ROH launches internal review of Mech suicide

Risk assessment can be ‘a complex challenge,’ says patient safety official

The Royal Ottawa Mental Health Centre has launched an internal review to assess its care of former CBC executive Greg Mech, an inpatient who took his own life while on a day pass.

Findings and recommendations of the quality-of-care review will be shared with the family, said Dr. Mathieu Dufour, clinical director for quality and patient safety at The Royal.

“We’re taking this seriously,” said Dufour, a forensic psychiatrist. “Our clinical team will reach out to the family to make sure they have the appropriate support to deal with this tragic event.”

Suicides are rare among the centre’s in-patients. Mech is the only in-patient who has died from suicide during the past three years, according to statistics provided by The Royal. Four outpatients — people who live in the community and visit the hospital for followup appointments — died from suicide during that same period.

Each incident triggers an internal review to understand what happened, and whether policies or procedures need to be modified.

Mech had spent more than three months at The Royal when he was approved for a day pass on Aug. 12. He told doctors he needed to pay rent on his Baseline Road apartment. Instead, Mech took a bus to the Queensway Carleton Hospital, and jumped from the sixth floor of the parking garage.

Mech’s wife and son are upset they were not told about his temporary release, and were not given the chance to accompany him on his day pass.

Dufour said that although rules that govern patient confidentiality preclude him from discussing details of Mech’s case, he could address The Royal’s policies and procedures.

He noted that every patient who applies for a day pass must go through a detailed risk assessment. Staff members assess each patient for three specific risks: suicide, violence and elopement (not returning).

Normally, he said, patients receive a day pass only after proving themselves trustworthy with more modest privileges, such as escorted and unescorted walks.

A treating physician must ultimately authorize or reject a day

pass based on information gathered from nurses, social workers and patients.

“Risk assessment is a complex challenge for a clinician because we’re trying to predict the future,” said Dufour, “and predicting the future is more difficult when the behaviour we’re trying to predict is complex.”

Suicide is a poorly understand phenomenon that is sometimes the direct result of mental illness, but not always, he said.

What’s more, Dufour said, clinicians have to rely to some extent on what patients report about their own mental state. Doctors assess responses against a patient’s observed behaviours and clinical history, but it’s not possible, he said, to be 100 per cent accurate in determining an individual’s risk.

Relatives are not automatically notified when a day pass is issued.

Some patients, Dufour said, are capable of making decisions about whether to consent to the release of their personal health information. In those cases, The Royal cannot reveal that a day pass has been granted unless doctors have a safety concern.

According to statistics provided by The Royal, six in-patients have died from suicide during the past nine years. During those years, 16 outpatients have died from suicide.

The Royal is about to launch a new chair in suicide-prevention research.