St. Joseph’s sui­cide re­view lacks specifics

Study prompted by clus­ter of deaths

The Hamilton Spectator - - FRONT PAGE - SU­SAN CLAIRMONT

“We are very com­mit­ted to these changes and we are com­mit­ted to be­ing held ac­count­able.”


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:­cide­pre­ven­tion


St. Joseph’s West 5th Cam­pus at West 5th Street and Fen­nell Av­enue West is less than four years old.

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