Original Title: Pratiques de suivi étroit auprès des personnes présentant un risque suicidaire à la sortie de l'hôpital : défis rencontrés et pistes de solution

Authors' objectives: Various suicide prevention practices have been implemented in Quebec institutions, including close follow-up, which aims to ensure that people who are or have been in serious danger of committing a suicidal act can benefit from rapid and intensive follow-up. Despite the consolidation of suicide prevention practices, the harmonized implementation of close follow-up for people at risk of suicide remains a challenge. For this reason, the Ministère de la Santé et des Services sociaux (MSSS) wishes to set up a project to improve the availability and accessibility of close follow-up, and to define and harmonize its practices (measure 2.8; Stratégie nationale de prévention du suicide 2022-2026 - Rallumer l'espoir)

Authors' results and conclusions: RESULTS: The analysis and integration of all the data collected highlight five central themes, enabling us to identify findings to support the harmonization of close follow-up practices for people aged 14 and over at risk of suicide upon hospital discharge, namely: • adapting close follow-up to the needs of people at risk of suicide by: – obtaining the free and informed consent of the user throughout the close follow-up trajectory; – implementing a flexible, individualized approach based on continuous reassessment of the user's needs at each stage of the close follow-up trajectory; – implementing training to enhance the clinical skills needed to offer personalized follow-up to certain specific populations (e.g., individuals with a complex clinical profile, members of indigenous or ethno-cultural communities) and those who minimize their suicidal risk or refuse the followup offered. • coordinating care services for people at risk of suicide on discharge from hospital by: – strengthening coordination and information sharing between hospital services and community services which will provide close follow-up, in order to avoid service interruptions and ensure safe, smooth transitions for users; – clearly defining the role of the various liaison entities (e.g., liaison officers, mobile crisis intervention teams, professional and inter-professional coordinators, liaison committees) to ensure that each person at risk of suicide receives the appropriate care and services; – setting up a centralized system for receiving requests for close follow-up, as well as 24/7 access to a service provider who receives the request; – promoting the range of services available to support people at risk of suicide, and ensuring that the various support actors work in a complementary and integrated manner. • involving relatives and recognizing their needs by: – obtaining the user’s consent to involve relatives in the close follow-up process; – increasing the ability of relatives to take care of themselves all the while supporting the person at risk of suicide. – sharing the suicidal risk as a team rather than having it rest on of the caregiver alone if the user refuses to involve relatives, or if they are unable to commit; providing more support for facilities and their partners, including community organizations, so that they can implement best practices to involve relatives in the user's service trajectory. • using common tools for close follow-up practices by: – harmonizing the various tools used across the province to support organizational and clinical practices within facilities, while ensuring that they are sufficiently flexible to respond effectively to the specific needs of users, caregivers and facilities; – regularly reviewing the tools used and appropriate training of clinical staff in their use; – developing clear and adapted intervention protocols to guide the clinical judgment of care providers; – improving the interoperability of information systems to support close followup data recording and information sharing with intrasectoral and intersectoral partners. • developing suicide prevention skills within health and social service institutions and their partners by: – adopting a comprehensive approach to raising awareness of suicide prevention among all staff, clinical and non-clinical, at all hierarchical levels and according to individual roles; – expanding and improving the specialized training offered in the health and social services network to all clinical staff, particularly by enhancing skills for intervening with specific groups (e.g., people with mental health or substance use disorders), by collaborating with community resources working with these populations, and conducting suicide risk assessments; – offering specialized training to other actors working with people at risk of suicide, particularly those in the community and parapublic sectors. For each of these themes, the challenges associated with implementing close follow-up practices and the solutions envisioned to overcome them are detailed. CONCLUSION: This state of practice is intended to be a complementary lever for initiatives aimed at strengthening the capacity of the health and social services network to better support people at risk of suicide. The themes identified, including the associated challenges and envisioned solutions, could thus be explored in greater depth in the future project initiated by the MSSS as part of the Stratégie nationale de prévention du suicide 2022-2026 — Rallumer l’espoir.

Authors' methods: This state of practice is based on two sources of data: a scoping review of the scientific and grey literature on close follow-up, including recent reports by the Quebec Coroner's Office, and a consultation with key Quebec stakeholders involved in providing this follow-up. The results of the thematic analysis of all the data are presented in the form of a narrative synthesis.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pratiques-de-suivi-etroit-aupres-des-personnes-presentant-un-risque-suicidaire-a-la-sortie-de-lhopital-defis-rencontres-et-pistes-de-solution.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pratiques-de-suivi-etroit-aupres-des-personnes-presentant-un-risque-suicidaire-a-la-sortie-de-lhopital-defis-rencontres-et-pistes-de-solution.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)