Dr Dermot Walsh 1931–2017

Dr Dermot Blaise Walsh, MB BCh, FRCPI, FFCMI, FRCPsych, MFCM RCP (UK), of Dublin and County Wicklow, Ireland, was a leading reformer of Irish mental health services, whose vision of compassionate, effective care was matched by pragmatic determination systematically to reform mental health policy, services and law to better serve the mentally ill and their families. For over six decades, he was a tireless, effective advocate for justice for the mentally ill and he contributed substantially to the end of the era of the asylum in Irish psychiatry.

Born in Dublin on St Blaise’s day, 3 February 1931, Dr Walsh was the eldest of four children. He had two brothers, Patrick and Brendan, and a sister, Marie Thérèse, all of whom predeceased him. Dr Walsh grew up in Rathgar and attended St Mary’s College, Rathmines and, as a boarder, Blackrock College, in Blackrock, County Dublin.

Dr Walsh’s parents were in business, but both Dermot and Patrick went into medicine. Dr Walsh graduated with the degree of Bachelor of Medicine and Surgery (MB BCh) from University College Dublin in 1955. Both brothers who entered medicine also entered psychiatry (Shannon, 2010).

Dr Walsh completed his internship in the Richmond Hospital in Dublin (1955–1956) followed by positions as a clinical clerk at Grangegorman Mental Hospital (later St Brendan’s) (1956–1957) and as registrar at St John of God Hospital in Stillorgan, County Dublin (1957–1958).

Dr Walsh then went to the United Kingdom where he completed his training at the Department of Psychiatry in the University of Leeds (1958–1962). He returned to Ireland in 1963 and worked at St Loman’s Hospital in Ballyowen, Dublin as assistant medical officer, senior psychiatrist and consultant psychiatrist until 1974.

Throughout his career, Dr Walsh was especially involved in community-oriented revisions of mental health policy, moving Ireland’s mental health system away from the old asylums and towards community care.

In 1961, Seán MacEntee, Minister for Health, appointed a Commission of Inquiry on Mental Illness (Coimisiún Fiosrúcháin um Easláinte Meabhrach) to report on the services available to the mentally ill and propose improvements. The commission was an important, influential body, which heard from witnesses including representatives of the Irish Division of the Royal Medico-Psychological Association and Dr Walsh. The resultant ‘1966 Report’ presented a blueprint for deinstitutionalisation and development of community mental health services over the following decades (Commission of Inquiry on Mental Illness, 1967).

In 1965, Dr Walsh was awarded a World Health Organisation (WHO) Travelling Fellowship in Epidemiological and Social Psychiatry and, in 1965 and 1966, acted as Regional Officer for Mental Health at the European regional office of WHO, based in Copenhagen. He also acted, over many subsequent years, as consultant to the office, serving on a number of relevant committees including the WHO Expert Committee on Mental Health and the WHO Research Committee on Mental Health (1967–1990).

Dr Walsh became a member of the Faculty of Community Medicine of the Royal College of Physicians in the United Kingdom [MFCM RCP (UK)] in 1975 and attained fellowship 2 years later. He became a fellow of the Royal College of Psychiatrists (FRCPsych) in 1976.

In the 1970s, Dr Walsh strongly promoted the establishment of the Schizophrenia Association of Ireland. He was a member of the Irish National Council on Alcoholism (1974–1979), the Sentence Review Group (1986–1988), Comhairle na nOspidéal (1989–1991), the Suicide Review Group in the Department of Health and Children (1999), the Expert Group on Alcohol-Related Problems in the Department of Health and Children (2001) and the National Taskforce on Medical Staffing (‘Hanly Report’; 2002–2003), among other groups. He was life president and former chairman of Treoir, a membership organisation that promotes the rights and best interests of unmarried parents and their children through providing specialist information; raising awareness on issues affecting unmarried parents; and campaigning for change (www.treoir.ie).

