Dialogue Volume 15, Issue 3 2019 - Page 50

PRACTICE PARTNER Defence. These concerns and recommenda- tions include: while under a "suicide watch" overseen by military personnel. CONCERN: Clinical documentation of the patient’s history was significantly lacking in the records provided for review. • Guidelines for suicide watch and post-dis- charge care plans should include frequency and means of monitoring, follow-up ar- rangements, and available social supports. Planning should be clearly communicated between the necessary military personnel and health-care practitioners CONCERN: Upon presentation to the emer- gency department with reported suicidal- ity, the treating physician did not appear to consult with psychiatry. • Health-care practitioners should consider consultation with a psychiatrist, either in person or by telephone/other means (e.g. Ontario Telemedicine Network), for a re- ported first suicidal concern. If consultation is not feasible, the attending physician should conduct and document a robust mental health assessment CONCERN: There did not appear to be a post- discharge care plan for the patient as he was able to purchase a firearm and ammunition 50 DIALOGUE ISSUE 3, 2019 • Suicide watch guidelines implemented by the Canadian military should be clarified, docu- mented and shared with hospitals in order to assist with assessment, discharge planning and monitoring of patients. • In a recommendation addressed to the CPSO, the Ontario Medical Association and the Canadian Medical Protective Agency, the Committee stated that when a patient is determined to be at risk to themselves and/ or others and in possession of a firearm and a Possession and Acquisition License (PAL), the physician should be required to im- mediately notify local law enforcement and request the seizure of the firearms, as well as the PAL so that the patient would be unable to legally purchase another firearm. MD • Health-care practitioners are to be reminded to document all relevant history (e.g. psy- chosocial, related stressors, etc.), including attempts to obtain collateral history, when as- sessing individuals with potential suicidality.