Born at Glenelg, South Australia, Hugh Birch was the sixth child in a family of seven children. A tall, athletic youth, he was a diligent scholar at Pulteney Grammar School, Adelaide, when at the age of fifteen his life was catastrophically altered. His cervical spine was fractured in a fall from his bicycle while riding on the beach. He was required to spend the next two years on his back. Later he was able to resume walking with a spastic gait, aided by a walking stick.

With typical courage and dogged determination, he eventually returned to school, completed his secondary education and entered Adelaide Medical School in 1919. In 1924, he journeyed to London by ship to complete his hospital experience at London Hospital (now the Royal London Hospital), and in the following year he passed the conjoint examination of the Royal Colleges of Physicians and Surgeons. After service as a house physician in London he left to return to Australia in 1926, as ship's surgeon on a cargo ship. He was fortunate to escape with his life and few belongings when the ship was wrecked on a reef in the West Indies on the way. Finally reaching Adelaide, he was appointed junior medical officer at Parkside Mental Hospital in 1926. This was the start of his distinguished psychiatric career.

Over the next thirty-five years he sequentially held the positions of acting deputy superintendent (1931), deputy superintendent (1933), superintendent (1935), and superintendent of mental institutions (1937), with the title of Director of Mental Health being added later. He remained based at Parkside until his retirement in 1961, with only a brief interruption in 1932 to 1933, when he returned to England to gain further experience in neurology and psychiatry before obtaining the Diploma in Psychological Medicine.

In 1938, he was elected a foundation fellow of The Royal Australasian College of Physicians, and in 1946, he was elected Chairman of the state branch of the newly formed Australian and New Zealand Association of Psychiatrists – the forerunner of the present Royal Australian and New Zealand College of Psychiatrists. In 1952, he was elected president of that Association. Prior to his election as president, his services as the superintendent of the three major mental institutions in Adelaide (Parkside, Northfield and Enfield) had been recognised by his appointment as a Commander of the Order of the British Empire in 1950. Particular regard had been paid to his heavy responsibilities in the years of the Second World War when depletion of staff in the mental hospitals, then accommodating some 3,000 patients, created many problems.

His scientific contributions were historically significant. In 1930, he instigated the use of malaria and arsenicals in the treatment of general paralysis of the insane, and later in 1938, the use of insulin coma and cardiazol therapies. Always interested in 'matters electrical', in August 1941, he was the first psychiatrist to apply electro-convulsive therapy in Australia, using a machine that he built himself, as the onset of the war in late 1939 had precluded the import of machines from overseas. He published his results of the use of ECT in the Medical Journal of Australia in June 1944. His later articles, published in the same journal, covered such diverse topics as prefrontal leucotomy, psychiatric disorders in general practice and issues of forensic psychiatry.

A man of many achievements, Hugh Birch, in contrast, led a relatively restricted social life. Driven by an indomitable will and a fierce need to be independent, he shunned any hint of pity or sympathy from others to the point that he sometimes seemed remote, brusque and taciturn. When required he could be courtly and charming, but his warmth and affection were reserved mainly for his English born wife Flora and a small circle of close friends. He married Flora in 1935. He missed her greatly after her death in 1967. Beset by increasing problems in walking, he was still able to remain at home with the help of a housekeeper until his own death, nine years later, at the age of eighty. As a memorial, the Hugh M Birch Library at Glenside Hospital has been named in his honour – a fitting tribute to his wide knowledge and outstanding originality.