of additional land would not be needed. Sometimes the necessary structural changes are very extensive and costly […]. But there may be other unoccupied Workhouses which could be altered at small cost so as to afford suitable accommodation for incurable and easily-managed Lunatics, and our suggestion is that the possibility of utilising some of the disused Workhouses in this way should be carefully considered.7
The Committee suggested ‘the creation of a General Board of Lunacy for Ireland’8 and various changes to administration9 and admission procedures.10 It also supported the idea of lunatics ‘boarding out’ of workhouses, in private homes:
It would not be difficult, in our opinion, by co-operation between the Lunacy Inspectors and the Local Government Board, to make such rules and arrangements as would afford a reasonable security that the money given for the relief of lunatics so boarded out of Workhouses, whether with relatives or with strangers, was spent for their benefit. If this reasonable security were obtained in such a way as to enable the Inspectors of Lunatics to certify that they believed the boarded-out pauper lunatics to be properly cared for, it seems to us only right that there should be participation on their account in the Grant from Imperial Sources towards the maintenance of the insane poor.11
Sadly, the Committee’s relatively enlightened and compassionate stances on many matters were generally not reflected in policy changes,12 although the early years of the 1900s did see continued discussion about possible reform along these and other lines. Issues relating to overcrowding inevitably dominated the Conference of the Irish Asylums Committee at the Richmond Asylum in 1903;13 the Richmond itself organised a special enquiry ‘into the question of provision for workhouse lunatics’ and a diagnostic ‘segregation’ of all asylum patients in 1907;14 and, in 1927, the Irish Free State published its seminal Report of the Commission on the Relief of the Sick and Destitute Poor, Including the Insane Poor.15
The 1927 Report noted that the Commission, appointed in 1925, was instructed ‘to inquire into the existing provision in public institutions for the care and treatment of mentally defective persons and to advise as to whether more efficient methods can be introduced especially as regards the care and training of mentally defective children, due regard being had to the expense involved’.16 The Commission interpreted the term ‘mentally defective’ to ‘include mentally disordered as well as mentally deficient persons’.
The Commission provided a mercifully brisk, useful summary of legislation underpinning the asylum system from the 1700s up to the early 1900s, with particular emphasis on changes occurring around the turn of the century:
The system of administration which we have outlined underwent radical alteration when the Local Government Act, 1898, came into operation. From 1821 to 1899 the asylums were in the general control of the Lord Lieutenant. The administration was divided amongst three bodies whom he appointed, namely, the Board of Control, the Boards of Governors and the Inspectors of Lunatics. The Board of Control was entrusted with the provision of accommodation, the local Boards of Governors managed the asylums in accordance with prescribed uniform rules called the Privy Council Rules, and the Inspectors had not only the duty of visiting the asylums and inquiring into their condition, but had administrative functions, such as the framing of estimates, the approval of pensions, the regulation of dietary scales, the fixing of hours of meals and of rising and retiring, and also certain duties in connection with the audit of accounts.
Under the Act of 1898 a new administrative system was set up and it became the duty of the County Councils created by the Act to provide sufficient accommodation for the lunatic poor, and manage the asylum for the county. The Board of Control was abolished and the powers of the Lord Lieutenant and the Inspectors as to the appointment and removal of officers and the regulation of expenditure were transferred to the Councils. The County Council’s powers were to be exercised through a Committee appointed by them, one-fourth of which might be composed of persons not members of the Council […].
The Committees of Management were given power to make regulations respecting the government and management of the asylums; the admission, detention and discharge of patients; and the conditions as to payment and accommodation for private patients. The Privy Council Rules were to continue in operation until these regulations were made and approved. All the Committees of Management except those for the asylums at Carlow, Castlebar, and Mullingar [had by 1927] made regulations under the Act.17
The Commission also noted that the Local Government Act 1898 made provision for the establishment of ‘auxiliary asylums for chronic and harmless lunatics’,18 and that the Lunacy Act 1901 introduced various additional reforms:
The Lunacy Act of 1901 provided for the conditional discharge of criminal lunatics and extended to Ireland certain provisions of the English Lunacy Act of 1890 designed to protect lunatics from ill-treatment. It provided for the expenses connected with the maintenance of criminal lunatics in district asylums being defrayed out of government funds. The central asylum at Dundum could not accommodate all persons classed as criminal lunatics, and it had become the practice to send persons who had committed only trivial offences, or were serving short sentences, to the district asylums, reserving the Central Asylum largely for those who had committed serious offences. The Act of 1901 gave the same power of recovering the cost of maintenance of dangerous lunatics as existed in the case of ordinary patients, and it also permitted Committees of Management to unite for the purposes of promoting pathological research.19
Against this background, the early twentieth century was, clearly, a time of considerable discussion and, to a certain extent at least, change in mental health services owing not only to the reforming Acts of 1898 and 1901, but also to growing unrest about the state of Irish asylums and the fate of the destitute mentally ill. Before considering asylum reforms of the early 1900s any further, however, it is worth exploring briefly what is known about the fate of the mentally ill outside the asylums in the early years of the new century.
Outside the Walls: The Mentally Ill
Outside the Asylums (1901)
The historiography of Irish psychiatry demonstrates a strong focus on the history of institutions, echoing the emphasis government traditionally placed on institutional provision as a key element in resolving the social problems presented by people with apparent mental disorder or intellectual disability.
Throughout the nineteenth century, these developments were largely shaped by a strong belief that rates of mental disorder were increasing rapidly, especially toward the end of the 1800s.20 As explored in Chapter 3, the subsequent expansion of the Irish asylum system was a complex sociomedical phenomenon,21 as was the admission of increasing numbers of the mentally ill to the Irish workhouse system.22
Notwithstanding these developments, there was still a large number of people with mental disorder who were not in asylums, workhouses or other institutions in Ireland at the start of the twentieth century. One study, based on Ireland’s 1901 national census,23 found that there were 482 persons described as ‘lunatics’ and not resident in psychiatric hospitals, workhouses or other institutions in Ireland on census night (31 March) in 1901, yielding a point prevalence of 11 per 100,000 population (i.e. approximately one in every 10,000 persons outside an institution was recorded in the census as a ‘lunatic’).24
| TABLE 1Geographical distribution of persons described as ‘lunatics’ and not resident in psychiatric hospitals, workhouses or other institutions in Ireland on census night (31 March) in 1901. | ||||
| Province | County | Population | Number of ‘lunatics’ outside institutions | Number of ‘lunatics’ outside institutions per 100,000 population |
| Connaught | Galway | 192,845 | 31 | 16 |
| Leitrim | 69,460 | 12 | 17 | |
| Mayo | 198,098 | 33 | 17 | |
| Roscommon | 100,563 | 23 | 23 | |
| Sligo | 80,555 | 13 | 16 | |
| Connaught Total | 641,521 | 112 | 18 | |
| Munster | Clare | 112,309 | 21 | 19 |
| Cork | 402,388 | 48 | 12 | |
| Kerry | 165,940 | 34 | 21 | |
| Limerick | 147,154 | 9 | 6 | |
| Tipperary | 155,517 | 11 | 7 | |
| Waterford | 87,205 | 12 | 14 | |
| Munster
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