Mental Health Reform Calls for Dedicated Crisis Centres to Ease Emergency Department Pressure
Mental Health Reform, a coalition representing 80 mental health organisations, has made a compelling case for the establishment of dedicated mental health distress centres located outside of busy hospital emergency departments. Presenting to the Oireachtas Health Committee on 8 July, the group argued that EDs are a "therapeutically inappropriate" environment for individuals experiencing a mental health crisis, with approximately 50,000 people presenting to EDs for mental health support annually.
The Problem
Ireland's emergency departments are under enormous pressure, and mental health presentations are a significant and growing part of that pressure. According to data presented to the Oireachtas Health Committee by Mental Health Reform, approximately 50,000 people present to emergency departments across the country each year for mental health support. These individuals — who may be experiencing acute anxiety, depression, suicidal ideation, or other mental health crises — often face long waits in loud, overcrowded, and clinically focused environments that are poorly suited to their needs.
The coalition argued that the emergency department is not only an inappropriate setting for people in mental health crisis but that the experience of attending an ED can actually make things worse. The noise, the waiting, the clinical atmosphere, and the lack of privacy can all exacerbate distress, and the long waits that are a feature of most Irish EDs mean that people in crisis may spend many hours in an environment that is actively harmful to their wellbeing before they receive any meaningful support.
The Safe Haven Model
Mental Health Reform put forward a vision for a new model of care, drawing on successful examples from other countries. The proposed "Safe Havens" or "Crisis Cafés" would offer a calm, welcoming, and non-clinical environment for people in crisis. These centres would be staffed by a mix of peer support workers — people with lived experience of mental health difficulties — and clinical staff, providing immediate support, assessment, and referral to appropriate services.
The model is designed to provide a more compassionate and effective first point of contact for people struggling with their mental health, thereby diverting them from the already overburdened acute hospital system. Safe Havens would be open outside of normal business hours, when the need for crisis support is often greatest, and would be located in accessible community settings rather than in hospital campuses. The coalition argued that the investment required to establish and run a network of Safe Havens would be more than offset by the savings generated by reducing the number of mental health presentations to emergency departments.
The Data
The presentation to the Oireachtas Health Committee included some deeply concerning data about the scale of mental health need in Ireland. Figures from the National Self-Harm Registry revealed that there were 12,621 self-harm presentations in 2024, a figure that represents only a fraction of the total number of people experiencing mental health difficulties. Particularly alarming was the data on the age of onset for self-harm, with the registry noting a disturbingly young age of first presentation between 10 and 14 years old.
These figures underscored the urgency of the coalition's call for action. Róisín Clarke, Interim CEO of Mental Health Reform, stated: "People in distress deserve to be met with compassion and care in a timely manner. The emergency department is simply not the right place for this. Investing in alternative, community-based crisis services is not just a compassionate choice; it's a practical solution to ease pressure on our hospitals."
Political Response
The presentation to the Oireachtas Health Committee was well received by members across party lines, with several TDs and senators expressing strong support for the Safe Haven model. The committee chair indicated that the committee would be making recommendations to the Minister for Health on the establishment of a pilot programme of Safe Havens, with a view to rolling out the model nationally if the pilot proves successful.
The Minister for Health has previously expressed interest in the Safe Haven concept and has indicated that the government is open to exploring new models of mental health crisis care. However, the coalition has called for a firm commitment to funding and a clear timeline for implementation, arguing that expressions of interest are not sufficient given the scale and urgency of the need.
International Evidence
The Safe Haven model has been successfully implemented in a number of other countries, including the United Kingdom, Australia, and Canada. In the UK, a network of Safe Haven services has been established in many areas, with evidence suggesting that they are effective in reducing the number of mental health presentations to emergency departments and in providing a more positive experience for people in crisis. The coalition has drawn on this international evidence in making its case to the Oireachtas, arguing that Ireland does not need to reinvent the wheel but simply needs to adopt and adapt a model that has already been proven to work.
