The Red Brick
A History of St. Otterans

The Living History of St. Otteran's

For nearly two centuries, St. Otteran's Hospital has stood as both witness and participant in Ireland's evolving approach to mental healthcare. From its founding in 1835 as a progressive "Lunatic Asylum" to its modern transformation into a healthcare hub, these limestone walls hold countless untold stories of resilience and change.

Like many Waterford families, mine has a personal connection to these halls. My grandmother, Nelly Rutter, spent her final years within these walls - not by choice, but because for generations, St. Otteran's represented the only refuge for those struggling with dementia and other mental illnesses. Her story, like so many others, is woven into the very fabric of this institution.

This is a chronicle of vision and adaptation. Of how a U-shaped Georgian building, originally designed for one hundred souls, expanded to meet Victorian demands, withstood a catastrophic twentieth-century fire, and has now been reborn to serve modern healthcare needs. The architecture itself tells a story - from the stately clock tower to the distinctive "Red Brick" additions, each era leaving its indelible mark. St. Otteran's is not just a place, it’s a continuing story of how society cares for one another.

The Founding and Early Years of St. Otteran’s Hospital

In May 1832, a significant step was taken to address the needs of the mentally ill in Waterford when land was acquired from the estates of two prominent local figures: Sir Simon Newport and Sir John Judkin Fitzgerald. The purpose of this acquisition was clear—to establish a dedicated Lunatic Asylum for the district. Sir Simon Newport received £841 11s 8d in compensation, while Sir John Judkin Fitzgerald was awarded £300 for his portion of the land.

Construction of the hospital, named in honour of Waterford’s patron saint, Otteran, began in 1834 at John’s Hill (also known as Upper Grange). The project was completed the following year, with the skilled builders Francis Johnston and William Murray overseeing its construction. The hospital was built using durable Irish limestone ashlar, a material chosen for both its strength and aesthetic appeal.

The original structure was designed to accommodate fifty male and fifty female patients. Its architectural layout featured a two-story, U-shaped central block with five bays, crowned by a distinctive tower and clock. This design reflected the institutional approaches of the era, blending functionality with a measure of grandeur.

As demand for mental health care grew, the hospital was expanded to house two hundred patients of both sexes. Among its early residents were some of the displaced inmates from the old House of Industry (later known as Fanning House), marking St. Otteran’s as a critical institution in Waterford’s evolving approach to social and medical care.

Thus, the foundation was laid for what would become one of the city’s most enduring landmarks—a place where history, architecture, and the changing tides of mental health treatment would intersect for generations to come.

Expansion and Adaptation in the Late 19th Century

By the late 1800s, St. Otteran’s Hospital had become a vital institution in Waterford, but its growing patient population demanded significant changes. In 1879, recognizing the spiritual needs of those under its care, the hospital added a small Roman Catholic chapel, deliberately constructed apart from the main building. A separate space was also provided for Protestant inmates, reflecting the religious demographics of the time and the institution’s commitment to accommodating all faiths.

The need for expansion became even more pressing in the following decades. By 1891, the hospital housed 359 patients—far exceeding its original capacity. To address this, two major new wings were added in 1894 at a cost of approximately £17,000. The project was entrusted to local builder George Nolan, with architect J. Otway overseeing the design.

The most notable addition was the male wing, constructed at the south-east end of the original building. Stretching 150 feet long and 50 feet wide, it was a substantial expansion. The basement housed practical workshops for carpenters and tailors, while the ground floor featured dressing rooms, bathing facilities, day rooms, and dormitories. The first floor also contained two large dormitories, each with attendant rooms and additional bathing spaces.

Externally, the new wings were built with red brick and limestone dressing, a striking contrast to the original limestone structure. This distinctive style earned the expansion its enduring nickname: the "Red Brick" building.

These changes not only addressed overcrowding but also reflected evolving attitudes toward mental healthcare—prioritizing functionality, hygiene, and a degree of comfort for patients. The late 19th century thus marked a transformative era for St. Otteran’s, as it physically and philosophically adapted to the needs of a changing society.

The St. Otteran’s Hospital Fire: A Narrow Escape from Disaster

On November 27th, 1974, a devastating fire broke out in the women’s wing of the hospital on John’s Hill, triggering a dramatic evacuation of 460 patients and a heroic response from staff, emergency services, and even local schoolchildren. The blaze, one of the largest in Waterford in decades, caused extensive damage to the three-storey wing but was narrowly prevented from engulfing the entire hospital.

The Outbreak
The fire began in an air vent on the top floor of St. Agnes’s Ward, where two workers—interior decorator Eugene McGarrigle (Donegal) and his colleague Frank O’Connor (Lucan)—spotted the flames. They rushed to grab fire extinguishers and raised the alarm as the fire spread rapidly to the recreation hall below. Within minutes, the automatic fire alarm sounded, and the ward’s roof collapsed, sending flames 20 feet into the air, fanned by a strong breeze.

The Evacuation
Nursing staff and groundsmen swiftly evacuated patients, some of whom were carried to safety while beds, furniture, and personal belongings were tossed from windows onto the lawns. The hospital’s fire drill protocol ensured an orderly response, aided by Gardaí who abandoned duties at Waterford Circuit Court to assist. Teachers and pupils from Newtown School and the Ursuline Convent joined the effort, helping salvage equipment and clear debris.

Averting Catastrophe
Fire brigades from Waterford, Tramore, and Dungarvan battled the blaze, containing it to the 1895-built wing. Dr. Seamus Lennon, the hospital’s superintendent, later noted that a night time fire would have been “extremely difficult” to manage, crediting the alarm system and daylight for preventing loss of life. Patients were relocated to the new occupational therapy unit and St. Declan’s Unit at Ardkeen General Hospital, with some families offering temporary homes.

