Rebuilding Ireland’s mental health system

Ireland’s overstretched mental health services need urgent reform, with community models offering a path to genuine recovery

It is time for Ireland to rebuild mental health services with a recovery-oriented philosophy.

People here experience the highest level of difficulty in accessing mental health services with prolonged waiting times, among citizens of the 27 European Union (EU) member states, according to a 2023 EU survey.

This is in a context of serious shortages of appropriate residential care, with the IHCA noting Ireland has only 23 psychiatric beds per 100,000 population compared to an EU average of 73.

This leads to serious negative outcomes for people, including delayed and reduced inpatient care, unnecessary readmission, with stretched community services unable to suitably meet people’s needs.

It is true to say that service provision needs improvement at every level, but one particular gap is worth noting: Over 60 per cent of admissions into psychiatric hospitals are readmissions.

In other words, people are being discharged too early into poorly resourced community services and then being readmitted when problems escalate again. In 2024 alone, according to Mental Health Reform, the HSE spent €93 million on outsourcing mental healthcare to private (often UK-based) providers, removing patients from their communities, and disrupting continuity of care.

National strategy

Although Sharing the Vision outlines an ambitious roadmap for mental health reform, implementation has been slow.

As of November 2024, only nine out of the 100 policy recommendations were marked as fully implemented.

A further 49 were either partially implemented or in progress, while the remaining 42 had yet to begin or showed no measurable progress.

These figures reflect persistent system-wide challenges despite policy development and strategic planning efforts. Ireland continues to spend only five-to-six per cent of its health budget on mental health, which is well below the Organisation for Economic Co-operation and Development recommendation of 10-to-12 per cent.

In 2000, Ireland had approximately 4,000 psychiatric beds. In 2024, the figure is approximately 1,800.

While the closure of older institutions is absolutely to be welcomed, the development of community services to replace them has stalled. As such, this point in time represents a significant opportunity to rebuild our service provision in line with international best practice.

Need for change

In 2023, the World Health Organisation (WHO) and United Nations published a forthright assertion of the need for change. In this joint publication, Mental health, human rights, and legislation: Guidance and practice, they note: “Mental health and wellbeing are strongly associated with social, economic, and physical environments, as well as poverty, violence, and discrimination. However, most mental health systems focus on diagnosis, medication, and symptom reduction, neglecting the social determinants that affect people’s mental health.”

The document also calls for legislation to take mental health services away from the narrow traditional ‘biomedical paradigm’. It says this paradigm has contributed to “coercive and confined environments in mental health services”.

Moving away from the current dominant model would be “setting a clear mandate for mental health systems to adopt rights-based approaches; enabling person-centred and community-based services; raising awareness and challenging stigma; eradicating discrimination and coercion; promoting community inclusion and participation; and developing accountability measures”.

The document follows on from the 2021 WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches.

That document criticised “an over-diagnosis of human distress and over-reliance on psychotropic drugs to the detriment of psychosocial interventions”.

“A fundamental shift within the mental health field is required, in order to end this current situation,” according to the guidance.

Innovative initiatives

Ireland now stands at a critical crossroads: The country has both the opportunity and the responsibility to rebuild its mental health services around a recovery-oriented, rights-based philosophy. Across the nation, innovative initiatives such as Open Dialogue in Louth and Meath, the Recovery College movement, Slí Eile in Cork, Gateway Mental Health, Grow, and crisis cafés like Aware’s Solace Café demonstrate that alternatives to the traditional biomedical model are both possible and effective. International examples, including Soteria Houses and the Trieste model, show that community-led, person-centred approaches can reduce coercion, promote social inclusion, and support lasting recovery.

The country has both the opportunity and the responsibility to rebuild its mental health services around a recovery- oriented, rights-based philosophy

These ‘green shoots’ of innovation are already present in Ireland. What is now needed is a coordinated effort to scale them, embed them into mainstream service delivery, and ensure that recovery, human rights, and social inclusion are at the heart of every mental health service. With sustained investment, strategic leadership, and a commitment to learning from both national and international best practice, Ireland can transform its mental health system from one of chronic crisis to one of hope, resilience, and genuine recovery.

Kyrie Farm

Based in Co Kildare, Kyrie Therapeutic Farm is an emerging project seeking Government support to fill a critical gap in Ireland’s mental health system: A step-down facility for people leaving hospital who need additional time and support on their recovery journey.

This initiative embraces a recovery-oriented, community-focused approach that combines psychosocial interventions and peer support with biomedical care – but does not rely on the latter as the sole or primary focus. The model draws inspiration from Gould Farm in the US, which has been operating successfully for over 115 years and demonstrates promising outcomes in supporting recovery.

Kyrie Farm offers the potential to create, from the ground up, a setting where every element is designed to promote health, healing, and recovery – for guests, staff, and the wider community. In the context of the current biodiversity and climate crisis, its focus on restoring the natural environment, fostering meaningful community participation, and providing healthy organic food alongside conventional mental health interventions underscores a holistic approach to wellbeing. This model recognises that recovery is not only about symptom management, but also about connection, purpose, and living in harmony with the world around us.

Ideally, Ireland could support several therapeutic farm settings, each operating to the highest governance standards and regulated by the Mental Health Commission. Each farm could offer around 40 beds, providing much-needed capacity to an overstretched system. More importantly, these facilities would signal a welcome shift toward a more holistic approach to mental healthcare.

It is clear that psychiatric hospital-based care does not meet the needs of everyone with serious mental health challenges, regardless of diagnosis, and many people find medication-heavy approaches insufficient. Kyrie Farm would provide a more restorative environment while doing so at approximately 50 per cent of the capital cost and 80 per cent of the operational cost of an equivalent number of psychiatric beds. Step-down facilities like this not only free up acute services, but also make sense from both therapeutic and economic perspectives. Ireland must embrace pluralism in mental healthcare: No single approach fits all, and a diverse range of solutions is essential to meet people’s needs.

References available on request