I really appreciate your responses to the initial update I sent last week. From the comments and from re-reading it myself, I realize there's more to say about Strategy #1 before I move to the next one.
First, there was a request for clarification of the recommendations we had for the hospital and doctors.
Referrals for someone who has accompanied a person to hospital because of a suicide attempt
Most of us know little about suicide assessment and intervention, yet need that information when someone close to us is suicidal. When someone is admitted to hospital due to suicidal behaviour or risk, there is an opportunity to provide education and support to the person or people accompanying them. In my experience and the experience of others with whom I've spoken, this opportunity has been missed.
The practice of referring accompanying people to agencies that specialize in suicide prevention and counselling services, such as SAFER, could strengthen the network of care for people at risk. The vast majority of counselors and mental health professionals in B.C. have little or no training in suicide assessment and intervention, and are therefore unable to provide effective support in that area to either the person who is suicidal or the people who love them. (More on that in a future update.)
Provision of basic information to visitors taking a patient out on a pass
Patients in the psychiatric unit are permitted to leave the hospital for progressively longer periods of time, provided they are with a visitor. This implies that the visitor has some responsibility for the patient, yet visitors receive no information on what to do or where to call if something goes wrong. Providing visitors with phone numbers for the hospital ward, mental health police unit, and 911 would at least give them a range of resources to call on if concerns arise.
Assessing opportunities for family involvement in patient care
At Vancouver General Hospital (VGH), where Cliff was a patient, spouses and family members are not invited to participate in meetings with the treating physician, social worker, community mental health worker, or other professionals involved in the care of a suicidal patient. In contrast, family members of patients with diabetes are encouraged to attend appointments and are invited to participate in Diabetes School with the patient. VGH purports to promote family involvement in patient care, yet in the case of suicidal patients this involvement rarely if ever happens. We recommend that treating physicians regularly assess the opportunity to involve, educate, and consult with family members.
If a suicidal patient opposes the involvement of a family member when it is apparent that there is a supportive and loving relationship, this should be taken as cause for concern and inform decisions such as whether the patient is well enough to be discharged.
Family involvement in discharge and transition
I am still shocked at how informal Cliff's discharge process was when later we learned that only the day before he had been assessed by a community mental health worker as highly suicidal. I have since heard of similarly casual discharges for patients who died shortly after. Although patients who have been hospitalized due to suicide risk are at high risk of dying within 48 hours after discharge, there are no provisions for informing family members that a patient is about to be discharged; for discharging the patient into anyone's care; for informing that person of the heightened risk following discharge; for involving family members in safety or transition plans; or for providing the person into whose care the patient is discharged with any information about the patient's risk assessment, what to watch for, or what to do if there are any concerns. Family members of patients at risk of a heart attack or stroke are much more likely to get that type of information and support.
My last email takes an optimistic tone that may belie my anger, frustration and distrust. We've tried to take a non-litigious and collaborative approach to generating change within the hospital system. Although the doctors have been receptive, the response to date hasn't convinced us that this approach will be effective. It may be time to re-examine other avenues.
I welcome your responses, experiences, and suggestions.
Dear Lynn,
ReplyDeleteYou are an inspiration and a faithful advocate for so many. Never underestimate the ripple effect of your actions. Each conversation you have leaves an imprint and an opportunity for people to think again when faced with preventing suicide. Whether its a doctor, a staff member, a support worker - questions you have raised will rest with them, hopefully informing their next actions and yes, eventually their protocols. You are making in difference. Perhaps not in big organizational shifts (YET), i.e. health care suicide prevention protocols but your are affecting the system.
As a therapist, I concur that the training I received was scant at best, and self-directed thereafter. I have been faced twice with this issue once in practicum and once thereafter. The first time, I had the benefit of my supervisor, the second the police came and the processes pre-admitting were very good. But, as you say Lynn, its the post events that are in dire need of process. I am grateful for your advocacy, you have spurred me on to be more proactive in my education even now. I am so grateful to have you in my life not only as a friend but as someone who is making a difference one connection at a time.
Dear Lynn,
ReplyDeleteYour work is needed and appreciated. Thank-you for sharing something so personal. You bring up points that are important for agencies that deal with families of those who attempt suicide to consider. In my work with Victim Services I have worked too often with police and families where suicide has been attempted, or tragically completed. While victim services workers are not usually trained specifically in this area they often have information on community and mental health resources, such as SAFER, that may be able to assist. VictimLink BC can be contacted for referrals even if police have not been involved. I will be passing your article on to the agencies I work with and asking that they consider your points in their staff training. Thank-you again for being such a strong advocate in this area. Sending you virtual hugs.