St Patrick’s Hospital was the first psychiatric hospital to be built in Ireland and one of the very first in the world. Its foundation was brought about by the will of Jonathan Swift, satirist, essayist, political pamphleteer, poet and cleric who, upon his death in 1745, left £12,000 to ‘build a house for fools and mad’. He was keen that his hospital be situated close to a general hospital because of the links between physical and mental ill-health, so St Patrick’s was built on a site between Bow Lane and Dr Steevens’ Hospital in the west of Dublin city.
The motivation for Swift’s legacy grew from his involvement with the day-to-day problems of the Irish people, not only as an individual but also as dean of St Patrick’s Cathedral in Dublin. In the eighteenth century, there were no specific provisions for the mentally ill. The first record of public provision for the mentally ill were the cells erected in the Dublin City Workhouse in 1708 and three years later ten cells were allocated for insane soldiers at the Royal Hospital, Kilmainham. Mostly, if not being cared for by their families or found wandering the streets or countryside, the mentally ill would be confined with criminals in prisons, with the poor in a workhouse, or with the sick in a hospital. Swift had firsthand knowledge of these conditions having served as a workhouse governor and as a trustee of several hospitals.
Bethlem Royal Hospital in London had been the first to house the mentally ill in 1377. By the eighteenth century, it had become infamous and known as ‘Bedlam’. It had a reputation for cruelty, neglect and poor living conditions, with an inadequate diet, rough clothing and inactivity. Worse still, the patients were displayed as entertainment – as a ‘freak show’, a ‘spectacle’, a ‘menagerie’ from which ‘both provincial bumpkins and urban sophisticates could derive almost endless amusement’ for a fee.
After a visit to Bethlem Royal Hospital, Swift got himself elected one of its governors in 1714. By 1731, Swift had decided on his legacy, intending his hospital to be charitable and more humane than Bethlem Royal Hospital.
Following the layout of the seventeenth century updated structure of Bethlem Royal Hospital, architect George Semple designed St Patrick’s with a basement, first floor, and second floor. Each ward was a long corridor with an iron gate, a keeper’s room at the entrance and cells opening from it. The eight by twelve-foot cells had sturdy doors and high windows.
St Patrick’s Hospital opened in 1757 with sixteen patients and a staff consisting of a master, male and female keepers, cook, laundry maid, housekeeper, porter, and surgeon. Lack of funds quickly required admitting chamber boarders (paying patients) along with pauper patients.
By 1793, two expansions provided more rooms and more staff but they had no special training to deal with the mentally ill and treatments were limited to baths, purges, bleedings, drugs or restraints and care was still primarily custodial. However, conditions for the comfort of patients in the early decades at St Patrick’s were superior to those at Bethlem Hospital.
On each ward, two apartments of sixteen feet by twelve were for the accommodation of chamber boarders who, in 1825, paid sixty guineas per annum. There were seven other apartments for the use of chamber boarders in the front of the building. In 1825, the occupants of these apartments paid one hundred guineas per year and had a servant for their own use exclusively.
Heating came from coal fires in the corridors and the cleanliness of patients and their surroundings was a priority. Paupers were supplied with stools, wooden beds, and bedding (straw was only used for violent patients). Meals consisted of porridge at breakfast, potatoes plus meat three times a week at dinner, bread and milk at supper and beer occasionally. Chamber boarders brought their own furnishings and would have had a higher-quality diet.
The hospital grew significantly throughout the 19th century. By 1817, two building extensions saw the patient population rise to over one hundred and fifty and by 1872, the number of staff was over fifty.
Dr Richard Leeper was appointed medical superintendent in 1898 and was largely responsible for transforming St Patrick’s from an asylum for the maintenance of the mentally ill to a modern hospital for their treatment and cure. Dr Leeper abolished the use of restraints, introduced the segregation of female and male wards and oversaw the construction of bathrooms and day rooms providing work and leisure activities for the patients.
Dr Leeper’s successor, Norman Moore, removed the old prison-like doors on the cells, introduced occupational therapy (including crafts and farm work) to the patients and challenged the assumption that the mentally ill were a danger to themselves and society and should be locked away.
After the introduction of deinstitutionalisation in the late 1980s, the hospital went into a period of decline but in 2008 the hospital announced the expansion of its outpatient services to a series of regional centres across Ireland. Today, St Patrick’s Mental Health Services is Ireland’s leading not-for-profit mental health organisation, with over 700 staff members delivering 12% of the country’s total inpatient care and treatment needs.