A group of consultant psychiatrists in the Carlow-Kilkenny-South Tipperary Mental Health Services have withdrawn confidence in the clinical management of the service, which they believe is unsafe.
In a letter, which RTÉ's 'This Week' programme received under Freedom of Information, the nine doctors wrote to the Minister with Responsibility for Mental Health to express "serious concerns" about local services in light of nine fatalities.
In the letter dated June 2013 to Kathleen Lynch, the doctors repeatedly question the safety of governance in the service and said they felt "devalued" and "ignored" in their attempts to raise their concerns internally in the Health Service Executive.
The nine senior doctors raised their concerns with the HSE about the management of the service in November 2012 and on a number of occasions subsequently.
Their concerns focus on nine fatalities in the 14 months from August 2011 to January 2013.
These included three suicides of in-patients by the same means; four suicides in home-based settings; and a further suicide in a crisis house.
The consultants called on the minister to intervene with the HSE to ensure proper investigation of incidents and that review findings would be properly communicated and appropriate reforms implemented.
In June 2013, the HSE Local Area Manager wrote to the consultants to say their concerns had been addressed, which they said was "inconceivable".
In a HSE briefing document prepared for the minister in response to the concerns, the fatalities in the service are said not to be out of line with figures for the preceding 11 years, citing Central Statistics Office statistics for counties Carlow, Kilkenny and South Tipperary.
However, speaking to RTÉ retired consultant Alan Moore said that CSO figures do not reflect the number of suicides occurring in hospitals, which he believes are unusually high.
HSE sources have said that in-patient deaths are not out of line with international norms and the Kilkenny-based service is safe.
The consultants also said they were never informed of the outcome of reviews of serious incidents.
RTÉ's 'This Week' understands that an investigation is being carried out by the Irish Mental Health Commission into governance structures within the service and a separate review by Dr Colm Henry, National Lead Clinical Directors' Programme, is also being carried out.
In its briefing document, the HSE expressed to Minister Lynch its concern that the consultants were not engaging in the clinical governance systems in place in the CKST Services.
The Local Consultant Group said that participation in such unsafe systems , which they describe as "a sham", would be a dereliction of duty.
HSE sources have told 'This Week' that the transition to the community-based service model in the Vision for Change policy is difficult and that it had the support of the majority of staff in the CKST Mental Health Service.
Sinn Féin Health spokesperson Caoimhghín Ó Caoláin has called on Minister Lynch to come into the Dáil next week to address these concerns.