Msw Service Protocol Suicidal Cases

MSW SERVICE PROTOCOL FOR SUICIDAL CASES INTRODUCTION The Service Protocol for Suicidal Cases serves as a service guide for MSS intervention in suicidal patients and their families. direction of care and concern when patients are in different stages. I)

It helps to give

Characteristics of Suicidal Patients Individuals considering suicide are struggling with a number of personal problems for which they see no solution. Most people who are suicidal truly do not want to die but feel unable to resolve their dilemma. For most of the time, they want to get rid of their emotional distress and cry for help. Some of them may in fact have communicated their intention to their relatives or friends before attempting suicide. However the communication is often not taken seriously or mishandled. Persons who are suicidal often feel : HELPLESS HOPELESS ISOLATED

II)

– – –

They feel powerless and unable to change their situation. They believe their problems and feelings of despair can never be resolved. They feel alone in their pain and believe no one is able to understand.

Goals of MSS in Suicidal Case i i i i

Handle the immediate crisis, empower patient and restore patient’s hope Enhance patient’s coping ability in face of problems/mishaps Prevent the negative impact of suicidal incident on patient and the family Assess and prevent suicidal risk

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

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III) Task and Intervention at Different Stages (Please also refer to Flow Chart in Handling Suicidal Cases at Appendix I for reference.)

Key Stages / Tasks 1.

DATA COLLECTION

Principle i To gather more background information on the suicidal incident and case background from other parties before approaching patient who may be too emotional/unmotivated to talk at that time.

Intervention

Recommended Time frame

i Case discussion with referrer i Medical record reading/clinical observation i Discussion with family members/relatives/ professional staff in hospital/ police

i Within 1 working day after case is known to MSW

i Active listening

i Within 1 - 2 working days after case is known to MSW

i To prepare the handling strategy 2.

INTAKE INTERVIEW

✧ Ice-breaking

i To show concern and establish rapport i To engage the patient in the helping process i To give emotional support

i Offer acceptance i Encourage expression of feelings i Explore whether case is known to other agencies and contact the agencies with client’s consent if necessary

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

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Key Stages / Tasks ✧ Psychosocial Assessment

Principle i To assess immediate suicidal risk i To explore the impact of the suicidal incident on patient and the family i To assess patient’s psychosocial condition and formulate an intervention plan i To facilitate the smooth communication with ward/other professionals/relatives on patient’s holistic care plan

Intervention i Assess the triggering and underlying causes for the suicidal incident

Recommended Time frame i Within 1 - 2 working days after case is known to MSW

i Assess suicidal risk (Please refer to Suicide Assessment Chart at Appendix II for reference.) i Crisis identification i Crisis counselling i Work out the initial psychosocial treatment plan with patient, relatives and other professional staff i Assess social network for support i Suggest medical officer to refer case to other professionals such as psychiatrist and clinical psychologist and/or refer to chaplain if necessary i Verbal/written correspondence for case progress to ward and referrer (Please refer to Sample of Deliberate Self Harm Assessment Report at Appendix III for reference)

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

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Key Stages / Tasks 3.

CRISIS INTERVENTION/ PROBLEM SOLVING

Principle i To help patient and family members to understand the causes leading to the suicidal attempt i To minimize the impact of suicidal act on patient and the family i To enhance their coping ability i To discuss with medical staff on formulation of discharge plan

Intervention i To start providing counselling on marriage, family and/or other related problems leading to the suicidal attempt i Mobilize patient’s formal and informal social networks i Mobilize appropriate community resources i Provide information on relevant community resources i Explore patient’s strengths, empower patient to create hope and confidence

Recommended Time frame

i Within 2 working days after case is known to MSW

If crisis is identified: i Provide crisis intervention for patient in ward in case of emergency situation e.g. sudden emotional outburst i Provide crisis intervention for the family e.g. emergency child care placement and immediate financial hardship i Suggest medical officer to refer case to other professionals such as psychiatrist and clinical psychologist and/or refer case to chaplain if necessary MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

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Key Stages / Tasks 4. PREDISCHARGE INTERVIEW (For risky case, goes back to crisis intervention)

