Implementing a Suicide Audit in Montreal: Taking Suicide Review Further to Make Concrete Recommendations for Suicide Prevention

Abstract

Objective: A suicide audit was pilot implemented in order to generate recommendations on how to improve suicide prevention. Methods: Thirty-nine consecutive suicides that occurred in Montreal, Canada from January to October 2016 were audited. A retrospective analysis of their life trajectory and service utilization was conducted using the psychological autopsy method, which included interviewing suicide-bereaved survivors and examining health and social services records and the coroner's investigation file. A psychosocial and service utilization profile was drawn for each decedent. A multidisciplinary panel reviewed each case summary to identify gaps in terms of individual intervention, provincial public health and social services, and regional programs. Results: Five main suicide prevention recommendations were made to prevent similar suicides: (1) deploy mobile crisis intervention teams (short-term, high-intensity, home-based treatment) in hospital emergency departments; (2) train primary and specialized mental health care professionals to screen for and manage substance use disorders; and (3) implement public awareness campaigns to encourage help seeking for depression and substance use disorders; (4) access for all, regardless of age, to an effective psychosis treatment program; and (5) provide universal access to a general practitioner, especially for men. Conclusions: The suicide audit procedure was implemented effectively and targeted recommendations were generated to prevent similar suicides. However, resistance from medical and hospital quality boards arose during the process, though these could be allayed if regional and provincial authorities actively endorsed the multidisciplinary and multi stakeholders suicide audit process. HIGHLIGHTSA bottom-up approach to generate recommendations for suicide prevention. Implementation was challenging with resistance to our interdisciplinary approach. The audit needs the support of the regional health department to lift barriers.

Explainable artificial intelligence models for predicting risk of suicide using health administrative data in Quebec

“…A third set of variables (age; rural areas) can be described as individual and community levels variables which are significantly associated with suicide [60][61][62]. Finally, the strong link with regional addiction or mental health budget echoed in the very recent Chief Coroner public enquiry on suicide based on a series of individual cases audit and their aggregation, suggested an increase in the public managed care health and social services ministry budget for mental health and addiction services [68].…”

Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ‐R

“…This shows that although suicide is a significant public health issue, health professionals are not well equipped to recognize individuals at high risk. In 2021, a suicide audit in Montreal highlighted the importance of better evaluating suicide risk in emergency departments (ED) (Lesage et al, 2021). Through their presence and expertise, nurses are an indispensable first line of suicide prevention care.…”