Aftermath and Investigation
Despite the severity of the fire, hospital secretary William Moore reported minimal overall damage, though a full survey was pending. The South Eastern Health Board had already approved a £90,000 renovation for the hospital, with work set to begin in 1975. An official investigation into the cause was launched, with early praise for the alarm system’s role in averting a “major catastrophe.”

The fire underscored both the vulnerability of historic institutions and the resilience of Waterford’s community. St. Otteran’s, a cornerstone of psychiatric care since 1835, would rebuild—its story forever marked by the day flames threatened its halls, but courage and quick thinking prevailed.

St. Otteran’s Hospital in the Era of Deinstitutionalisation:

In the late 1980s, St. Otteran’s Hospital, like many psychiatric institutions across Ireland, faced a transformative challenge: the nationwide push for deinstitutionalisation. This policy aimed to replace long-term hospitalisation with community-based mental health services, emphasising patient autonomy and social inclusion. The hospital, which had operated since 1835 as a cornerstone of psychiatric care in Waterford, began a gradual decline as resources shifted toward outpatient programs and smaller residential facilities.

A Hospital in Decline

By the 1990s, St. Otteran’s saw its patient numbers dwindle. The original Victorian buildings, once bustling with hundreds of residents, became partially vacant. Critics called for its full closure, arguing that the institutional model was outdated and incompatible with modern mental health philosophies. Yet, the hospital resisted complete shutdown. A core group of long-stay residents—many of whom had lived there for decades—remained, their complex needs making community transition difficult. For these individuals, St. Otteran’s was not just a facility but a home, and its closure threatened to disrupt fragile support systems.

The Human Cost of Transition

The hospital’s partial operation highlighted tensions in deinstitutionalisation. While the policy sought to empower patients, some long-term residents faced isolation or inadequate community placements. Families and advocates noted that alternative services were often underfunded or inaccessible, leaving vulnerable individuals in limbo. St. Otteran’s became a microcosm of this struggle: a relic of the past still serving those the new system had failed to absorb.

Legacy and Adaptation

Despite its reduced role, St. Otteran’s retained symbolic and practical significance. The Health Service Executive (HSE) repurposed parts of the campus for social inclusion programs, including arts initiatives like the Building Memories project, where former patients created artwork reflecting their experiences. Meanwhile, the hospital’s history—from its 19th-century origins to its contested modern role—offered lessons about the unintended consequences of policy shifts.

A Contested Future

Today, St. Otteran’s stands as a testament to both progress and unresolved challenges in mental healthcare. Its decline mirrors Ireland’s broader move away from institutionalisation, yet its persistence underscores the need for nuanced solutions that balance ideology with the realities of patient care. As debates continue over its future, the hospital remains a touchstone for understanding the complexities of reform—and the lives caught in its wake.

In 2022, what had once been called the St. Paul’s building, according to the, HSE website, (Link to HSE Article) received approval for renovation. The following article from the Munster Express explains all.

Integrated Healthcare Hub to open at St. Otteran’s Complex

The HSE are due to open a recently completed, new Integrated Healthcare Hub in St Otteran’s Waterford. The project cost €17 million and involved renovating the St. Paul’s building at St. Otteran’s, John’s Hill, Waterford.

The new Hub will facilitate outpatient appointments across three Consultant led disciplines which were previously provided for in University Hospital Waterford. Two floors of the existing St. Otteran’s Complex have been extensively renovated to feature medical treatment facilities for Audiology, Orthodontics, and Ophthalmology services.

Theatre-based, acute interventional and specialist operations in all three disciplines will continue to occur at University Hospital Waterford. All outpatient activity in Audiology, Orthodontics and Ophthalmology will continue to be provided within the community setting but now in one centralised location at the new St. Otteran’s Complex, John’s Hill, Waterford.

The main building for what had been St. Otteran’s psychiatric hospital ceased to house patients in 2007. Following planning approval in 2022 and extensive enablement works that began in 2023, the next phase in the St. Otteran’s complex project was the refurbishment of disused wards.

St. Otteran’s Hospital, originally opened in 1835, stopped being a psychiatric hospital in 2007. The St. Paul’s building, built in 1895, has been preserved, with its red brick Victorian design incorporated into the new development.

Planning for the Integrated Healthcare Hub was approved in 2022, and renovations began in 2023. A new two-story entrance was added, along with 42 parking spaces, disabled parking, landscaping, and accessibility improvements.

The new complex covers approximately 30,000 square feet across three floors (including the lower ground floor). The Integrated Healthcare Hub at the St. Otteran’s Complex is currently undergoing an equipping phase and patient services across all three disciplines are expected to begin in May.

Epilogue: The Clock Still Ticks

As the hands of St. Otteran's clock continue their measured movement, they mark more than the passage of hours. They trace the arc of a story that began with good intentions in Georgian Ireland, weathered the storms of institutional care, survived the flames of disaster, and now finds new purpose in our modern age.

The €17 million transformation of the Red Brick building into a gleaming healthcare hub represents both continuity and change. Where Victorian orderlies once supervised crowded wards, audiologists now fit hearing aids; where distressed patients once gazed through barred windows, orthodontists straighten children's smiles. The limestone walls that absorbed so much sorrow now echo with the mundane chatter of outpatient clinics.

My Grandmother Nelly's story, like those of countless others, remains etched in these stones. But the hospital's rebirth suggests a hopeful truth - that places of healing can evolve, just as understanding evolves. The clock tower still stands watch, its face now turned toward a future where dignity and care need never be confined within walls again.

St. Otteran's endures. Not as an asylum, but as evidence that even our most troubled institutions can find redemption—if we have the courage to remember their lessons while embracing change. The hands keep moving, the story continues.