Systematic Services Audit of Consecutive Suicides in New Brunswick: The Case for Coordinating Specialist Mental Health and Addiction Services

Article excerpt

Objective: To weight the potential of promotion, prevention, and treatment programs to help establish priorities in multipronged suicide prevention strategies.

Methods: Psychological autopsy methods served to collect information on consecutive suicides over 14 months in New Brunswick (n = 102). A panel of researchers, clinicians, provincial planners, and consumers reviewed the cases and applied a systematic needs assessment procedure to establish interventions and services received, unmet needs at the individual level, and programmatic and systemic shortcomings.

Results: More than two-thirds of the individuals suffered from a depressive disorder and a similar proportion from substance (essentially alcohol) abuse or dependence; one-half also presented a personality disorder. In the last year, more man one-half had been in contact with a mental health services specialist, but less than 5% had contact with addiction services, though one-third had previous contact in their lifetime. In one-third of the cases, service gaps called for greater coordination and integration of mental health specialists and addiction services within the health care system. In one-half of the cases, system needs were found to be unmet for public awareness efforts aimed at encouraging individuals to consult health and social services professionals, and in terms of training efforts geared to improving detection, treatment, and referral for mental illness, substance-related problems, and suicidal behaviour by primary medical, social, and specialist services.

Conclusion: This study supports multipronged suicide prevention strategies that should include integrated public promotion, professional development campaigns, and better program coordination. Authorities in New Brunswick have opted to favour the latter strategy component, whose development and application must be evaluated to determine its impact on suicide rates.

Can J Psychiatry 2008;53(10):671-678

Clinical Implications

* Psychiatric services should actively collaborate with addiction services in the case management of difficult comorbid cases.

* Assertive approach protocols should be in place for the case management of difficult-to-engage comorbid cases with suicidal behaviour seen at hospital emergency services.

* Primary medical, social, school, and police services should receive more support by specialist psychiatric and addiction services in detecting, treating, and referring individuals with mental and substance-related disorders.

Limitations

* The new components of the comprehensive needs assessment method were not tested for reliability by another set of raters.

* In the end, systematic needs assessments remain hypotheses to be tested.

* No control group was used.

Key Words: suicide, public health, mental health services, mental disorders, substance-related disorders

Both top-down and bottom-up information is required when assessing needs for care and services relative to mental health care systems. Clinical audit constitutes a bottom-up evaluative approach that can prove extremely useful in this regard.' When carried out nationwide, such audit informs on the performance of health care systems and can influence the development and course of national policies, including suicide prevention.2 Its matrix model draws on the general health care evaluation model of Donabedian,3 which apportions investigative efforts at the individual-clinical, local-regional-programmatic, and systemic-provincial-state levels in relation to health outcomes.

The coroner's annual report represents an audit of a minimal data set, covering age, sex, location, means, and population rates. The UK National Confidential Inquiry into Suicide and Homicide collects data through a survey form sent to attending clinicians to ascertain, among other things, clinical variables and suicide preventability.4 However, the approach is overly narrow, as only about 25% of suicides in the United Kingdom and Australia4'5 have been shown to be committed by current mental health service users and less than 5% were inpatients. …