5. POSTDISCHARGE MONITORING

Principle

Intervention

Recommended Time frame

i Before discharge i To provide supportive counselling from hospital i To further conduct risk assessment (Please refer to Suicidal Assessment Chart at To engage patient for future Appendix II for reference.) social work follow-up i To empower patient on stress management and problem solving skills To enhance patient’s future i To give patient relevant pamphlets on coping ability prevention of suicide and the hotlines for help i To mobilize family’s support on suicidal precaution for patient i To formulate discharge plan with patient, relatives and other professionals i To engage patient for social work follow-up intervention i Within 1 week To monitor the psychosocial and Scenario (A): after discharge emotional functioning of patient i To transfer risky case to appropriate from hospital after discharged home service unit for follow-up service immediately after discharge if necessary To continue to provide support to Scenario (B): Reassessment: patient’s adjustment at home i Within 1 to 2 1. To reassess the suicidal risk and tendency, after the suicidal incident and weeks after 2. To provide supportive counselling, discharge discharge from 3. To further empower patient on stress hospital To prevent further suicide management and problem solving skills and 4. To transfer case to appropriate service unit for follow-up service if necessary OR To terminate case according to MSS internal guidelines for closure of case if necessary

i To conduct risk assessment on further suicidal tendency i i

i i

i

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

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Appendix I Flow Chart in Handling Suicidal Cases

ADMISSION of patient Patient DAMA Case Known to MSW

Case Referred to MSW

1. DATA COLLECTION

2. INTAKE INTERVIEW

Telephone contact, showing concern to patient’s condition within 2 days after

✧

Ice-breaking

discharge (assess suicidal risk and

✧

Psychosocial Assessment

emotional stability).

3. CRISIS INTERVENTION/PROBLEM SOLVING

If patient agrees to receive social

If patient rejects social work intervention

work service.

or lost contact, sent concern letter with

4. PRE-DISCHARGE INTERVIEW

information on community resources

(For risky case, goes back to Crisis

to patient for reference and assistance

Intervention/Problem Solving.)

(Appendix IV).

Discharge with OPD follow-up within other MSSU’s

Discharge with OPD follow-up

service boundary or without OPD follow-up

within own MSSU’s service boundary

5. POST-DISCHARGE MONITORING YES

NO Service Need?

Transfer of case to

Termination of Case (Please

other MSSU or FSC

refer to MSS internal guidelines for closure of case.)

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

Appendix II (Page 1 of 2) (Reference made to P.19 and Appendix 10 of LTTC Reference Kit No.22 of SWD, “ Adolescent Suicide”)

SUICIDE ASSESSMENT CHART (For MSW’s Reference Only) Users may wish to circle client indicators. Lower Risk 1.

Medium Risk

High Risk

SUICIDE PLAN

(a) Details

Undefined/Vague

Some specifics

Well-formed plan. Knows when, where and how.

(b) Availability of means

Not available. Means yet to be obtained.

Available close by

Immediately at hand

(c) Time

No specific time set

Suitable time determined

Immediately

(d) Lethality of method*

Pills, slash wrists

Drugs/alcohol, car “accident”, Gun, hanging, jumping. carbon monoxide.

Others present most of time. Others available nearby or if No one nearby, isolated. (e) Chance of called upon. Intervention. (f) Message

*

No message prepared

Message attempted but not Message prepared finalized

Note that women are far less likely to use the violent methods of men, and that pills increase in risk with knowledge, quantity and toxicity. Lower Risk

2.

Medium Risk

SOURCES OF STRESS

reaction to (a) Stressors as No significant stressors Moderate significant loss or change both experienced by internal and/or external, suicidal person unmet needs. 3.

High Risk

Severe reaction to significant loss or change both internal and/or external, unmet needs.

INTERNAL COPING MECHANISMS

(a) Coping behaviours Daily activities continue as usual with little change. Willing and able to use support systems, agencies, etc. (b) Avoidance behaviour

Some disturbance to daily routines, e.g. sleep, eating, school/work, leisure, etc. Reluctance to seek help and use support systems.

