ABSTRACT
This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.
