Portrane facility should be beginning, not end, of forensic mental health reform.

The HSE finally opened the National Forensic Mental Health Service (NFMHS) in Portrane, Co Dublin at the beginning of the month. It is the only centre in the Republic to provide specialist forensic psychiatric treatment for acute and medium-to-longer-term psychiatric care. 

The relocation of the Central Mental Hospital (CMH) in Dundrum to this new state-of-the art, purpose-built facility is a significant step in the development of mental health services in this country. 

However, the opening of the new facility has been a long time in coming, having suffered numerous delays, the most recent of which was due to an industrial relations dispute with the Psychiatric Nurses Association. 

It is Ireland’s largest capital project and cost in the region of €200 million. This was higher than the original budget and it is another example of the difficulty in keeping the cost of healthcare infrastructural projects from spiralling. 

The new facility will provide care for 130 patients and has the capacity to care for 170 patients on campus when fully operational, as well as providing community and prison in-reach services. The hospital also has a forensic child and adolescent mental health service and an intensive care rehabilitation unit (ICRU) on site. 

The design concept for the new facility is to support the underlying roles of therapeutic care and security with dignity, embodying the best principles of high secure mental healthcare design. A total of 130 single-patient bedrooms are laid out in small wards around shared indoor and outdoor spaces, in which collective activities and therapies take place. 

The final report of the high-level taskforce to consider the mental health and addiction challenges of those who come into contact with the criminal justice sector, which was published in September, welcomed the imminent opening of the new facility. The report stated that the Portrane facility “will greatly assist in alleviating the existing bed capacity pressures on the system”. It also stated the Portrane model of care is the appropriate clinical pathway to manage patients following their admission to the CMH. 

However, the report noted there will continue to be capacity issues despite the new building. 

“Under different scenarios, in males, bed capacity will be exceeded in 2023 if the current pattern of admissions from prison, approved centres, and as a result of NGRI [not guilty by reason of insanity] is maintained,” according to the report. 

“This trend will continue up to 2026 and result in increasing waiting lists for CMH admission.” 

It recommended the development of an additional facility for patients who require a long-term, medium secure setting. Planning for this facility should commence at the “earliest opportunity” in order to meet the male bed capacity requirements for the new NFMHS in Portrane. 

The report also stated the need for “egress solutions” to ensure that the NFMHS bed capacity is optimised and “throughput of patients can be achieved”. In this regard, it was recommended that further ICRUs are planned. 

The new facility is a positive step, but more work is required to improve specialist forensic psychiatric services, which have been allowed to languish for too long.