Auditor finds gaps in treatment for northern patients at risk of suicide

Provincial Auditor of Saskatchewan Judy Ferguson released volume 2 of her 2019 annual report at the Legislative Building in Regina on Thursday, December 5, 2019. TROY FLEECE / Regina Leader-Post

Staff working in northwestern Saskatchewan aren’t always following procedures, are lacking training and are failing to follow-up with some patients at high risk of suicide, the provincial auditor revealed Thursday.

Auditor Judy Ferguson released the second volume of her annual report Thursday. One of the performance audits her office conducted was on northwest Saskatchewan in terms of how it handles mental health and suicide risk. The area examined included the Battlefords, Lloydminster, Meadow Lake, La Loche and surrounding smaller communities.

Ferguson’s office said it looked into the issue because the rate of suicide for northwest Saskatchewan “has been consistently higher” than the rest of the province for the last three years.

The Saskatchewan rate of deaths by suicide per 100,000 population is 14.9, already higher than the national rate of 11.7. The average rate of deaths by suicide in northwestern Saskatchewan in 2018 was 27.9.

“In Canada, suicide is just behind accidents as the leading cause of death for young adults,” Ferguson told reporters Thursday.

“The rates of suicide in northern Saskatchewan have been significantly higher than the rest of the province for the past number of years”

The audit found that for the most part, the Saskatchewan Health Authority’s policies follow the Saskatchewan Suicide Framework, which was developed in 2012. The framework follows best practice, Ferguson said, and provides guidance for the assessment and management of people at risk of suicide and recognizes that health care providers play key roles in early detection and intervention.

However, the audit found,” staff are not always following” those policies.

In 23 of the files tested, the auditor’s office found the instances where emergency room staff did not seek a psychiatric consultation for patients with a high risk of suicide before their discharge. Further, patients who have accessed mental health services through the emergency room are not followed-up with in the same way that inpatient mental health clients are.

“Because of differing protocols, the authority did not always formally follow-up with patients at risk of suicide after discharge from emergency departments,” the audit found.

“Proactive follow-up care promotes continuity of care and continues the assessment and management of suicide risk.”

Ferguson said that research has shown that at least one-third of people who die by suicide visit an emergency department about one month before their death.

“If you are a patient that is an inpatient, you’re automatically referred to outpatient services when you’re discharged,” Ferguson said.

“From the emergency department, they just don’t do it. We think that they should, particularly because research shows about one-third of people who have accessed an emergency department because of a suicide attempt die within one month of visiting.”

That wasn’t the only shortcoming the performance audit found.

The report said that most records in the northwest region are kept manually, which can make it harder to coordinate services. The authority has been implementing a single mental health record for patients that allows information to be shared, but that’s not currently done in some of the facilities the auditor’s office visited.

The audit also found that the Saskatchewan Health Authority had not looked at whether services available address the demand for services.

“We found it did not have coordinated efforts to analyze key data about suicide rates and the prevalence of suicide attempts and related services,” Ferguson said.

“Coordinating efforts with other would help make sure the availability of these services.”

Services available weren’t the only things the health authority was failing to track. Ferguson said that about 50 per cent of patients at risk of suicide frequently missed scheduled videoconferencing appointments, yet the authority hadn’t analyzed why.

“Not knowing why patients miss appointments or are reluctant to use services provided through telehealth reduces opportunities for the authority to identify and help patients overcome barriers,” the report said.

Psychiatrists are growing frustrated, Ferguson said, as they have to go to a special location to ensure the connection is secure.

“You can’t just use a Skype method,” she said.

From a patient end, though, Ferguson said she wasn’t sure why patients weren’t showing up.

It could be transportation issues, or it could be a matter of people in small communities who could be reluctant about going to the facility the video conferencing is held at because in a small community everyone knows each other.

“Anybody who works with individuals in that mental health area is a stressful situation. when you’re in a smaller community, everybody knows everybody. I think that makes it harder and even more personal,” Ferguson said.

The other issue the audit found is a lack of staff training. Some of that is due to staff turnover.

“Especially in some of the smaller communities, they have a lot of turnover of staff working in the mental health areas. They have a lot of vacancies too,” Ferguson said.

“What we found is that some staff received no training because the timing of the training is so infrequent, we also found that the training provided doesn’t meet the minimum set out by the suicide framework.”

What the audit didn’t examine is whether staffing levels are appropriate. Ferguson said an examination of staffing levels in health care in northern Saskatchewan will likely be a topic of a future audit.