Suicides in northwest under auditor’s microscope

The epidemic of suicides in the province’s northwest was a focus in the provincial auditor’s 2019 report released Thursday.

In that report Provincial Auditor of Saskatchewan, Judy Ferguson, focuses on the processes used by Saskatchewan Health Authority to treat patients at risk of suicide in northwest Saskatchewan. Communities in northwest Saskatchewan included in the audit were North Battleford, Lloydminster, Meadow Lake and La Loche.

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Among the findings of the audit, according to a news release from the province:

- In 2018, the average suicide rate (per 100,000) suicides in northwest Saskatchewan exceeded the provincial average rate by almost 50 per cent. In 2018 the average suicide rate per 100,000 population was 27.9 in northwest Saskatchewan compared to the provincial average of 18.7.

- Saskatchewan Health Authority utilizes the Saskatchewan Suicide Framework as guidance for its efforts in suicide prevention; however, staff do not always follow them.

“For three instances in 23 files tested, emergency department staff did not provide psychiatric consultation for patients with high suicide risk prior to their discharge, as per protocol,” it was stated. “In addition, the Authority’s follow-up protocols for patients accessing mental health services through an emergency department differ from those accessing outpatient services — emergency department staff do not refer patients to mental health outpatient services for follow-up. Proactive follow-up care promotes continuity of care and can reduce the number of patients who attempted suicide from re-attempting.”

- Training was cited as an issue. Ferguson noted health care staff in northwest Saskatchewan facilities do not receive sufficient training on caring for suicidal patients, and that training varies significantly. As an example, emergency department nursing staff at Battlefords Union Hospital received online training related to mental health and suicide screening, whereas staff at other emergency departments did not.

- It was also noted the health authority does not periodically inspect northwest Saskatchewan facilities providing services to patients at risk of suicide for staff sightline obstructions or physical structures potentially used in attempting suicide. Staff at facilities there conducted quick, visual reviews every 12 hours of mental health inpatient rooms for safety risks, but it was noted the scope of these reviews is narrower than what is expected under the Framework.

- Of concern was the number of missed psychiatric services provided via scheduled telehealth (e.g., videoconferencing), which ranged closed to 50 per cent in some years. Many suicidal patients from smaller communities in northwest Saskatchewan must access mental health services in larger centres. It was noted 51 per cent of patients treated at North Battleford’s mental health inpatient services travelled from outside the Battlefords’ area in 2018-19.

-There were varying services available for patients at risk of suicide but it was unclear whether they were in the right locations, according to the auditor’s report. It was noted that given the geographic spread and size of communities in northwest Saskatchewan, and with most suicide prevention services available in larger centres, improved use of psychiatric services through use of videoconferencing could minimize travel time and costs and increase service accessibility.

Among the recommendations in the audit, the Saskatchewan Health Authority needed to do the following:

Offer ongoing staff training for assessing and managing suicide risk;

Conduct psychiatric evaluations for emergency department patients with high risk of suicide, as required;

Consistently follow up with patients after emergency department discharge address barriers to effective use of Telehealth for psychiatric consultations;

Determine reasons why patients miss scheduled outpatient appointments.

The Authority also needed to rationalize services made available to patients at risk of suicide. “If the Authority analyzed key data to rationalize available services, as well as to identify barriers in using mental health services,” said Ferguson, “it could better inform treatment program planning, placement, and implementation.”

Two more recommendations were to conduct risk-based file audits of for patients at risk of suicide, and implementing a single, provincially accessible electronic health file for mental health, addictions and suicidal patients.

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