Suicides in hospitals | Patients “escaped” by the system

For three years, at least 17 patients have committed suicide within the walls of a hospital in Quebec, according to a review by Press. Several were hospitalized precisely because of suicidal ideation. The situation is likely to worsen with the current shortage of personnel in the health network, warns an expert.

Florence Morin-Martel
Press

“How come a person you send to the hospital for a suicide attempt is able to kill themselves?” This is the question Suzy Bossé has been asking since her brother, Marc Bossé, committed suicide in December 2020 at the Grand-Portage Regional Hospital in Rivière-du-Loup.

Since 2018, at least 17 people, including Mr. Bossé, have committed suicide in a hospital, according to an analysis of the coroner’s reports carried out by Press. There are many shortcomings identified: drugs or harmful products within easy reach of patients, poor assessment of the risk of suicide, poorly recorded notes in the file. “This is a suicide that could have been avoided,” notes coroner Pierre Guilmette about a man who swallowed a toxic disinfectant.

The risk of suicide in hospitals “worries a lot” Jessica Rassy, ​​associate professor at the School of Nursing at the University of Sherbrooke. “I hear it on the ground,” she says. This is a situation that comes in search of nurses who have not been able to provide the necessary services due to a lack of time and resources. ”

How to avoid these deaths? This is the central question of a public inquiry by the Coroner’s Office on the theme of suicide, the factual part of which ended in October. Started in 2019, the public hearings examined six cases. Press presents two others, which were not the subject of the coroner’s inquest.

“I send it to you and you drop it”

On December 15, 2020, almost 10 days before his suicide, Marc Bossé, 51, was not doing well and appeared to be in psychosis. A week later, after stopping a suicide attempt, his family decided to hospitalize him. However, on the morning of December 24, Mr. Bossé hanged himself with a sheet in a bathroom in the hospital.

His sister Suzy Bossé learned the sad news when she called the hospital. She went to Bas-Saint-Laurent. “You think you’re going to wish your parents Merry Christmas, but finally, you’re going to tell them that we just lost one,” she says, her voice shaking with emotion. .

The family of the deceased believed to protect him by having him hospitalized, underlines M^me Bossé. “I send it to you and you drop it”, laments the latter. “I know very well that it is not the hospital which passed a sheet to her neck”, she nuances. Still, the conditions were not sufficient to ensure his safety. No one was assigned “constant camera surveillance,” but the patient was monitored every 30 minutes, the coroner’s report reads.

At the hospital, Mr. Bossé was assessed as at “moderate risk” for suicide, “nonsense” for his sister.

“He came home for a suicide attempt and you’re telling me he’s not at risk for suicide?” She asks.

Were the hospital staff overloaded? Breathless due to fatigue? These questions remain unanswered. The COVID-19 pandemic had been raging for 10 months already in the network.

At the CISSS du Bas-Saint-Laurent, it is argued that follow-ups are adapted “according to the assessment of each case” and their “level of risk”. “For example, in-person visual tours are held every 15 minutes,” explains Claudie Deschênes, director of mental health and addiction programs.

“It ended like that”

“I want my brother not to have died for nothing,” drops Mélanie Gélinas, who would have liked the coroner’s public inquiry to study her case. “If her situation can help us improve the system, it will allow me to heal,” she explains.

On July 11, 2018, Jean-Sébastien Gélinas hanged himself in his room at the Douglas Mental Health University Institute in Montreal. He was 40 years old. His mental health had deteriorated in the year before his death, testifies Mélanie Gélinas. The man was hospitalized five times for suicidal ideation in the six months before the tragedy, the last time for a suicide attempt. “He called 911 a few times because my brother didn’t want to die at first,” his sister explains. He asked for help for a long time. And it ended like that. ”

Mélanie Gélinas wanted to wait until her brother was feeling better before going to visit him. It never happened. “I regret, laments the latter. I trusted the Douglas to take care of my brother, and the wrong thing has happened in that hospital. Without accusing anyone, she wants to understand.

During his last stay at the Douglas, Jean-Sébastien Gélinas “would have expressed on several occasions” that he was going to commit suicide when he left, writes the coroner. His report, described as “thin and cold” by Mr. Gélinas’ psychiatrist, Dr.^r David Bloom, leaves questions unanswered, regrets Mélanie Gélinas.

Need listening shouting

According to Professor Jessica Rassy, ​​gaps in patient assessment and follow-up, as well as a lack of resources, are the cause of suicides in hospitals. “I find it sad that a death must occur in order for resources to be released for training, support and follow-ups,” she emphasizes.

Interventions with suicidal patients mainly aim “to put out fires” and do not “go to the bottom of this distress”, observes M^me Rassy.

These patients’ need to listen is often not met. Seeing the overwhelmed staff, “they feel they are disturbing”, summarizes the professor.

Suicide in hospitals is however the concern of all staff, who must be trained for this purpose, underlines M^me Rassy.

The lack of objective means to make a diagnosis – such as a blood test for other types of disease – makes it difficult to assess the risk of suicide. “As psychiatrists, we are not very good at predicting suicide,” admits D^r David Bloom, psychiatrist at the Douglas Institute. Studies show that many patients deemed high risk by psychiatrists do not take action, while conversely, people assessed as low risk commit suicides.

Generally, the Douglas protects suicidal patients well, according to Dr.^r Gustavo Turecki, head of psychiatry at the CIUSSS de l’Ouest-de-l’Île-de-Montréal. To succeed in committing suicide during hospitalization, the person must have planned “a lot to find where the faults are”, he argues.