The latest annual report from the National Psychiatric In-patient Reporting System (NPIRS) on activities in psychiatric inpatient units and hospitals shows that the total number of admissions to inpatient care has continued to fall.1 The report, Activities of Irish psychiatric units and hospitals 2005, was published in November 2006 by the Health Research Board (HRB) and is the latest in a series that began more than forty years ago. 

In 2005, there were 2,995 cases admitted with an alcohol disorder, of whom 962 were treated for the first time.1 Figure 1 presents the rates of first admissions to inpatient psychiatric services between 1990 and 2005 with a diagnosis of alcohol disorder, per 100,000 of the population.1-4 It is notable that the rate decreased steadily between 1991 and 2004 and more than halved during the reporting period. The rate of new admissions stabilised in 2005. The trend since the early nineties reflects changes in alcohol treatment policy and practice during the period and the resultant increase in community-based and special residential alcohol treatment services. Of the 3,007 discharges with an alcohol disorder, just under 43% spent less than one week in hospital and 17% spent more than one month in hospital.

In 2005, there were 777 cases admitted with a drug disorder, of whom 308 were treated for the first time.1 There are no data presented in the report on psychiatric co-morbidity. Figure 2 presents the rates of first admissions to inpatient psychiatric services between 1990 and 2005 with a diagnosis of drug disorder, per 100,000 of the population.1-4 It is notable that the rate increased steadily between 1990 and 1995, with a dip in 1996, and further annual increases between 1997 and 2001. The rate was almost three times higher in 2001 than it was in 1990.  The dips in 1996 and 2002 can be partly explained by the fact that the rates are calculated from new, larger census numerators in 1996 and 2002 compared to the year preceding each of these years. The small number of drug dependence cases each year would be sensitive to this change in numerator.  The increasing rate of new cases of drug-related admissions between 1990 and 2001 reflects the increase in problem drug use in Ireland and its burden on the psychiatric services.  There was a notable decrease in 2002, which was sustained in 2003.  This overall decrease since 2001 possibly reflects an increase in community-based specialised addiction services during this period. The increased rate in 2005, partly accounted for by the diminishing denominator in the 2002 census, may reflect a failure of community-based specialised addiction services in Dublin to deal with drugs other than opiates, and of community-based specialised addiction services outside Dublin to deal with opiate users. Of the 818 discharges with a drug disorder, just under 45% spent less than one week in hospital and just over 19% spent more than one month in hospital.

1. Daly A, Walsh D, Ward M and Moran R (2006) Activities of Irish psychiatric units and hospitals 2005. Dublin: Health Research Board.

2. Daly A, Walsh D, Moran R and Kartalova-O'Doherty Y (2004) Activities of Irish psychiatric services 2003. Dublin: Health Research Board.

3. Daly A, Walsh D, Comish J, Kartalova-O’Doherty Y, Moran R and O’Reilly A (2005) Activities of Irish psychiatric units and hospitals 2004. Dublin: Health Research Board.

4. Walsh D and Daly A (2004) Mental illness in Ireland 1750–2002: reflections on the rise and fall of institutional care. Dublin: Health Research Board.