In Ireland patients who are found unfit to plead are automatically detained in the Central Mental Hospital (CMH) at the pleasure of the court. The CMH is the only high security psychiatric hospital in the Republic of Ireland. There is no limit on the length of detention and no review system in place. We reviewed the case notes of all the prisoners admitted to the CMH since 1937 who were found unfit to plead. We identified 24 cases which included only one female. The mean age was 33.5 years. Nearly 25% had a criminal record and over 60% had a past psychiatric history. The primary diagnoses were schizophrenia (12), mental handicap (4), personality disorders (3), psychotic episode (2), dementia (2) and manic depression (1). The average length of stay in the CMH was 18 years. We review the situation in the UK and in the USA and we make recommendations about legislation.
