As Nova Scotia's suicide rate climbs, parents fight to change systems that shut them out

When Garret Conway tried to end his life in March 2018, he'd been having suicidal thoughts for four years. His parents had been by his side during this difficult period — but when he was discharged by the hospital some 30 hours after the attempt, they had no idea.

Five months earlier Garret had taken an important step to protect himself: he signed up for a program called Circle of Support that allows mental health patients' personal information to be shared with their loved ones. The goal is to help prevent suicide by getting families involved.

But shortly after the 24-year-old arrived home, he tried to take his own life again. He died three days later.

It turns out that when Garret was in the hospital after his initial suicide attempt, he had revoked his consent with Circle of Support. As a result, no one from the hospital had called his family to let them know he was even admitted.

"I believe honestly if I could have spoken with Garret on the phone — because of the relationship that we had, just him being able to hear my voice — I believe Garret would be here today," said Yanna, his mother.

The Circle of Support program is run by the Nova Scotia Health Authority. The program hinges on consent, and a patient can revoke permission to share their health information at any time — even directly after a suicide attempt.

That's exactly what Garret, who had depression and bipolar disorder, did.

This program, his parents argue, failed him, and they want to see a change.

Nova Scotia's suicide problem

For the last decade, I've been reporting on suicides in Nova Scotia — it's one of the top three causes of death and hospitalizations among people 16 and over. During that time, I've seen the suicide rate grow at a troubling pace. 

According to provincial data, there were 140 deaths by suicide in 2018, the highest since 2008. 

The biggest spike has been in recent years: From 2015 to 2018 the average annual number of suicides jumped to almost 137, compared to 2008–2014 when the average was 114.

(A spokesperson for the province's health department, meanwhile, says that work is underway to update its 2006 prevention strategy, adding that $4.38 million is being spent this fiscal year on suicide prevention initiatives.)

One issue I've seen come up time and again in prevention programs is weighing a patient's autonomy against their own safety.

The patient's right to make choices in care — including safeguarding privacy — is a fundamental legal and ethical principle the province's Circle of Support strives to balance. 

But in Garret's case, his parents say it tilted too far in the direction of privacy.

"Protecting Garret's right to privacy ultimately took his life. I just will do everything that I can to fight to see it change," said Russ.

One of the people behind the creation of the Circle of Support couldn't agree more.

A decade ago, 20-year-old Alex Fountain died in Halifax, in circumstances very similar to Garret's. Alex took his life the day after leaving the emergency room.

Following his death, his father, Fred Fountain, began advocating for change. The creation of Circle of Support was the resulting effort to prioritize safety, according to Fred, but he says the provision that allowed Garret to take away his consent is a major concern.

"A family member should be brought in and involved as much as possible and that should balance, and in some cases override, issues of privacy," said Fred. 

Suicide strategies across Canada

Suicide isn't only a concern in Nova Scotia. In Canada, about 4,000 people take their own lives each year — about 11 people every day. 

I researched other programs across Canada that are looking at suicide prevention a bit differently, and learned about a group intervention at St. Michael's Hospital in Toronto specifically for people who've attempted suicide at least twice. 

Suicide interventionist and social worker Yvonne Bergmans created Skills for Safer Living in 1999. The group meets once a week over 140 days, getting participants past the 90-day period that's considered high risk for people leaving the hospital. 

Bergmans, who has a background in teaching and a Phd in nursing and human sciences, works with suicidal patients in the emergency room. She's observed that many of them have something in common.

"A lot of folks don't have that awareness or the ability to identify or describe those feelings, because when the intensity gets so high, it's almost as if the only thing they can think of is, 'I gotta get rid of this, and the only way I can get rid of it is to end my life,'" said Bergmans. 

In small groups of 12, supported by peer facilitators, Bergmans guides participants through the fundamentals of "living safely." She says it starts with building emotional literacy and helping people to understand their feelings before they escalate into thoughts of ending their life.

Revoking consent should wait, says social worker

They're also armed with a document aimed at protecting themselves if they're in crisis. It's a safety instruction sheet for the emergency department, which she encourages participants to fill out. The form has information about their medications, what they find helpful in the ER, and what they don't. The letter also instructs hospital staff to call their loved ones.

Though the letter is non-binding, it's intended to serve as the patient's voice — before the emotional crisis has set in, and when decision-making is risky. It's a way to respect patients' autonomy by having them do the advance work of determining their individual needs. 

"[There are a] number of clients who have told me that they fake or lie their way out of the emergency department… because being miserable and thinking about ending your own life is sometimes less traumatic than being in an emergency department," said Bergmans.

She says it's not uncommon that some people in crisis might refuse help — but the letter reminds them they wanted it.

Bergmans advises against asking a patient who's in the emergency room following a suicide attempt whether they still want their mom or dad or friend called. She says revoking consent should wait for at least two or three months after the crisis has passed. 

Since 1999 nearly 700 people at high risk of suicide have completed the program. (Even with the intervention, 12 people have died by suicide.)

The intervention was recently put on hold while peer support certification is obtained. St. Michael's Hospital says the goal is to resume the program in a few months.

Outside Toronto, Bergmans' intervention program has seen even greater success. Groups are now running in the Waterloo-Wellington region of Ontario through the Canadian Mental Health Association.

The Waterloo-Wellington group says over the last six years, 600 people have participated, and no one has died by suicide during a program. It now has plans to expand the program.

Living proof

Skills for Safer Living graduate Jay credits the intervention for helping him to see what he didn't think was possible. (We're not using his last name because suicide still carries stigma.)

"Hope is something that went out of my vocabulary a long time ago," said the 54-year-old Toronto man. Though he didn't experience childhood trauma, his suicidal thoughts began when he was 12.

Jay, who had attempted suicide three times, says that since taking the program, instead of planning to die, he's now planning to live.

He's filled out an emergency form naming his girlfriend as his emergency contact, though he doubts he'll find himself in crisis again.

Jay has also become a peer support facilitator for the group. He's anxious for the program to resume so he can go back to helping others.

"I wouldn't be standing here today if it weren't for Yvonne's group," he said.

Back in Nova Scotia, the families of Garret Conway and Alex Fountain are hoping their pleas will be heard. They're calling for the Circle of Support guidelines to be rewritten, so the intervention cannot be broken during a crisis.

"This really is for Garret Conway and for Alex," said Fred. 
 

To hear the full documentary, tap or click the Listen link at the top of this page. 

About the Producer

Elizabeth Chiu is a reporter in Nova Scotia and hosts Atlantic Tonight on Saturdays at 7 p.m., 7:30 p.m. in Newfoundland. If you have a story idea for her, contact her at elizabeth.chiu@cbc.ca.

This documentary was edited by Julia Pagel.