Jana Davidson, an expert from British Columbia, was appointed after an earlier report into the case raised concerns about the hospital.
The report made 14 recommendations, all of which are endorsed by Health Minister Leo Glavine.
One of the recommendations includes ignoring an earlier recommendation by the Nova Scotia physician resource plan to reduce the number of psychiatrists for youths.
The report identified a number of barriers to treatment, including the need to recruit more staff and physicians, delays in developing an electronic medical record system, lack of funding for youths 17 to 19 years old, and lack of communication and integration between departments including justice, social work, health and mental health services offered at schools.
Rehtaeh strip-searched, says family
Another recommendation is to implement trauma-informed care — recognizing patients have some kind of trauma that brought them into the hospital in the first place. This trauma should be considered when treating patients.
"Young people feel more empowered in terms of managing how they are within the system of care and feel like they've got some say in the treatments. We know that in the institutions — psychiatric institutions — both adult, child and youth that have implemented trauma informed care that there is a significant reduction in the use of seclusion and restraint," said Davidson.
Rehtaeh was admitted to the hospital in March 2012, about five months after the 17-year-old was allegedly sexually assaulted and became suicidal.
Her family alleges she was sexually assaulted by four boys, and a digital photograph of the incident was passed around her school. She died in April after she was taken off life support following an attempted suicide.
Glen Canning, Rehtaeh's father, told CBC News that his daughter said she had been strip-searched at the hospital by two male workers who were looking for a razor.
The hospital said in extreme circumstances that clothing is removed from patients who are at a severely high risk of using their clothing to harm themselves, but later issued a statement saying the teen "was not stripped nor strip-searched by two men while in our care."
Davidson said a trauma-informed approach could prevent certain situations in hospitals, such as what is alleged to have happened to Rehtaeh.
"I think that the focus is always safety first. Using a trauma-informed approach would reduce the likelihood of a team working with the young person ever getting to that point — that's the strength of the trauma-informed approach ... [N]eeds for seclusion and restraint are significantly reduced and engagement with the patient ... is very much improved in terms of helping the system help them manage what they're experiencing at a moment in time in a collaborative manner."
Among the other recommendations in Davidson's report:-
Better integration of services at all levels within the health-care system so patients don’t end up falling through the cracks. People interviewed for the report expressed frustration over the lack of integration across education, health, community services and justice.
- Fully implementing the School Plus program, which integrates social work, health, justice and mental-health services offered at schools.
- Increasing the number of mental-health clinicians in schools. There is currently one clinician allocated for every 10 schools.
- Establishing a formalized method for standardized communication of suicide risk that includes better communication about a patient’s risk, and managing that risk for those not staying in hospital.
- Making digital medical record implementation a priority, aimed at improving continuity of care across institutions and schools.
- Expanding the use of multidepartmental consent forms for better communication across jurisdictions (for example, education, health, community services and justice).
- Establishing a formal process to keep patients and their families engaged in getting the help they need.
- Instituting formalized supports and plans to help youth and their families, specifically after they’ve been released from hospital.
- Introducing “System Navigators” to help families understand how to make the system work for them so youth do not fall through the cracks.
- Reconsidering recommendations of the Nova Scotia physician resource plan to reduce the number of psychiatrists for children and adolescents. The report said a lack of doctors makes it harder to those with mental-health and addiction issues get the help they need.
The report was initially expected by the end of September, but Davidson was given more time to complete it.