THE OMBUDSMAN HAS upheld a complaint against Coombe hospital that it directed women with perinatal mental health challenges to a €200-a-visit private consultant rather than offering them free services they were entitled to.

The complainant argued that the maternity hospital was not informing private and semi-private patients of their right to access publicly funded services.

Instead of being given the option to be directed to Specialist Perinatal Mental Health Services (SPMHS), which is funded by the HSE and free of charge for all patients, the complainant said she was directed to a private consultant costing €200 per session.

The Ombudsman, which examines complaints from the public who believe they have been treated unfairly by a public body, upheld the complaint following an investigation.

The hospital, in response to the Ombudsman’s findings, “acknowledged the potential for confusion” and made changes to its website to provide clarity to patients.

Perinatal refers to the period of time during a woman’s pregnancy, birth and up to a year afterwards.

SPMHS provides support for women who are experiencing moderate to severe depression during this time.

These are staffed by multidisciplinary teams and operate out of six maternity hospitals across the country – the National Maternity Hospital (Holles Street), Coombe Hospital and the Rotunda Hospital in Dublin, as well as the maternity hospitals in Cork, Limerick and Galway.

In 13 other maternity hospitals across the country, SPMHS are provided by perinatal mental health midwives, though women with some complex cases can be referred to the six main hospitals.

The Journal Investigates has reported that women are experiencing difficulty accessing these specialist services, including long wait times and tightening acceptance criteria.

The investigation heard from almost 40 women across the country who had experienced mental health challenges related to their pregnancy.

SPMHS are publicly funded by the HSE and so are available to all women regardless of their patient status at the hospital.

The complaint the Ombudsman investigated contended that “the Coombe have been directing private/semi-private patients to a private consultant, which incurs an additional fee, instead of informing the patient of their right to access the publicly funded SPMHS, which is available to all women regardless of their patient status at the hospital.”

Coombe hospital’s staff guide did make it clear that private patients could avail of the publicly funded SPMHS, the Ombudsman’s investigation found, and statistics provided by the hospital showed that some private patients did make the switch.

But Coombe hospital “acknowledged the potential for confusion”, particularly with how the section of the website detailing the fees for a private mental health consultant did not make clear that SPMHS is free and available to public and private patients who attend the hospital.

At the Ombudsman’s request, the hospital provided a three-month snapshot of 44 private patients directly referred for perinatal mental health support.

It found that 14 patients chose to attend SPMHS, 12 decided to continue with private care and 18 declined an appointment.

The Ombudsman upheld the complaint on the basis that “there is lack of clear process and information around accessing this service.”

“There is ambiguity on how a private patient can access the SPMHS without being referred to the private consultant,” he added, and “the lack of clear information to patients”.

Social Democrats spokesperson for health, Pádraig Rice TD, told The Journal, “all women are entitled to access public Specialist Perinatal Mental Health Services (SPMHS), regardless of their patient status.”

“There should be no ambiguity about that in the Coombe, or any other specialist hub,” he added.

The hospital has since made changes to its referral process, with patients now required to be asked which service they would like to attend.

A notice has also been added to the hospital’s website informing private and semi-private patients of their right to access SPMHS free of charge.

Coombe hospital declined to comment further but pointed to the changes they have made following the complaint.

This article is part of a project supported by the News Reporting Scheme.

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Conor O’Carroll is an investigative reporter with The Journal Investigates.