Perinatal Mental Health Crisis: Pregnant Women Face Month-Long Waits as Coombe Directed Patients to Paid Services
Pregnant women and new mothers across Ireland are facing wait times of more than a month for specialist perinatal mental health support, with some hospitals tightening their acceptance criteria and restricting access to women more than six months postpartum, while the Coombe Hospital in Dublin was found by the Ombudsman to have directed women to paid private sessions instead of free HSE services.
Background
Perinatal mental health — the mental health of women during pregnancy and in the year following birth — is one of the most significant and least adequately resourced areas of women's healthcare in Ireland. Conditions including perinatal depression, anxiety, post-traumatic stress disorder following traumatic births, and postpartum psychosis affect a substantial proportion of new mothers, with estimates suggesting that up to one in five women experience a significant mental health difficulty during the perinatal period. Left untreated, these conditions can have serious consequences for both mother and child.
The HSE's model of care for perinatal mental health, developed in 2017, envisaged a network of specialist multidisciplinary teams based at six hub maternity hospitals across the country, with spoke services extending to other hospitals and community settings. The six hubs are located at the Coombe, the Rotunda, and the National Maternity Hospital in Dublin, Cork University Maternity Hospital, University Hospital Galway, and University Maternity Hospital Limerick. The model of care specifies that support should be available to women up to one year after birth.
In practice, the implementation of the model has been uneven, with significant variation in waiting times, acceptance criteria, and the availability of community-based support across the country. Women in rural areas face particular challenges, with some required to travel several hours to reach the nearest specialist hub.
Key Developments
An investigation by The Journal, published this week, found that wait times at some of the six specialist hubs exceed one month, with some hospitals having introduced tighter acceptance criteria to manage increasing demand. Specifically, some hubs have restricted referrals for women more than six months postpartum, despite the HSE's model of care aiming for support up to one year after birth. Women who fall outside the narrowed criteria are being referred back to community mental health services, which are themselves under severe pressure.
The Ombudsman found that the Coombe Hospital had directed women to paid private sessions instead of the free HSE perinatal mental health service to which they were entitled. The Coombe's Iris Clinic, which provides specialist perinatal mental health care, currently reports wait times of approximately four to six weeks. The hospital has temporarily relocated its Perinatal Centre to the third floor of the main building due to refurbishment.
The government has indicated that a "refreshed" model of care is in development to expand multidisciplinary teams to all 19 maternity hospitals in Ireland, but no timeline has been provided for this expansion. Advocates have called for the explicit definition of the perinatal period as lasting up to 12 months postpartum to be enshrined in the model of care.
Why It Matters
The perinatal period is one of the most psychologically vulnerable times in a woman's life, and the consequences of inadequate mental health support during this period extend far beyond the individual. Untreated perinatal mental illness is associated with adverse outcomes for children's cognitive and emotional development, increased risk of relationship breakdown, and in the most severe cases, maternal suicide — which remains one of the leading causes of maternal death in Ireland. The finding that women are being directed to paid services instead of free HSE provision is particularly troubling, as it suggests that financial barriers are being introduced into a system that is supposed to be universally accessible.
The geographic inequity in access to perinatal mental health services is also a serious concern. Women in Connacht, Munster, and the border counties who do not live within reasonable distance of one of the six hub hospitals face a choice between travelling long distances for specialist care or going without. This is not a minor inconvenience — for a woman experiencing postpartum psychosis or severe perinatal depression, a four-hour round trip to a specialist appointment may simply not be feasible.
Local Impact
In Dublin, women registered with the Coombe, the Rotunda, and the National Maternity Hospital have access to specialist perinatal mental health services, but wait times and tightened criteria mean that access is not guaranteed. Women in Cork, Galway, and Limerick face similar challenges at their respective hub hospitals. For women in counties without a hub hospital — including Donegal, Sligo, Leitrim, Roscommon, Tipperary, and Waterford — access to specialist perinatal mental health care requires travel to the nearest hub, often in another county. GPs and public health nurses have been asked to screen for perinatal mental health difficulties at routine appointments and to refer women to the appropriate service, but the capacity of those services to respond is limited.
What's Next
The HSE has been asked to respond to the Ombudsman's findings regarding the Coombe Hospital and to confirm what steps have been taken to ensure women are directed to free services. The Department of Health has indicated that the refreshed model of care for perinatal mental health will be published before the end of 2026. Advocacy groups including Maternal Mental Health Ireland have called for an emergency investment in perinatal mental health services ahead of Budget 2027, and have submitted a pre-budget submission to the Department of Health outlining the scale of the unmet need.