Among his many other roles over these decades, Dr Walsh served as clinical director of the St Loman’s Mental Health Service and (later) Department of Psychiatry, Tallaght Hospital (1974–2001), director of the Mental Health Division of the Medico-social Research Board and (later) Health Research Board (1969–2004), and Inspector of Mental Hospitals and advisor to the Department of Health and Children (1987–2003) (Shannon, 2010).

As inspector, Dr Walsh was fair but unsparing in his assessments, and was especially concerned that there should be up-to-date reports on patients. He was very deeply engaged in this work, often in a difficult climate, and he left an enduring legacy in many psychiatric hospitals around the country. The inspector’s reports themselves were detailed and extensive, but, in addition, the visits and consultations often led to changes and improvements at local level that were not always documented.

Dr Walsh was similarly direct and fair about overall levels of service provision, especially when there was a significant divergence between policy and practice in relation to the mentally ill, the elderly or people with intellectual disability. In 1992 he wrote:

Services for the elderly and the mentally handicapped in this country have much in common. For neither is there a comprehensive nationwide, rationally-controlled and operated coherent system of care-delivery despite recent policy documents in both cases. What does exist is a ramshackle ad hoc jumble of poorly-orientated inputs without an overall policy objective or planned programme approach. Unfortunately all this rebounds on the psychiatric service so that, as a general catchall for fringe medical and social problems, psychiatry has taken up the slack. […] there is very little psychiatrists themselves can do. Help must come from without through the development of appropriate services for mentally handicapped and elderly (Walsh, 1991 a : 2).

In sharp contrast with other commentators who simply commented and did little else, Dr Walsh devoted his entire career to improving conditions on the ground for the mentally ill, their families and their communities. Along with Dr (later Professor) Ivor Browne and Dr Vincent Crotty, he initiated one of the first community-based mental health services in Ireland, in Dublin in the 1960s, and he went on to strongly influence mental health policy for several decades thereafter, as a clinician, inspector, policy-advisor and leader of change.

Mindful always of the need to reform the existing system and to work with government, Dr Walsh participated in the development of both Planning for the Future (Study Group on the Development of the Psychiatric Services, 1984) and A Vision for Change (Expert Group on Mental Health Policy, 2006), two seminal statements of national mental health policy.

As clinical director, Dr Walsh was involved pivotally in opening the Lakeview Unit in Naas, County Kildare in 1992 and remained as clinical director of the Kildare/West Wicklow Mental Health Service until 1996. Also as clinical director, he led the move of psychiatric services from St Loman’s to the Adelaide and Meath Hospital, incorporating the National Children’s Hospital (later renamed Tallaght Hospital) in 1999.

From a research perspective, Dr Walsh made invaluable contributions to the understanding of mental illness in Ireland and elsewhere (Higgins, 1968). Over the course of his career, he wrote and co-wrote over 250 articles in national and international peer-reviewed journals, many relating to mental health legislation, as well as book chapters, books and innumerable articles for newspapers.

Dr Walsh was involved in developing a depression rating scale in Leeds and was a key figure in the Roscommon Family Study, an epidemiological study of psychosis (Torrey et al. 1984; Kendler et al. 1993) which was conducted jointly with Ken Kendler (Department of Psychiatry, Medical College of Virginia), as were later studies of the genetic epidemiology of schizophrenia and alcoholism, as parts of a collaboration extending over nearly a quarter century. Dr Walsh also established the National Psychiatric In-Patient Reporting System in what was then the Medico-Social Research Board (amalgamated with the Medical Research Council of Ireland to form the Health Research Board in 1986) and the contemporary three county case register initiative, reproduced in the St Loman’s catchment area.

