A call for help

Hey there, time traveller!
This article was published 19/09/2015 (4001 days ago), so information in it may no longer be current.

In a city the size of Winnipeg, it’s believed as many as 1,400 people think about suicide each day.

Over the course of a year, about 28,000 people will have considered ending their life.

And in an average year, about 110 people commit suicide in the Manitoba capital.

Mostly, these deaths go unreported, the grief from their premature departure confined to family and friends.

Occasionally, a suicide makes the news, putting the spotlight on the state of mental health services in Manitoba and whether there is more the system could have done to prevent it.

Jill Tardiff’s apparent suicide over the Labour Day long weekend — her body was discovered in the Red River Sept. 10, three days after she went missing — is one of those cases.

Described as an upbeat, creative and powerful educator who brightened thousands of lives in Winnipeg during her long career, Tardiff also suffered from depression. Suffered to the point that she spent a month in a psychiatric ward at Seven Oaks General Hospital until shortly before her death.

What happened after her release has raised renewed questions about the adequacy of the province’s mental health services.

 

* * *

Debbie Lazaruk had been best friends with Tardiff since they were both six years old, the type of friends who call each other every day.

But even in a friendship that spanned 55 years, it was nearly impossible for Lazaruk to know Tardiff was nearing her darkest hour.

Tardiff recently spent about a month in Seven Oaks hospital for depression, occasionally receiving day or weekend passes, Lazaruk said.

A week before she was to be discharged from hospital, Tardiff was on a weekend pass when she waded into the Red River.

“She attempted then to drown herself in the river and was able to save herself from it,” Lazaruk said.

She and Tardiff’s husband returned her to hospital immediately. She stayed one more week before being discharged. According to Lazaruk, the hospital’s immediate follow-up plan was an appointment with a psychiatrist at the hospital in two weeks.

A day later, she overdosed on pills and was rushed to St. Boniface General Hospital. She was not admitted, but kept in the emergency department overnight.

“They said they needed to do observation and watch her vital signs and she would be speaking to a psychiatric nurse,” Lazaruk said. “I don’t think there were any psychiatrists on for the weekend. It was the long weekend.”

She was discharged from St. Boniface hospital the following afternoon. According to Lazaruk, Tardiff had agreed upon her release that she would contact Seven Oaks for follow-up care.

“But it was up to her to do it, though,” her friend added. “They didn’t do it (line up an appointment) for her at St. Boniface.”

Security footage at her condo showed Tardiff leaving the building at about 1:20 the following morning. Her body was recovered from the river three days later.

Lazaruk believes both hospitals — Seven Oaks and St. Boniface — let her friend down. “I have no idea what the discharge protocol is, and I have come to learn through knowing people with depression that they can put up smokescreens and can fake things fairly well. I have no idea if she told them she was fine and that was enough,” she said.

The day Tardiff was discharged from Seven Oaks, she spoke with Lazaruk on the phone for well over an hour.

“In my mind, she was completely herself. She sounded carefree and planning for the future… I would never have known that the next morning she was going to take all her pills.

“I don’t know if it was a case of the roller coaster of depression or if it’s what they say when a person has finally made a plan and they feel the relief. I have no way of knowing.”

 

* * *

 

Dr. Murray Enns is a psychiatrist, an expert in mood disorders, such as depression, and suicide. He is the head of the department of psychiatry at the University of Manitoba and medical director for the Winnipeg Regional Health Authority’s adult mental health program.

In an interview this week, Enns said he could not comment at length on a specific case. However, he did say the health region would not be investigating Tardiff’s death as a critical incident. An internal review of her care found that it “was managed appropriately,” he said.

It’s understandable people are looking for answers when they occur, he said. But the answers aren’t so easy.

“(A suicide) is a personal and familial tragedy. It’s awful and it’s gut-wrenching,” Enns said.

Despite several decades of “pretty intensive” suicide and suicide prevention research, the rate has not changed much across North America in years, he said. “We really haven’t made a dent in them.”

Part of the issue, he said, is there no checklist or protocol that can predict who will or will not “complete” suicide — even among those who have tried it.

Suicide thoughts are common among the general population, he said. And even if someone has attempted it, it doesn’t necessarily mean they’re still planning it. What’s more, a person who is contemplating suicide may deliberately say they are not having those thoughts.

“Cardiologists treat people and they still die of heart disease. Cancer (doctors) treat people and they still die of cancer. And psychiatrists treat people and they still die due to their mental illness…”

As with heart disease, there are factors that can be controlled and those that can’t in dealing with mental health and suicide risk, he said. Among things you can’t control are age (risk rises as we get older), sex (males are three times more likely to kill themselves than women), family history, impulsiveness, a history of traumatic experiences, particularly childhood trauma. Then there are modifiable or potentially modifiable factors, such as depression, anxiety, substance abuse, major stresses, medical problems and feelings of hopelessness.

It’s impossible to keep all people who are suicidal in hospital, Enns said. And it’s also a fallacy that a hospital stay will cure an individual of any possibility of suicide. What it can do is temporarily remove someone from a stressful situation, and temporarily protect them from harm. It can allow health care professionals to assess them, initiate a care plan (be it therapy or medication), and help them with any social supports such as housing. A consideration in the release of anyone from hospital is what kind of supports they have in the community, such as family and friends.

Enns cautioned that if patients remain in hospital too long, they can become “institutionalized” and overly dependent on that level of support and lose connections in the community. “It (hospitalization) has its place and it’s got its limits.”

At the same time, Enns said, you won’t catch him saying that there’s an abundance of mental health resources.

“It sounds cold, but there’s a little bit of an element of rationing going on. So who do we admit to hospital? Clearly not just anybody. Not everybody who is suicidal, not everybody who is depressed, not everybody who is psychotic. There’s not nearly enough space for that. So we hospitalize people with severe illness (who) can’t function and are deteriorating and when we think that the risk to them right now is substantial.”

 

* * *

 

Funding for mental health services in Manitoba and the country as a whole is woefully inadequate, according to the Canadian Mental Health Association.

Marion Cooper, executive director of the association’s Manitoba and Winnipeg branch, said while the stigma around mental health is being lifted and more sufferers are seeking help, funding is not keeping up.

“We’ve got a public demand for good mental health care but we don’t have the services funded to where they need to be to meet demand,” she said.

Cooper said more investment is needed in both hospital and community care.

“We see people having to wait for months and months to see a specialist in psychiatry and in mental-health care. They’re waiting six months to a year to get into a cognitive behaviour therapy group, which would be an evidence-based treatment for depression or anxiety,” she said.

With cancer rates rising, government has stepped up with investments. Not so with mental health, Cooper said. “We don’t see the kinds of waits (for cancer treatment) that you see in mental health.”

A report in 2012 by the Mental Health Commission of Canada recommended Canada boost mental health funding to nine per cent of the health funding pie, from seven per cent. Today, it still languishes at seven per cent and within Manitoba, the number is probably lower, Cooper said. In the United Kingdom, 10.8 per cent of health spending goes to mental health services.

More community supports for patients discharged from hospital or emergency departments is especially important, Cooper said. This would include follow-up phone calls and help for family members to help their loved ones.

The association sponsors about a half dozen family education workshops at its offices on Portage Avenue each year.

The response, she says, is “pretty overwhelming.”

larry.kusch@freepress.mb.ca