Synopsis

I trained in St Ita’s, Portrane and St Brendan’s, Grangegorman. I have watched Ireland move on from those buildings, yet too many people in mental health crisis still meet a system that fails to offer the right support at the right time. Today that often looks like a chair in a noisy waiting or in a corridor of a busy emergency department, in an environment designed for everything except a mental health crisis. I have worked in liaison psychiatry and know the system well. In April 2025, the Mental Health Commission published its national survey of acute mental healthcare in Irish EDs. It found a “poverty of appropriate space” across most emergency departments, substantial assessment delays, and prolonged inappropriate placement of children. An estimated 51,000 people access mental health services for the first time through an Irish ED each year. Sharing the Vision (Implementation Plan 2025–27) commits to therapeutic alternatives. The need is acknowledged but the model is not yet built. Since 2016, Emergency Psychiatric Assessment, Treatment and Healing (EmPATH) units, developed by Dr Scott Zeller, have been transforming crisis care across more than sixty US sites. Recliners replace trolleys and open, naturally lit spaces replace locked cubicles. Peer specialists work alongside multidisciplinary teams. Peer-reviewed outcomes from a Midwestern academic medical centre showed psychiatric admissions fell from 57% to 27%, ED boarding time reduced by approximately two-thirds, and 30-day follow-up engagement rose by 60% (Kim et al., Academic Emergency Medicine, 2022). Restraint use is consistently reported under 1%. Adolescent and paediatric variants are emerging, including a recent $45.5 million state-funded expansion across 13 South Carolina hospitals.