St. Joseph’s suicide review lacks specifics
Study prompted by cluster of deaths
“We are very committed to these changes and we are committed to being held accountable.”
DR. IAN PREYRA DEPUTY CHIEF OF STAFF
On the plus side, the long-awaited external review of nine suicides by St. Joseph’s Healthcare psychiatric patients calls for better understanding of their stories, closer collaboration with families and better safety planning.
On the minus side, the review lacks specifics about the means of suicide and what has been done to change the physical environment of the hospital to prevent similar deaths.
A report, stemming from the review, was posted Friday at noon on the St. Joe’s website and includes 24 recommendations which the hospital says will be implemented by January. Some have already been acted on.
The review was requested by the hospital last year after a cluster of suicides among psychiatric patients.
The Spec has previously reported that the review was triggered by the suicides of three in-patients within the hospital in 2016 at the West 5th Campus, the city’s adult psychiatric unit. But the report reveals for the first time that in addition to those deaths, two patients on day passes also died by suicide as did four outpatients. Outpatients could include anyone who has had contact with the COAST (Crisis Outreach and Support) program or even the emergency department, for example.
There were 2,138 mental-health inpatient admissions at St. Joe’s last year, with 61 per cent of the acute general psychiatry admissions due to “threat or danger to self,” according to the report.
There is a lack of national data related to hospital suicides, making it difficult to know if St. Joe’s numbers are higher or lower than anywhere else.
The Spec has reported that in 2017 there have been at least two suicides associated with the hospital. One was an in-patient who died at the hospital
last month. The other was Nicole Patenaude, 20, who was on a day pass when she jumped from a bridge onto Highway 403 in May. I recently told the story of her life, her struggle with mental illness and her suicide in a long Spectator story.
The 2017 deaths were not part of the review, which was conducted by Dr. Paul Links and Dr. Craig Muir. Links teaches in the psychiatric department at McMaster University and is an expert in suicide studies. Muir was a regional coroner and was on the province’s Patient Safety Review Committee, which is under the direction of the Office of the Chief Coroner for Ontario.
The lack of specifics in the final report is disappointing for Tammy Woodfine, whose stepsister is one of the in-patients who took her own life at the West 5th Campus.
Eva Bryant, 53, hanged herself with an electrical cord at the hospital last August, according to Woodfine. She had admitted herself to hospital a few days earlier because she was having suicidal thoughts.
“It’s a specialized hospital where she’s supposed to be safe and watched,” says Woodfine. “I would never have thought this would happen. I blame the hospital 100 per cent, knowing she had gone there for help and they failed her.”
Woodfine says she cannot tell from the “vague” recommendations in the report if the hospital has made changes so that patients cannot access electrical cords to hang themselves.
Eva left behind three grown children.
Those sorts of specifics are in an internal review the hospital conducted into the 2016 suicides, says Winnie Doyle, vice-president of clinical services, mental health and addiction at St. Joe’s. But that review has not been made public because it contains information that could identify the patients. Asked by The Spec if the personal information could be redacted, and the report then made public, Doyle said she was prepared to look into that request.
Doyle cited patient confidentiality as one reason why specifics related to the method of suicide and recommendations related to environmental changes at the hospital are not in the external review. She also notes details like that could give patients ideas about how to die by suicide in the hospital.
The West 5th Campus is less than four years old and “enormous work was undertaken to ensure the safety of the building,” says Doyle. “Best practices were integrated into the design of the building.”
Doyle would say that as a result of the 2016 suicides, changes were made to eliminate “ligature points” in the facility, making it more difficult for a patient to die by hanging.
One report recommendation is to update the hospital’s “search procedure” to be sure they are not bringing anything that is potentially harmful into the facility. That could be their own prescription medicine, “sharps” or anything else that could be unsafe for them, other patients or staff.
Many of the recommendations involve working more closely with patients and their families. For instance, “a series of focus groups will be held with patients and families to ascertain their experiences of staffs’ interventions and perceived gaps in knowledge, skills and attitude.”
“Families are asking for more involvement,” says Doyle. But for that to happen, adult patients must be competent and consent to the hospital sharing information with their family. The hospital works to keep families involved whenever possible because that often helps the recovery of the patient, says Doyle.
That was a frustrating issue for the Patenaude family. Nicole did not want the hospital to share her information, which left her mother and sisters out of the care loop.
Also, “clinical monitoring” by staff will no longer be a mere head count. The hospital has already moved toward more meaningful interaction with each patient several times an hour.
“Hearing their story,” says Dr. Ian Preyra, who is deputy chief of staff at St. Joe’s and also chief of emergency medicine and a coroner. He adds that a patient’s family often knows their story very well, again emphasizing the need to have families included.
Another critical recommendation is to do suicide risk assessments of all patients coming into the hospital with a history of mental illness. Even if they are presenting with physical symptoms that seem unrelated to their mental health issues, says Preyra.
Risk assessments are done of every psychiatric patient leaving the hospital on a day pass, but the thoroughness of those assessments ought to be re-examined, says the report. The report also recommends the hospital do away with the practice of asking patients to enter into a “contract” in which they promise not to harm themselves.
“Contracting for safety is not an effective suicide prevention,” the report says.
Doyle says the hospital had already begun to move away from that practice and will quit entirely by January.
Updates on the implementation of the recommendations will be posted regularly on the St. Joe’s website and Preyra emphasizes the report will be shared with other hospitals.
“We are very committed to these changes and we are committed to being held accountable,” he says.
To read the study, go to: http://www.stjoes.ca/suicideprevention
St. Joseph’s West 5th Campus at West 5th Street and Fennell Avenue West is less than four years old.