ROH launches in­ter­nal re­view of Mech sui­cide

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

Ottawa Citizen - - CITY - ANDREW DUFFY aduffy@post­

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.

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