(Pub­lished in The Huff­in­g­ton Post)

Inter­na­tion­al Sui­cide Pre­ven­tion Day came and went last week. But it’s hard to know whether most hos­pi­tals noticed it, or how well they are doing in com­bat­ing self‐harm by their patients. How hos­pi­tals han­dle men­tal health issues can have seri­ous con­se­quences.

One win­ter night in 2004, Cyn­thia Oster, 44, slammed her rent­ed Buick into an oncom­ing car full of pas­sen­gers. She had been speed­ing down High­way 11 in Graven­hurst, Ontario and trav­el­ling the wrong way. Five peo­ple were killed in the head‐on crash, includ­ing Ms. Oster.

A coroner’s inquiry would lat­er hear that just the day before, Ms. Oster, who had a his­to­ry of men­tal health issues, had been appre­hend­ed by the Ontario Provin­cial Police under the Men­tal Health Act and tak­en to the emer­gency depart­ment of South Musko­ka Memo­r­i­al Hos­pi­tal for a men­tal health assess­ment. But the emer­gency room physi­cian saw no rea­son to detain her fur­ther and released her. The jury’s rec­om­men­da­tions includ­ed bet­ter train­ing of hos­pi­tal emer­gency physi­cians to deal with men­tal health issues.

An expert wit­ness in psy­chi­a­try tes­ti­fied that Ms. Oster’s emer­gency room exam­i­na­tion was “cur­so­ry, pro­ce­du­ral­ly flawed” and “incom­plete.” He also said that fail­ure to deal prop­er­ly with men­tal health patients was not iso­lat­ed to the hos­pi­tal or doc­tor involved in this inci­dent. 

In anoth­er high‐profile case in Ontario ten years lat­er, Prashant Tiwari, who was only 20 at the time of his hos­pi­tal­iza­tion in 2014, took his life while on “sui­cide watch” at Bramp­ton Civic Hos­pi­tal.

Though he was sup­posed to be checked every fif­teen min­utes, his life­less body was dis­cov­ered hang­ing from a ceil­ing grate in his bath­room. He had fash­ioned a noose out of his bathrobe and used a chair that nev­er should have been there.

He had been left unat­tend­ed for three hours. The hos­pi­tal has since admit­ted that prop­er pro­ce­dures were not fol­lowed. The fam­i­ly has com­menced a $12.5 mil­lion law­suit.

Some years ago, the U.S. Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS) declared inpa­tient hos­pi­tal sui­cides and unsuc­cess­ful attempts that lead to dis­abil­i­ty to be “nev­er events.” That means the care required is so cru­cial to patient safe­ty and the harm is so clear­ly pre­ventable by fol­low­ing cer­tain well‐documented stan­dards of care that there is no excuse for such events to hap­pen.

And because of the huge amount of fed­er­al funds that go into hos­pi­tals all over the U.S. through these twin pro­grams, these CMS stan­dards car­ry a lot of clout.

That point was recent­ly learned the hard way by a health­care facil­i­ty in Texas. Tim­ber­lawn Men­tal Health Sys­tem is set to close the doors of its 144‐bed psy­chi­atric hos­pi­tal in Dal­las, and a small­er hos­pi­tal in near­by Gar­land, after being cut off from fed­er­al fund­ing as a result of patient safe­ty vio­la­tions.

Anoth­er big federally‐funded health­care play­er in the U.S., the Agency for Health­care Research and Qual­i­ty, also calls sui­cides or “attempt­ed sui­cide or self‐harm result­ing in seri­ous dis­abil­i­ty,” while being cared for in a health care facil­i­ty to be a “nev­er event.” It warns fur­ther that while “nev­er events” in gen­er­al are rare, their con­se­quences are usu­al­ly dev­as­tat­ing to patients. Most are fatal.

In Cana­da, it’s not clear to what extent inpa­tient sui­cides, or unsuc­cess­ful attempts that lead to dis­abil­i­ty, are con­sid­ered “nev­er events” by health­care deci­sion mak­ers, or who is keep­ing track of them for that mat­ter.

The fact is there is a wall of secre­cy that sur­rounds hos­pi­tal sui­cide and attempts at self‐harm in Cana­da. We just can’t get the straight goods, such as where it is occur­ring, how often and whether errors or fail­ures in care con­tributed to the inci­dents.

It can be dif­fi­cult for even major media orga­ni­za­tions with deep pock­ets to get accu­rate infor­ma­tion.

An inves­ti­ga­tion by CTV’s W5 pro­gram in 2014 esti­mat­ed that there had been at least 300 inpa­tient deaths from self‐inflicted harm in Cana­di­an hos­pi­tals in the pre­ced­ing ten years. 

But these fig­ures were based on data which W5 admit­ted were “extrap­o­lat­ed.” The pub­lic, who pay the bills for hos­pi­tals in Cana­da, should not have to rely on “guessti­mates” when deal­ing with crit­i­cal health­care issues.

The lack of clar­i­ty can be attrib­uted to the fact that there are no manda­to­ry report­ing stan­dards for in‐hospital sui­cides in most Cana­di­an provinces, includ­ing Ontario where the recent known inci­dent occurred.

We are left to try to make sense of a con­fus­ing and con­tra­dic­to­ry pic­ture. For exam­ple, while W5 said in its report that in the past 10 years, some 98 deaths from sui­cide occurred in Ontario hos­pi­tals, that province’s Chief Coro­ner would only con­firm that “more than a dozen” patients have tak­en their lives while receiv­ing hos­pi­tal care in the past five years.

No fig­ures were giv­en for the num­ber of attempts that were unsuc­cess­ful, which can also have last­ing dev­as­tat­ing con­se­quences for a patient, such as brain dam­age.

Sui­cide by hos­pi­tal patients is the second‐most com­mon sen­tinel event report­ed to the Joint Com­mis­sion, the giant agency that accred­its health­care facil­i­ties in the U.S. Only wrong‐site surgery exceeds it in fre­quen­cy.

No com­pa­ra­ble data are avail­able in Cana­da. Why is this the case in a pub­licly fund­ed health­care sys­tem?

Per­haps most telling of all: as of 2015, there are still no manda­to­ry stan­dards of care for the han­dling of known sui­cide risks in Ontario hos­pi­tals. 

Experts say “inpa­tient sui­cides are viewed as the most avoid­able and pre­ventable because they occur in close prox­im­i­ty to staff.”

Hos­pi­tal errors and fail­ures in care are a big cause of pre­ventable death in Cana­da and in the U.S.

While these are unac­cept­able for any group of patients, they are espe­cial­ly shock­ing to the con­science of soci­ety when they involve the most vul­ner­a­ble. That includes those suf­fer­ing from debil­i­tat­ing forms of men­tal ill­ness.

We owe it to them, and to their fam­i­lies, to ensure that they are pro­tect­ed from harm, whether by their own hand or because of a hospital’s neglect or break­downs in care.

It is gen­er­al­ly agreed in med­ical cir­cles that the safest patients are patients who are ful­ly informed about the facts and risks involved in their care. The same can be said of soci­ety when it comes to know­ing what is going on in its hos­pi­tals.

We can­not allow a cur­tain of silence and lack of trans­paren­cy to thwart the public’s abil­i­ty to assess how well our hos­pi­tals are mea­sur­ing up to their most impor­tant respon­si­bil­i­ties.

Want to know more about the role of com­pas­sion in the health­care set­ting and in mit­i­gat­ing emo­tion­al harm?  See Our Health­care Sys­tems Need A Strong Dose of Com­pas­sion.