Suicide intervention training in emergency rooms the focus of U of C study

A new University of Calgary research study is looking at how to help frontline doctors in emergency departments better support patients who are suicidal, and better understand or recognize symptoms of mood disorders.

Dr. Eric Chan, a clinical assistant professor with the Cumming School of Medicine’s Department of Psychiatry, is conducting the research in hopes of providing physicians with effective interventions based on a patient’s need.

“We know that individuals at risk of suicide are all different and unique, and that each one has different needs, so part of our goal is to understand the different types of populations at risk so that we can better provide effective treatment,” said Chan.

“One of the main challenges is certainly the availability of mental health resources – both in hospitals and in the community – but the other part is making sure that resources that we connect people with are those that are most likely to actually help them.”

The two-year study, which is still ongoing, has involved researchers collecting three separate questionnaires from patients waiting in various emergency departments.

More than 400 responses have been collected from patients at Calgary’s South Health Campus and Foothills Medical Centre along with Edmonton’s Royal Alexandra Hospital and Misericordia Community Hospital.

“We look at history of suicide attempts, history of abuse, difficulty sleeping, chronic pain, feeling really on edge, history of substance use, feelings of hopelessness, worthlessness, guilt and shame, even hearing voices or feeling alone without any supports,” Chan said.

An additional study Chan is working on also aims to explore mental health barriers in emergency rooms.

Given longer wait times for some patients, he hopes to help doctors pinpoint risk factors for suicide or mental health emergencies from the very moment a patient arrives at an intake desk.

“We have such limited time because of the number of patients we see, so this will also help ensure that doctors ask the questions that are most needed, because otherwise, right now, there are so many different things to ask about, but it’s really not feasible to ask about everything every single time.”

“Suicide is the second leading cause of death in young people, and so this shows how important this is for these specialties to feel comfortable with supporting individuals at risk and to have the skills to work with patients, especially given the limitations in mental health resources that were experiencing.”

‘Chronic underfunding’

Dr. Warren Thirsk, the president of the Section for Emergency Medicine with the Alberta Medical Association, says additional health-care resources are desperately needed to reduce wait times for patients going through a mental health crisis.

“This old system is taking a gamble that the patient will be okay to wait, when in many cases they aren’t OK and none of that is acceptable,” Thirsk said.

“These tragedies are reproduced every day across Alberta, in big cities, in small cities, in Fort McMurray, in Red Deer, in Edmonton, in Calgary, they are everywhere, and they are across the entire system.”

Thirsk gave a simple example, mentioning that he moved to Edmonton in the 1990s and how not much has changed in terms of emergency capacity since then.

“We had four hospitals here back then in the greater Edmonton area, and guess how many we still have today? Four.”

“If the capacity hasn’t changed from the acute care side and hospital resource side, then, as the population triples, the wait times for every resource are predicted to go up. This is just one example, a concrete, simple example that is relatable, and most people can understand, for the chronic underfunding of the system from every aspect.”

Much of this overload leads to burnout of frontline workers, who Thirsk says are “trying their best” every single day to help, but he notes that patients should speak up as well.

“We as doctors have been making these cries for help for decades now, and the help and resources haven’t shown up, so more patients need to share their stories – because we can’t share as physicians the individual suffering of our patients; they need to share it themselves.

“We as frontline workers don’t view it as a criticism of ourselves when the system has failed someone. We recognize that happening every day, and we’ve been trying desperately to get that information out there to the people who provide the resources, who whose job it is to find the resources for Albertans.

‘We are committed to addressing these issues’

CTV News reached out to the office of Alberta Health Minister Adriana LaGrange for comment on how the province plans to improve wait times, particularly those for people who may be experiencing a mental health emergency.

In a statement, she said the Alberta government “recognizes the stress and frustration” that can result from delays, and said her team is “committed to addressing these issues.”

“To address this issue, the work to refocus Alberta’s health care system includes transitioning AHS, over time, to focus on delivering only acute care services,” LaGrange said.

“The new acute care provincial health agency, which will commence full operations later this spring, will work directly with service providers, including AHS, Covenant Health and contracted EMS providers, to speed up access to high-quality care, reduce wait times and make sure the patient’s journey through the acute care system is efficient and effective across the province.”

LaGrange said that the province is also planning to work closely with future leaders of the new acute care provincial health agency to make sure Alberta has a “high-performing emergency care system” that can be relied upon across the province.

‘There is hope for everyone’

Mental health experts say the painful reality of depression is that sometimes it can be unrecognizable to the average person.

“I think we tend to fall into the trap of thinking that people who consider suicide present those kinds of Hollywood-esque depression symptoms, like they’re withdrawn or they’re sad or they’re lethargic,” said Mara Grunau, CEO of CMHA Alberta and the Centre for Suicide Prevention

“That very well could be, but often it’s more subtle than that.”

Grunau says instead, it’s important to recognize changes in behaviour that include mood swings, self-disparaging jokes like “the world would be better off without me” or a loss of interest in everyday activities or work.

Grunau notes that these are all invitations to start a conversation and to ask the person you care about questions as to what you’ve been noticing or why their behaviour is changing.

“Getting to the actual question of if someone is thinking of suicide however is also very important to ask,” she said.

“It’s really important to ask directly, because what you’re doing is you’re holding the burden for them, and all they have to say is, “Yes” or “No,” and if it’s “No,” okay, it could be a little bit awkward and embarrassing, but they are going to walk away from the conversation knowing that you cared enough to step out and be vulnerable,” Grunau said.

“If the answer is “Yes,” don’t panic, even though you will be panicking. Our instinct is going to be like, ‘Oh, don’t do that,' but try to just be really calm and say, ‘Thank you for telling me, because that’s a lot to carry.‘”

Giving a suicidal individual the relief of being able to share their feelings can go a long way to pointing them in the right direction for help, says Grunau and calling the crisis line alongside them can be a meaningful first step.

“There is hope, even when it feels like there isn’t, and sometimes hope feels like it’s too big, so I invite those people to consider the fact that there is possibility, and if you can hold that possibility and reach out, people are standing by waiting to talk to you.”

Mental Health resources:

- Call or Text 988 – Talk Suicide Canada Hotline - Answered 24/7 by counsellors at the Distress Centre in Calgary and 24/7 by counsellors at CMHA Edmonton.

- Call 211 for 24/7 assistance for mental health resource.

- Alberta Crisis Line – call or text 403-266-4357

- KidsHelpPhone (Ages 20 years and under) - 1-800-668-6868.

- First Nations and Inuit Hope for Wellness 24/7 Help Line - 1-855-242-3310.

- Canadian Indian Residential Schools Crisis Line - 1-866-925-4419.

- Trans LifeLine (all ages) - 1-877-330-6366.