Fax, scanning, working hours, lack of communication… A host of factors contributed to the rapid psychiatric follow-up requested for Amélie Champagne being completed only 13 days later, well after her suicide, we heard at the public inquiry on Wednesday.
What there is to know
- The public inquiry into the suicide of Amélie Champagne, who consulted two psychiatric emergencies in the last week of her life, began Monday in Montreal.
- Rapid psychiatric follow-up, within 24 to 72 hours, was announced to M.me Champagne during his visit to the Douglas Mental Health University Institute. He arrived 13 days later, his parents denounced during public hearings.
- A reminder letter was sent to Mme Champagne on September 20, 2022, well after his death and his time at the Douglas, we learned at the public inquiry on Wednesday.
“It’s a little surprising, the delay in which nothing has been done,” noted M.e Pierre-Olivier Bilodeau, the public inquiry prosecutor who assists the coroner, Me Julie-Kim Godin.
It took nearly an hour and two witnesses to retrace the route of the request for psychiatric follow-up made for Amélie Champagne on the evening of September 6, 2022, during her visit to the Douglas Mental Health University Institute, in Montreal.
Mme Champagne had been brought to the Douglas by her mother, after she asked her brother to show her how to tie a knot with her climbing ropes. The young woman refused the offer to stay the night, but was recommended for rapid psychiatric follow-up. “The highest possible priority means P1, a service provided in 24 to 72 hours,” explained the psychiatrist on call that evening, Dr.r Eduardo Chachamovich, at the public hearing on Tuesday.
The request was faxed (faxed) to the adult mental health access window (GASMA) the following day, September 7, shortly before 3 p.m. and seen on September 8 by a charge nurse. However, she was informed that Mme Champagne was under observation at the Sherbrooke University Hospital Center (CHUS). When the nurse checked again, on the morning of September 9, the young woman was still in the CHUS.
“So I kept the file in hand […] to call her the day she was leaving the hospital,” nurse Sophie Bellefeuille testified on Wednesday.
Amélie Champagne finally left the CHUS that day, but the GASMA nurse was not informed of this.
The fax from Sherbrooke arrived at 5:36 p.m. that Friday, after the opening hours of the access counter. And the following Monday morning, September 12, this information was “scanned directly into the file” instead of being delivered “in person” to Mr.me Bellefeuille, so the nurse was not informed.
What Mme Bellefeuille also did not know that Amélie Champagne was already dead, since she had committed suicide on September 11 in Montreal.
Laborious communication
Thursday September 15, surprised by the length of M’s stayme Champagne at Sherbrooke University Hospital, nurse Sophie Bellefeuille asked a colleague from GASMA to contact the patient directly.
The social worker Cynthia Leblanc, who was the caseworker on call that day, therefore dialed M’s numberme Champagne and left him a message. On September 20, having no news, Mme Leblanc follows “procedural standards” and sends a reminder letter to the home of Amélie Champagne, who lived with her parents.
“We’re still talking about faxes: someone has to fax it, someone has to go get that fax and bring it to you,” the coroner commented in an empathetic tone. “What can we do to reduce these delays? »
In terms of communications, it is sometimes very, very laborious, in the health field, to manage to speak to someone.
Nurse Sophie Bellefeuille
“As long as we get out of our CIUSSS a little [Centre intégré universitaire de santé et de services sociaux] and we deal with a different CIUSSS, the barriers are different. Sometimes we’ll try to call [et] we don’t have a return call, we don’t have the right phone number. »
Improving communications between establishments and facilitating access to their files, “that could be very helpful,” added M.me The White.
These two health professionals work at the Integrated University Health and Social Services Center of South-Central Montreal. They made these comments in a personal capacity, and not on behalf of their establishment, they stressed.
“I don’t think it’s normal in 2023 […]to be told: “This person doesn’t take calls, you have to send him a fax”,” said Mme Bellefeuille.
NEED HELP ?
If you need support, if you have suicidal thoughts or if you are worried about a loved one, contact 1 866 APPELLE (1 866 277-3553). A suicide prevention worker is available to you 24 hours a day, seven days a week.
You can also visit the website commentparlerdusuicide.com