Suicide Awareness Month & World Suicide Prevention Day

Shaely Ritchey, RN

September is Suicide Awareness Month with the 10th being World Suicide Prevention Day. During this month people typically share numbers for crisis lines, reminders to check on one's friends, and similar sentiments. While these are important messages, they barely touch the surface of real and meaningful suicide prevention strategies.
 

The Basics

Like many things, suicidal ideation exists upon a spectrum from passive to active. Wherever someone finds I along this spectrum, the pain they are experiencing is real and deserving of support - although what this support looks like for each person will be entirely individual (even for the same person at different times in their life.) Whether someone is experiencing passive or active suicidal ideation; whether these are experiences they live with or are encountering for the first time, people deserve the space to talk about their experiences without fear of judgment, stigmatization, and incarceration. The latter of which, a good deal of emerging research supports, can be more harmful than helpful.
 

Creating meaningful change for those experiencing a mental health crisis, living with mental illness and related struggles is complex and requires comprehensive prevention strategies and significant social and political change. If we want to truly see and participate in effective suicide prevention efforts, it requires us to be bold and reflective across multiple sectors of government and policy.
 

Real and meaningful suicide prevention looks like addressing the rising cost of living, safe supply, and access to harm reduction services, as well as accessible and affordable housing. It is better research and treatment advances in rare diseases and chronic health concerns, including disability and other forms of social justice. It is actions beyond words that align with truth and reconciliation as advocated for by Indigenous communities. It is searching the Brady Road landfill, the preservation of Indigenous languages, land back, and supporting traditional ways of being and knowing. It is essential infrastructure in rural and remote communities. It is climate justice. It is the deconstruction of white supremacy. It is anti-patriarchal. It is an equitable society and the redistribution of wealth. It is fair compensation for labour as all labour is skilled. It is access to affordable childcare. It is a living wage. It is people before profit. It is connection to community and purpose. It is gender affirming care and safe spaces to be as you are. It is non-carceral in nature whether we are talking about prison systems or mental healthcare. It is access to timely public health services. It is addressing mass burnout in our healthcare system whose staff have been calling for change for years. It is a world that is safe enough to reach out for help as we are so often instructed. It is changing the Mental Health Act and other outdated laws that impact people's fundamental human rights.
It is all these things and so much more.
 

For Nurses

To narrow in on one focus of change on this important topic that is relevant to nurses and other healthcare professionals, I want to bring our professional attention to the Health Professions Act (HPA) and the newer Health Professions and Occupations Act (HPOA). Both pieces of legislation outline regulations on practice for nurses experiencing a mental health crisis, living with mental illness, and struggling with substance use that are important to know.
 

The relevant portion of these acts to the topic of suicide prevention is section 32.3 and the related sections in the newer HPOA. Section 32.3 was first outlined in the HPA; It was enacted in 2003 and made effective in 2005 under then Minister of Health, George Abbott.
 

For reference, section 32.3 (1) of the HPA is as follows:

"If an other person is a registrant in a college prescribed by the minister for the purposes of this section and because of admission to a hospital or a private hospital as defined in the Hospital Act, for psychiatric care or treatment, or for treatment for addiction to alcohol or drugs the other person is unable to practise, the chief administrative officer of the hospital, or someone acting in that capacity, and the medical practitioner who has the care of the other person must promptly report the admission in writing to the registrar of the other person's college."

In simpler terms, if a nurse or other healthcare professional governed by the HPA is admitted to hospital (voluntarily or involuntarily) with a primary diagnosis of mental illness, a mental health crisis, and/or substance use, that individual is to be reported by the chief administrative officer to their regulatory body, whereby the body must review and approve the individual's ability to return to work alongside documentation from a medical professional indicating fitness to practice. In its determination of fitness to practice and/or any practice limitations to be made for a registrant who has been reported under section 32.3, the regulatory body may require information regarding the patient's diagnosis, prognosis, treatments, and/or details of their mental health status.
 

