Death of Amélie Champagne | The “hospital trauma” of emergencies

Overwhelmed units, distressed patients, underfunded mental health care: the public hearing into the suicide of Amélie Champagne shed harsh light on the difficult conditions that persist in psychiatric emergencies.

“We are trying by all means to avoid what I call hospital trauma,” summarized the D on Thursday.^r Stéphane Proulx, head of the psychiatric emergency at Notre-Dame hospital in Montreal.

The D^r Proulx provided this personal insight in response to questions from coroner Julie-Kim Godin.

On September 8, 2022, the psychiatric emergency of the Sherbrooke University Hospital Center (CHUS), where M^me Champagne had been brought after a first suicide attempt, requested her transfer to Notre-Dame, which serves the area where the 22-year-old student resided.

That day, however, the 10 beds and 2 overflow places in the Montreal psychiatric emergency were occupied, and 5 other psychiatric patients were on stretchers in the general emergency, which was 137% occupied. “Not acceptable” conditions for psychiatric patients “who are in hospital gowns through this maze that is the Notre-Dame emergency room” while they “need conditions conducive” to evaluation and observation.

Notre-Dame therefore accepted the transfer of M^me Champagne, but asked for a delay, to be seen again the next day. A request for a delay “like [il en a] done again this morning,” said Dr.^r Proulx on Thursday, specifying that “it is not uncommon for it to last up to 72 hours”.

M^me Champagne, however, was discharged from the CHUS the next day, so that the question of transfer no longer arose.

A “feverish” emergency room

When the young woman arrived at the CHUS on September 7, 2022, she had just attempted to drown herself in Lake Magog, and had barely been able to sleep for more than a week. But she didn’t find the psychiatric emergency relaxing either, and called her parents several times a day begging them to get her out of there.

“It was a feverish emergency room, a lot of patients who had had a lot of seizures during the night,” confirmed the D^r Khashayar Asli, who was responsible for this service on September 8, 2022. He nevertheless managed to convince M^me Champagne to stay there, given its suicidal risk.

The situation was not new. This psychiatric emergency with 6 places has already had “more than 20 to 25 patients […] on stretchers, on chairs, waiting.” But with the pandemic, the number of psychiatric patients who could be in this secure area was limited to 12, with the others finding themselves in the general emergency room. Staff must therefore decide “which patient does not require constant monitoring, […] is not at risk of fleeing, […] is not at risk of aggression.

If the CHUS requested that M^me Champagne is transferred, therefore hospitalized, near her place of residence, in Montreal, it is because of the importance of “continuity of care”, including appointments with doctors and other professionals or services after the exit, explained the D^r Asli. “We must understand that in psychiatry, hospitalization is a tiny part of care. »

“Major underfunding of services”

The young woman finally left the CHUS on September 9. Her parents nevertheless regained hope, because her father managed, through a contact, to have her seen at the CHUM in Montreal at the beginning of the following week.

“Given the information I had at that time […]it seemed absolutely legitimate to me to have access to a proper evaluation. […] This is why I offered to Madame and her father to mobilize energies and efforts,” explained the head of the CHUM psychiatry department, Dr.^r Didier Jutras-Aswad, to the coroner on Thursday.

This evaluation ultimately did not take place, because M^me Champagne ended his life on Sunday September 11. The D^r Jutras-Aswad, who had only spoken to him on the telephone, therefore did not want to make a diagnosis during his testimony. However, he took the opportunity to denounce “the major underfunding of services” in mental health and addiction, “a context where it is extremely difficult to do well [le] work “.

Notre-Dame hospital will, however, see “a major breakthrough” at the beginning of next year, with the addition of a brief hospitalization unit which will offer behavioral therapy, underlined the D^r Proulx.

Two other services have also been established at Notre-Dame in recent months. The mobile crisis team can ensure follow-up between the time a patient is discharged from the psychiatric emergency and the time they are taken care of externally. And the “hospital at home” team visits patients several times a day to implement their treatment plan at home “to avoid hospital trauma as much as possible,” explained Dr.^r Proulx.

“There are certainly efforts being made to catch up, but we have come so far away! », nevertheless underlined the D^r Jutras-Aswad, from CHUM.