagined that psychiatric practice and thinking – including in forensic psychiatry – must have evolved considerably since. The Professor said: “Yes, there have been some interesting positive developments, but scientifically, it’s been in the doldrums. For example, there’s still little
recognition that severe mental illnesses like schizophrenia are life-shortening; people with such illnesses lose about 16 years of life expectancy, compared with those who don’t, and we’re not making much progress here.” The Professor added that people with severe mental illness have higher incidence of cancers, cardiac, and respiratory diseases, and in effect age prematurely. Having done the bulk of his psychiatric
training at The Maudsley – ‘a really inspiring place to train’, the Professor took his first consultant post as consultant and Clinical director for forensic psychiatry for North London. He explained: “I started on a ward at Friern Hospital, an old asylum in the process of closing; the last ward to exit was the forensic ward, where I started in 1992. In 1993 we moved out to a new, purpose-built medium secure unit in Enfield. During my time there, we expanded very rapidly. It was 32 beds when we moved, and when I left to return to Ireland in 2000 we were up to 70, with another 70 under construction. It was all single roomed, but not with en-suite facilities. It was an interesting stage in the transition from old asylum care. In Friern, the buildings were pretty grim, with Nightingale wards, and very little privacy or safety. It had been an enormous Victorian-built asylum, with thousands of beds.”
Return to Ireland By this point, Professor Kennedy had been in England for 19 years, really enjoying his work. “However,” he explained, “I was
The DUNDRUM Toolkit is now used not only in Ireland, but also in the UK, and has subsequently been translated into French, Dutch, Italian, and Danish.
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construction of the Central Mental Hospital had been initiated in 1845 by The Criminal Lunatics Insanity (Ireland) Act of 1845, and opened in 1850. He said: “The Victorians were wonderful project managers; once they decided to do something, it happened; very different to modern times. At the time, people found Guilty But Insane (GBI) were accumulating in the county asylums throughout Ireland, and were regarded with huge stigma as ‘criminal lunatics’; the political solution was thus to build a special hospital for them – the Central Mental Hospital, also a pilot project for the subsequent building of Broadmoor in England (which opened in 1861). At the time, there were already secure hospitals for the so-called ‘criminally insane’ in America in places like Philadelphia.”
Victorians’ skills I wondered how quickly, and to what extent, the model of forensic psychiatric care has changed over the years in Ireland. The Professor said: “Interestingly, the Victorians – without realising it – were very good at the idea of model of care.” Here, he retrieved from his bookshelves reprints of two architectural texts – one by Thomas Story Kirkbride (a physician, alienist, and superintendent for the Institute of Pennsylvania Hospital), and the other by Sir Henry Burdett (an English financier and philanthropist). Both are about the ‘construction, organisation, and general arrangements, of hospitals for the insane, with some remarks on insanity and its treatment’. He said: “They are full of beautiful architectural illustrations, floorplans, and elevations, but then increasingly, the building as a process; a machine. So, they consider aspects such as the kitchen and laundry location – and if you have 100, 500, and eventually thousands, of patients, how large must the kitchen be? Thus although ostensibly written mainly by architects, they are really about the process of providing for people, and include really interesting comments on how best to select the staff.” The Professor said the books
contained ‘interesting, practical, and quite enlightened views’. “Unfortunately,” he added, “while the asylums started in a blaze of idealistic glory, were well funded, well run, and quite inspiring on opening, their success proved their
NOVEMBER 2023 | THE NETWORK
National Inventory of Architectural Heritage, Ireland
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