Crusade for psychological autopsies on suicides

Since her son died two years ago, Martine Brault has read over 800 coroner’s reports of suicide cases.
Srecommendation? “We need psychological autopsies, it’s urgent”.

In the vast majority of reports of suicide cases that Ms. Brault has read, the investigation of the psychosocial causes of suicide is too limited to understand how others could be prevented from killing themselves, she says. .

In addition, recommendations are very rare. Ms. Brault’s compilation shows that just 23 reports contain about 1046 suicide cases in 2016.

“It’s a big problem, because you have to know where you’ve escaped and what measures you can put in place,” says Martine Brault, whose son, Patrick Chouinard, 20, committed suicide while heading for board of his car on a viaduct of Duplessis Highway, Quebec, September 6, 2017.

The suicide rate has dropped in Quebec in the last decade, but it remains one of the most important causes of death. Every day, three Quebeckers take their lives.

M me Brault claimed that coroners routinely perform psychological autopsies of suicides and “accidental deaths of undetermined intent” – the dead who are not classified as suicides, but could be in the circumstances.

Psychological autopsies consist in reconstructing the psychological, social and medical path of a person who has died by suicide by gathering information from those around him and from the health system.

The Quebec Association for the Prevention of Suicide sees “with a very good eye” the idea that coroners do psychological autopsies, says the general manager, Jérôme Gaudreault.

The work of the coroners, notes Mr. Gaudreault, “is really to give the cause of death and explain, as far as possible, what brought to the cause. Except that they are still in a very specific context and they do not go very far in their final reports that are public.

As a result, “when it comes time to study the coroner’s reports to understand the phenomenon, it gives us a version that is summary of the reality of the suicidal person,” added Jerome Gaudreault.

Value-added approach

A form of psychological autopsy called “systematic audit of suicide cases” has already been tested in a project on the territory of the CIUSSS of the East-de-l’Île-de-Montréal.

Psychiatrist and researcher Alain Lesage and his colleagues examined in greater depth 14 cases of people who committed suicide in 2016. They read the police reports and the medical reports and those of the Régie de l’assurance maladie du Québec. contacted relatives and conducted interviews of about three hours with some of them.

This work of 30 hours per case allowed Dr. Lesage and his team to write a “vignette” of a few pages on the trajectory of life, social and health problems and the recourse of the deceased to the care of health. A multidisciplinary panel then discussed the vignettes.

This exercise then led to recommendations for improving the quality of social services. “The added value of this approach can be appreciated firstly because in none of the 14 cases analyzed did the Coroner make a recommendation while we made 31 recommendations,” reads the preliminary report of the D Dr. Lesage, presented in October 2018.

Joined by phone, Alain Lesage hoped that such thorough and systematic evaluations will soon be the norm, everywhere in Quebec. He believes that they will provide better care for those who are most at risk of suicide, including those who have a mental health problem or addiction to alcohol or drugs.

“Audits are an analysis of the flaws in a system,” he says. If we address these weaknesses, we can improve things. ”

The Coroner’s Office does not have the means to do psychological autopsies, but is open to the method. “The psychological autopsy is a specialized method that requires very specialized expertise. The Coroner’s Office has neither the expertise nor the resources to do psychological autopsies on its own, “spokeswoman Dominique D’Anjou said by email.

The Office of the Coroner continues to collaborate on major research projects aimed at better understanding suicide by reconstructing the life trajectories of deceased persons and applying the psychological autopsy method, notes Mr. D’Anjou. The pilot project for the systematic audit of suicide cases at the CIUSSS East Island (CEMTL) was conducted in collaboration with the Office of the Coroner. Currently, such research on suicide is underway in the Nunavik communities, says Dominique D’Anjou. This is a collaboration between the Office of the Coroner and the research team Monique Séguin, professor of psychology at the University of Quebec in the Outaouais and member of the McGill Group for Suicide Studies.

The Coroner’s Office is also open to future collaboration with specialized research teams who would like to work on suicide through psychological autopsy or any other recognized scientific method.

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