Susan Siemens was a busy woman.
She was raising a 19-year-old son and 11-year-old daughter on a tight budget.
She was blessed with a fiancé she had fallen head-over-heels in love with.
She also had to contend with a slew of devastating physical and mental illnesses. Siemens was diagnosed with bipolar disorder, arthritis and fibromyalgia - as well as several other physical disabilities. She was having issues finding medication that would properly maintain her mood levels.
Those illnesses finally overwhelmed Susan Siemens, when on Dec. 16, 2011, she committed suicide.
"When you have a mental illness and you have [life events], those trigger episodes and [in the end] she was just tired of fighting," said Steve Flanagan, her fianc for two years.
Siemens's loved ones saw her battle firsthand, and did everything to help her. However, they feel the area's mental health resources were inadequate, and they're not alone in saying there's not enough.
In late October, Siemens was placed in the psychiatric unit of the University Hospital of Northern B.C. Six weeks later, she was granted a day pass out of the third floor.
Within hours of her temporary release, she had swallowed a bottle of pills and slid down an embankment into the Nechako River.
It was her third suicide attempt within six months. And it shouldn't have happened, said Flanagan.
The day before her death, Flanagan had to drive to Kamloops to tend to his dying father. Before he left, he told the nurses on the ward not to grant Siemens a pass while he was gone.
"She was just overwhelmed. Everything she did, she had to dig and scratch and claw her way out of," said Flanagan.
A coroner's investigation into Siemen's death is ongoing.
Northern Health communications officer Jessica Quinn told The Citizen physician-patient confidentiality prevents her from commenting on specific cases. But, in general, day passes are granted to patients at the discretion of a psychiatrist, said Quinn.
Flanagan has claimed that, during the first two weeks in hospital, Siemens was meeting with a psychiatrist twice a day and was making progress, but afterward received no attention other than medication, because the attending psychiatrist had left Northern Health.
Siemens was under a lot of stress, said Flanagan. Her daughter had been taken away after the previous suicide attempt. She was struggling with her finances while on disability benefits, which had recently been reduced.
Flanagan is convinced that had someone taken an extra second to evaluate her mental state, she wouldn't have been granted a pass that day.
"I had to go to Kamloops and she really wanted to come with me but she couldn't get a pass from the hospital [for that length of time]," said Flanagan. "While I was gone, we texted back and forth the entire time. I really didn't think she'd go through with it but when she stopped answering my texts, I knew something was wrong.
Siemens's daughter broke the news to him and he immediately drove back to Prince George that day.
"I don't remember anything about that drive," he said.
Her body was found downstream from the John Hart Bridge the afternoon of Dec. 16.
Her personal effects were found at the top of the steep shoreline bank.
A trail in the snow led to the water's edge.
OBSTACLES FOR THOSE IN CRISIS
Her loved ones feel Siemens's death is partly a result of the obstacles northern residents face when trying to get adequate mental health care.
Verna Macleod, executive director of the Crisis Prevention, Intervention and Information Centre for Northern B.C., based in Prince George, agrees lack of services in the North for mental health is a problem.
The crisis line she helps operate is responsible for fielding calls from Quesnel to the Yukon to the Alberta border.
"Because some of the communities are so small, we can't possibly have mental health services in every little tiny community," said Macleod. "Sometimes it is very difficult for people who are depressed to get to a city centre that does offer services."
She says, for example, someone who lives in Greenville, three hours north of Terrace, would have to go to Terrace to get counselling and most of the people couldn't afford to take that trip on a regular basis.
"So they just suffer," she said. "I don't honestly know how you address those kinds of gaps, given our geography."
The psychiatric unit at UHNBC is always in high demand.
With 10 adult beds and four youth beds, finding space for patients in need is often a game of musical chairs.
Flanagan said while Siemens was admitted, for a few days her room was located in a converted office.
"We never turn people away - never, ever," said Joseph Savage, manager of northern interior residential services, mental health and addictions. "[We] are pretty full. There is definitely a lot of demand for that resource."
The mental health branch of the hospital offers a multidisciplinary team to work with patients in determining the best course of action.
"In working with [the patient], there is an assessment that takes place and part of that is whether they should be admitted to the hospital. In most cases with people presenting as suicidal, they will be admitted to Three North East - the third floor of psychiatry," said Savage.
SUICIDE INVESTIGATION STILL UNDERWAY
Barbara Mclintock, B.C. Coroners Service spokeswoman, said the investigation in to Siemens's death is ongoing.
"It's very much an open file and under investigation," said Mclintock. "All the deaths that aren't natural, we investigate in some depth and I know there are some issues, so the investigation will be... very in-depth."
The services the hospital's psychiatric unit provides runs the gamut of group therapy, individualized therapy, recreational opportunities and a psycho/educational group that focus on life skills.
According to Savage, the bulk of Northern Health's resources go into community resources that are found outside the hospital, because the vast majority of people don't need admission to an intensive unit like psychiatry.
"The first point of contact is the Community Response Unit - they access people based on their history and then can better determine the best resource and strategy for them," said Savage.
"We have programs specifically for adolescents, elders, people with mental disabilities, acquired brain injuries. We have a whole slew of programs available," said Savage.
MacLeod is quick to point out that, if a person is determined to be suicidal, there is very little that can be done.
"We have to think [the hospital staff] made an error in letting [Siemens] out. But I don't want to judge the system, they work really hard. They are understaffed and underfunded and they do the best they can with the resources they have," she said.
"I do think individuals can fool people. If [a person] is determined to kill themselves... they'll find a way," said MacLeod. "But to walk into a freezing cold river is terrible desperation... Despite all the help she was getting, it just didn't work."
PARLIAMENT LOOKS AT STRATEGY
Suicide is the 10th leading cause of death in Canada and among Canadians aged 15 to 24, it is the second leading cause of death, with at-risk groups facing higher rates.
According to the most recent B.C. Coroners report in 2009, there were 11.4 suicides for every 100,000 people in B.C., with the northern part of the province having the highest ratio at 20 suicide deaths per 100,000 people.
The economic cost of suicide and related behaviour in Canada is estimated at more than $2.4 billion per year.
One of the biggest undertakings to develop a useful strategy to deal with suicide is private members Bill C-300 - subtitled An Act respecting a Federal Framework for Suicide Prevention - which is currently in front of Parliament and has just passed its second reading.
While most of the provinces have a strategy already in place, having a national strategy would get all of the provinces on the same page when it comes to prevention.
Conservative MP Harold Albrecht is sponsoring the bill.
"At the heart of this bill is a clear call for national leadership, a co-ordination of the great efforts of many community groups across Canada, suicide prevention groups already doing all they can to bring hope," said Albrecht in the House of Commons on Feb. 9 before quoting Margaret Somerville, a McGill University professor.
Hope is dependent on having a sense of connection to the future, even if that future is very short-term. Hope is the oxygen of the human spirit; without it our spirit dies."
