Suicide prevention mandatory for national accreditation

Posted on October 21, 2008 in Health Debates – health – Suicide prevention mandatory for national accreditation
October 21, 2008. LISA PRIEST

For the first time, Canadian hospitals and nursing homes seeking a national stamp of approval will have to develop suicide-prevention programs.

Under rules starting in January, institutions seeking accreditation will not only have to make patient safety paramount, but must also identify treatment and monitoring strategies for those at risk.

“The intention is to make sure that organizations have an approach in place to identify the client who is at risk,” said Wendy Nicklin, president and chief executive officer of Accreditation Canada, a non-profit, independent organization. “And that specific steps are taken to minimize the possibility of suicide occurring while in the facility, in the program.”

Although accreditation is a voluntary process, 99 per cent of Canada’s acute-care hospitals participate in it, as do many nursing homes, some community health centres, home-care organizations and other health-care facilities. In this case, 76 institutions – namely, those with mental-health programs – are affected by the new requirement.

By making suicide prevention a requirement, Canada is following the United States, where the accrediting Joint Commission requires hospitals and other health-care organizations to do the same.

According to Statistics Canada, 3,614 people died by suicide in 2004, the latest figures available. However, there are no national numbers on how many of those deaths were in hospitals or nursing homes.

In Ontario, there were 114 suicide deaths in hospital, 33 in long-term care homes and 39 in retirement homes, seniors residences and assisted-living centres from 1995 to 2005, according to the Office of the Chief Coroner of Ontario.

Paul Links, who holds the Arthur Sommer Rotenberg Chair in Suicide Studies at the University of Toronto, said there is a strong relationship between suicide and psychiatric issues.

“If you look at people who died by suicide and you reconstruct their story, nine out of 10 people who died by suicide were suffering with psychiatric illness at the time of their death,” said Dr. Links, deputy chief of mental-health service at St. Michael’s Hospital.

Marnin Heisel, vice-president and research committee chairman of the Canadian Association for Suicide Prevention, described it as being “almost always a preventable death.”

Dr. Heisel, a clinical psychologist, said one of the challenges of caring for patients at risk of suicide is the lengthy queues for care. Not only are there long waits to see a specialist but clogged emergency departments across Canada.

“All of those things can increase risk,” Dr. Heisel said in a telephone interview from London, Ont. “Tragically, lives are lost as people do try to negotiate the system.”

Indeed, several years ago, a patient killed himself in the emergency department at Grand River Hospital in Kitchener, Ont., while waiting to see a doctor. Two others died in the psychiatric ward of the same hospital.

A coroner’s jury examined those deaths, which occurred from Nov. 20, 2000, to March 28, 2001, and recommended, among other things, that there be more hospital staff, improved communication and a psychiatric acute-care unit for patients at risk of suicide.

Isaac Sakinofsky, a psychiatrist who is an internationally recognized author on suicide, applauded the move of Accreditation Canada, saying education of gatekeepers, such as family physicians, emergency-room doctors, and those in nursing homes is critical to suicide prevention.

“Gatekeeper education is critical,” Dr. Sakinofsky said in an interview at his Toronto office. “And so is the recognition of suicidal behaviour.”

Particular care should be taken before patients are discharged from emergency departments and in-patient units. Until they have been thoroughly assessed and deemed not to be at risk, persons who have presented in the emergency department need to be kept under direct observation at all times, he said.

For a list of crisis centre telephone numbers, go to

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