We know that nurses are subject to traumatic situations, high levels of stress, fatigue, and moral distress on a daily basis. Even for nurses who do not live with mental illness, the strains of the profession in the current state of BC's healthcare system make nurses highly vulnerable to poor mental health and/or mental health crises. It is important to note that those clinicians who are required to report another healthcare professional under section 32.3 of the current HPA are only following the law when such a report is made, and privacy is protected by the regulatory body.
 

The concerning aspect of section 32.3 is that its basis in research as to the risks potentially posed to a healthcare clinician who receives acute care treatment for a mental illness, or a mental health crisis are difficult to ascertain. The key questions should be whether a healthcare professional who receives acute care treatment for a mental health condition versus those with a mental health condition who do not receive acute care treatment, pose any higher risk to patients.
 

In the newer Health Professions and Occupations Act (HPOA), there are important updates to section 84 (what was previously section 32.3 in the Health Professions Act) which are as follows:

"Sec 84) (1) A licensee who is an employee of a health care facility must make a regulatory report with respect to another licensee if (a) the other licensee receives health services through the facility, and (b) the first licensee has reasonable grounds to believe that the other licensee is not fit to practise due to a health condition, whether or not the health condition is the cause of the other licensee's receipt of health services.
 

(2) A regulatory report must be made as follows: (a) subject to paragraph (b), as soon as reasonably practicable after the other licensee begins to receive health services through the health care facility; (b) if the health care facility is a hospital, on or before the date that the other licensee is discharged from the hospital.
 

(3) A regulatory report must include all of the following: (a) a description of the health condition referred to in subsection (1) (b); (b) the opinion of the first licensee as to whether the other licensee is fit to practise.
 

Sec 85) Duty to report if suspected significant risk to public : A licensee must make a regulatory report with respect to another licensee if the first licensee has reasonable grounds to believe that (a) the other licensee is not fit to practise, and (b) the continued practice of a designated health profession by the other licensee presents a significant risk of harm to the public."

These changes remove the specific stipulation of reporting a healthcare professional receiving acute care treatment for a mental illness, a mental health crisis, or substance use. While this is a positive step, we must consider that given stigma remains in our society for those experiencing mental health concerns, we can potentially expect that these acute care instances may still be reported.
 

There is a great deal of evidence that supports that individuals who have presented to emergency psychiatric services are at a much higher risk of completion of suicide after discharge. When you add in the stigma that is felt from being reported for simply having an illness (even if the intent is not meant to stigmatize – of course patient safety comes first) and the financial instability of not being able to work until approved to return to work after obtaining documentation, it is reasonable to be concerned for nurses going through this experience.
These are not conversations we typically have with our colleagues, but these are not uncommon situations, especially for nurses who may live with a mental health diagnosis. If this has happened to you, please know you are not alone nor are you less of a nurse for experiencing these challenges.
 

While the newer HPOA shifts away from specifically targeting mental illness and substance use in its language, education and anti-stigma work will be an important part of bringing this Act into practice. We must ensure that psychiatrists, physicians, and other health providers in the hospital are made aware of these changes, and address the internalized and systemic biases facing those experiencing mental illness, a mental health crisis, and/or substance use.
 

Improving the current state of the healthcare system also requires us to ensure that we improve the health of our nurses and other professionals who face incredibly challenging circumstances on a daily basis. Access to safe and supportive mental healthcare options that are non-punitive and individualized, allowing people to tend to their own wellbeing and fitness to practice, are critical in times like these.
 

Author Biography

Shaely Ritchey (she/they) is a registered nurse who works in acute and complex surgery. Originally raised upon unceded Lheidli T'enneh traditional territory; currently living upon unceded Lək̓ʷəŋən traditional territory Shaely is passionate mental health advocacy, is a co-founder of Vancouver Island Voices for Eating Disorders (VIVED), and volunteers with CMHA BC. In their free time, Shaely enjoys photography, hiking, and art.