In addition, Dr Walsh made numerous original contributions to the study of the history of psychiatry in Ireland (Walsh, 2008, 2010, 2012 a , 2015, 2016), including an outstandingly lucid history of schizophrenia in Ireland (Walsh, 1992 a ) and an insightful account of mental health services from 1959 to 2010 (Kelly, 2012; Walsh, 2012 b ; Finnane, 2013; Fitzpatrick, 2013; Miller, 2013; O’Sullivan, 2013). He also co-authored, with Antoinette Daly, a data-rich account of the rise and fall of Ireland’s psychiatric institutions, titled Mental Illness in Ireland 1750–2002: Reflections on the Rise and Fall of Institutional Care (Bates, 2004; Walsh & Daly, 2004; Kelly, 2016).

Dr Walsh founded (1982) and edited the Irish Journal of Psychiatry, published by the Irish Institute of Psychiatry, and he devoted editorials to signs of emergent change in Irish psychiatry (Walsh, 1992 b ) and the extent of psychiatric illness in populations (Walsh, 1993), among other topics. A key leader of deinstitutionalisation, Dr Walsh made a vast and unique contribution to enlightened mental health policy, law and practice through his clinical work, medical leadership, involvement with governmental reviews and policy, and the Health Research Board.

An erudite and prolific communicator, Dr Walsh wrote for public (Walsh, 1991 b ), academic (Walsh, 2006) and professional audiences (Walsh, 2011), commenting on, inter alia, the need for, and evolution of, an independent college of psychiatrists for Ireland (Walsh, 2009 a , 2009 b , 2009 c ). This had been a long-standing theme: in 1992, Professor Thomas Lynch recalled Walsh’s early suggestions that Ireland should have its own college, rather than a division of the London-based Royal College of Psychiatrists (Healy, 1992).

This eventually came about in 2009 when the College of Psychiatry of Ireland (re-titled College of Psychiatrists of Ireland in 2013) emerged as an organisation when three former bodies merged: the Irish College of Psychiatrists (a division of the Royal College of Psychiatrists in the United Kingdom), the Irish Psychiatric Association, and the then training body for psychiatry, the Irish Psychiatric Training Committee.

Dr Walsh participated enthusiastically in the new College and, in 2010, Dr Justin Brophy, first president of the College, presented Dr Walsh with the College’s first Outstanding Achievement Award for his lifetime of work dedicated to all aspects of mental health care in Ireland.

Having retired from clinical practice in 2001, Dr Walsh continued to work extensively for the Mental Health Commission, remain involved with the Health Research Board, and write about the history of psychiatry up until the brief illness that preceded his death (Walsh, 2016). He had an immense knowledge and love of art and architecture, informed by his command of languages, particularly French and Italian. Nothing pleased him more than to take someone on an architectural tour of a psychiatric hospital. These broad interests were a substantial part of Dr Walsh’s life and he was scholarly in their pursuit.

Dr Walsh will be remembered as a determined, effective reformer of mental health services, advocating endlessly for better conditions in hospitals and hostels, improved treatments for mental illness, and greater justice for the mentally ill and their families. He was an outstanding clinician, always treating patients with dignity, respect, understanding and compassion.

Dr Walsh will also be remembered as an excellent colleague, a gifted researcher, an educator (he was a lecturer in psychiatry in University College Dublin from 1969 to 1985), a unique historian of the Irish asylum system, and a man of outstanding principle and integrity. His contribution to the modernisation of Irish mental health services was unique, invaluable and immeasurable.

Most of all, however, through his example, Dr Walsh demonstrated to several generations of psychiatry trainees how properly to conduct oneself as doctor, policy-maker and champion for patient rights. He combined uncompromising idealism with genuine pragmatism, and worked tirelessly to place the dignity of the mentally ill and their families at the heart of reform. Dr Walsh’s contributions were myriad, manifold and utterly essential to the modernisation of Irish mental health services in the late 20th and early 21st centuries.

Dr Dermot Blaise Walsh died in Dublin on 8 February 2017, following a brief illness. He is survived by his wife Eilís and a broad circle of family, friends and colleagues.