Suicide prevention programs lacking due to reliance on ERs for patients in crisis
It is still something whispered about for many people, but suicide is slowly emerging from its shadow of shame.
As it does, medical professionals are realizing how little we know about its scope in Canada. Uniquely among developed countries, Canada has no national suicide prevention strategy. There is also a significant gap in data to guide what services are needed most, and when.
“The suicide data that we have is not adequate enough to develop public health policies – to create targeted intervention,” said Mark Snaterse, Executive Director of Mental Health and Addiction for the Province of Alberta, in an interview with W5.
Targeted intervention is another missing piece in most suicide programs in Canada, as the system tends to be reactive and reliant on hospital emergency departments. By then the patient is in crisis and is requiring much more attention and care than most ERs are capable of providing.
ERs do not routinely staff psychiatrists around the clock, and even fewer have immediate access to adolescent mental health care. Most provinces consider ER doctors the front line of defence, but the Canadian Mental Health Association says that’s not the best place to treat someone prepared to take their own life.
“Emergency rooms are one function only, for people in a mental health crisis and that’s to keep them safe,” said Mark Henick, who speaks on suicide on behalf of the CMHA. “But don’t just discharge them into the street and expect that you’ve solved the problem. We need to be doing a better job of giving them the services, of connecting them, of showing them other ways.”
There are models for that kind of care. W5 travelled to Detroit to see how the Behavioral Health Services division of the Henry Ford Health System is working to prevent suicides. A decade after implementing a standard suicide risk assessment for every behavioral patient, Henry Ford claims to have reduced the cases of suicide among its out patients by 80 per cent.
“I have no doubt about the fact that for a therapist to have this type of assessment in place has made a world of difference in their comfort level in being able to really understand the risks of suicide,” said Michigan Clinical Social Worker Dr. Jeffrey Devore.
When assessing for suicide risk, there is not one standard suicide risk assessment used in Canada, and the lack of sharable electronic medical records means a patient’s state of mind is rarely shared between specialists.
The experts say that increases the likelihood a suicidal person can elude what care exists, which they often try to do because of the stigma that still surrounds admitting you want to end your life.
When care is unstructured, relying on already overburdened hospital emergency rooms, and applied without sufficient data, it suggests the medical profession is trying to coax the suicide stigma out of the shadows without the benefit of well targeted light.