Staff at St John of God complained about poor governance structures in the service, an unpublished report seen by The Irish Times reveals.
Management at the mental health services were strongly criticised by staff working with children and adolescents. They were interviewed for a report into suicide of a teenager in their care two years ago.
Poor communication and a lack of consultation between clinical staff and management were also a source of concern, according to the report.
St John of God has been at the centre of controversy in recent weeks, most recently following revelations about secret €1.64 million top-up payments made to 14 senior managers.
The report relates staff frustration at the lack of action in addressing concerns and the lack of implementation of decisions that were taken and agreed.
Some staff cited a lack of clarity about who had responsibility for quality and safety. They also said that not all staff were aware of their lines of responsibility.
Review recommended
The report was compiled by two investigators following the suicide of a young woman who was being treated by the child and adolescent mental health service.
The investigators recommended a review of governance arrangements “to ensure that the services are appropriately developing, implementing and auditing local procedures and guidelines”.
The report found no evidence that a risk register had been developed, despite a recommendation to this effect in a strategic review.
Suicide attempts
HSE policy is for all safety incidents to be reported and investigated but staff told the investigation team there was inadequate risk management and learning from adverse incidents.
The report says the team was under “unprecedented pressure” due to the number of suicide attempts they were dealing with without access to inpatient hospital beds.
The clinical team treating the young woman was flexible, responsive and supportive “despite external and unpredicted resource and manpower issues,” the report found.
The care provided was “in line with accepted practice” and it would not have been possible to predict the subsequent suicidal behaviour.
The report says the young woman’s mother was critical of the lack of mental health service provision for adolescents.
“She expressed her distress that if they had access to money they would have been able to access a private inpatient facility which she believes would have helped her daughter,” it says.
The team treating her expressed frustration at the lack of access to mental health beds, work overload, high caseloads and the increased urgency and complexity of cases.
