Ireland’s Health Service Executive (HSE) spent approximately €80 million in 2024 to source 385 external mental health placements in private facilities to manage short-term capacity issues, according to a spending report released by the Comptroller & Auditor General (C&AG). The watchdog’s examination revealed high occupancy rates exceeding 90% across three of the four acute adult mental health facilities visited in April 2024, highlighting ongoing capacity constraints within the public system.
C&AG Report Details €80 Million Private Bed Spend
The practice of purchasing access to private beds or sourcing external placements has become a mechanism for handling short-term capacity deficits. According to the C&AG spending watchdog, the HSE informed examination teams that the 385 external placements secured in 2024 varied significantly in duration. Auditors noted that relying on external private facilities creates notable time-consuming administrative hurdles and raises value-for-money concerns for the health service.
Over the past four decades, the total number of acute adult inpatient mental health beds in Ireland has decreased substantially. This reduction aligns with long-standing national policy objectives aimed at shifting resources away from traditional psychiatric institutions and toward community-based mental health services.
Site Visits Reveal High Occupancy Rates at Acute Units
In April 2024, the C&AG examination team conducted site visits to four acute facilities, which collectively account for 161 beds—representing roughly 16% of the national total of publicly registered general acute adult inpatient beds based on HSE figures. The primary objective of these visits was to verify whether reported bed counts accurately reflected operational availability.
The site evaluations identified occupancy rates exceeding 90% at three of the four facilities inspected. Every facility visited confirmed that negotiating and sourcing beds from alternative public facilities or purchasing private access was occasionally necessary to accommodate incoming patients.
Specific operational arrangements vary. For instance, Cluain Mhuire, a community-based adult mental health service, purchases access to inpatient beds annually from St John of God University Hospital. Financial provisions allowed Cluain Mhuire to purchase access to up to 28 beds in 2025, which increased to 34 beds in 2026. During recent inspections, 27 of these contracted beds were occupied—26 by Cluain Mhuire patients and one by a St John of God patient—leaving seven vacant. Similarly, the Lakeview Unit operates 29 beds and maintains an operational agreement with Midlands Regional Hospital for ten additional beds when needed, though five beds were temporarily non-operational due to construction work.
HSE Plans Comprehensive Mental Health Bed Census for 2026
The C&AG concluded that comprehensive, up-to-date data concerning all available bed types and community services is essential for evaluating current service performance and planning future capacity for a growing population. While the Mental Health Commission publishes high-level capacity data in annual reports, the last complete census of mental health beds conducted by the HSE took place in November 2021.
In response to the findings, the HSE Chief Executive Officer confirmed that a nationwide mental health bed census is scheduled for November 2026. This upcoming census will catalog all categories of mental health beds, including acute adult inpatient beds, child and adolescent units, private beds, continuing care beds, and specialized units. The HSE also plans to establish a formal framework to conduct regular bed censuses every six months going forward.
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