Hospital suicide: So many obstacles to prevention

CBC Radio Metro Morning's Matt Galloway spoke with Dr. Jennifer Brasch, a psychiatrist and former medical director of psychiatric emergency services at Joseph's Healthcare in Hamilton, about the challenges health care providers face with patients who attempt or contemplate suicide.

According to data collected by the CTV's W5, 300 people have died in psychiatric units across the country in the past 10 years.

Here is an edited and abridged transcript of Galloway's interview with Dr. Brausch. You can listen to the full interview by clicking the audio link on this page.

MG: Are you surprised by the number of people who have died while in psychiatric unit care?

JB: I don't think so. People are hospitalized in psychiatric wards because their are mentally ill and because they are at risk of harming themselves or others.

MG: How do you determine whether someone is at a real risk of attempting suicide?

JB: Suicide risk assessment is a very complex task. It involves a very careful assessment, a consideration of risk factors as well as an interview in which one explores with a person what are their thoughts on ending their life, if they are having those thoughts and what those thoughts are like — the intensity and frequency of them, how specific and detailed they are.

MG: Does that speak to the difficulty of insuring they are safe when in psychiatric care?

The person's suicidal thoughts or urges can shift frequently or in response to a number of difficult to quantify things including changes in medication to changes in one's mental illness to events in a person's life or circumstances.

MG: How do hospitals go about protecting those patients?

All hospitals are required to have policies and procedures in place for assessing all mental health patients about their risk for suicide and for monitoring and determining changes in their level of risk. There are a number of interventions that are implemented when a person is deemed to be at risk of suicide. Those include monitoring and insuring the person's environment includes as few risks as possible and engagement nursing which is working with the person to explore and understand their thoughts of suicide as well as treatment with medication, of course.

MG: How much does the stigma around mental health care play into the difficulty health care providers have in that initial care?

I would like to think people working in mental health recognize the importance of identifying risk of suicide and that stigma is not a factor in determining risk. It's important to talk openly with the person about their thoughts of suicide. You won't give them ideas. It makes it easier to cope.

MG: It's been argued, by lawyers, doctors and others, that these suicide cases are preventable. Do you agree with that?

I know that at St. Joe's when there is critical incident there is a death review to examine the circumstances to prevent further instances. I'm certain all hospitals across Canada do this. St. Joe's built a new facility. The furnishings were chosen to minimize risk to patients who might be at risk of suicide.

Why do you think there's a reluctance to talk about patient suicide, whether in-hospital, or after the patient has been discharged?

As a psychiatrist, if a tragedy were to happen to one of my patients I would feel like a failure. I think psychiatrists are uncomfortable to admit that. Some of them will have malignant illness and will want to end their lives despite our best efforts.

MG: Is that something you have gone through?

I am aware of people who I had assessed who took their lives after being released from the hospital... People are very complex. We like to think patients want help. Sometimes the stress becomes so overwhelming they are desperate for an escape and do whatever they feel is necessary. Many organizations are working so people can find reasons to go on living.