Gross disruption to former routines and functions. Unwilling to use help, support systems, agencies. Irrational. Parental model of suicide.

Responds to stress in Running away, withdrawing, life-affirming ways. reduced communication.

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

Appendix II (Page 2 of 2) Lower Risk (c)

Self-directed behaviour

(d) Previous attempt

Mild, tattooing, etc.

suicide None

Medium Risk Self-harm, self-abuse. Risk taking behaviour.

One or two attempts, History of repeated threats, predictable discovery. slightly Moderate – some moodiness, sadness, irritability, loneliness and decreased energy. Some “acting out” (children & youth)

(e)

Depression

Mild, feels down.

(f)

Perception

Sense of future. Sense of short-term. Rational, problem Some periods of rational, solving. Problem-solving behaviour.

(g)

Communication

Direct and open Other directed suicide goals. expressions of feelings “They’ll be sorry….. I’ll show including suicidal them.” thoughts.

(h) Lifestyle

Stable relationships, personality and school/work performance.

Instability of relationships, substance abuse, once only suicidal behaviour in a stable personality.

(i)

Health status

(j)

Substance abuse

No significant health problems Little change in usage pattern.

Short-term or psychosomatic illness Increased dependence for mood swings.

4.

EXTERNAL COPING MECHANISMS

(a)

Support systems Help available. Significant others concerned and willing to help. Range of agencies available. Living with family.

Family and friends available but unable or unwilling to help consistently. Limited availability of other help.

High Risk Self-destructive behaviour, doing major harm to self. Many attempts or a major attempt with accidental discovery. Overwhelmed with feelings of sadness, helplessness, hopelessness and worthlessness. Extreme “acting out” (children & youth) Absence of future consideration. Irrational and fixed. No direct verbal expression of suicidal intent, but strong indirect and non-verbal expressions of suicidal intent. Suicidal behaviour in unstable personality, emotional disturbance, repeated difficulties in relating to peers, family, teacher, fellow workers, etc. Chronic debilitating or acute catastrophic illness Increase in drug mixture and dosage with decreasing effect.

No help available. Family and friends unavailable, hostile, exhausted or injurious. No agencies available. Not living with family.

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

MR 4286 I.D.No.

Hospital No.:

HOSPITAL AUTHORITY CARITAS MEDICAL CENTRE

(

Name :

Deliberate Self Harm Assessment Report

Sex :

Medical Social Work Department：G/F Wai Ming Block

Informant :

Age:

)

Ward:

Bed:

醫務社會工作部：懷明樓地下

Date of Assessment :

Social Background : Marital Status :

Single

Cohabited for

months / yrs

Married / separated / divorces / widowed for Family member (HK) : Employment :

children

months / yrs

siblings / parents

Nil

Yes, occupation : No, duration & reasons :

Financial Status :

Stable / unstable income No income

CSSA / SSA Others

Other significant social information :

Suicidal Incident : Means of attempt :

Drug overdose

Corrosive / detergent Ingestion

Wounding

Gas poisoning

Jump

Hanging

Others

Precipitating events leading to this attempt :

Intention : Intend to cause death to 'end' the problem Intend to cause death for revenge or achieving a purpose towards others To communicate the extent of distress To influence others Others

Motive :

Acute reaction without plan

Well planned action

Others

Reaction after the incident : patient / family / significant others

Problem identified : Other significant information related to this attempt :

Previous Attempt

No

Yes :

times

Not known

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

MR 4286

Assessment : Family / Interpersonal Relationship :

Social / Family Support :

Suicidal Risk : High

Moderate

Low

Treatment Plan :

Discharge Plan :

Inform MSW if patient is fit for discharge

Yes No

Supplementary Notes :

Seen by :

Assessed by : Medical Officer

MSW,

Ext :

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.

Appendix IV (SAMPLE)

先生/女士:

閣下入院期間，本部門醫務社工未能與你會面，我們極希望為你提供服務。如有 任何情緒困擾或社會服務需要，歡迎致電醫務社工 電話：

先生/女士，

。此外，你亦可向以下機構求助。

(

)

醫務社會服務部 ________年

月

機構

日 地址

電話

社會福利署熱線

2343 2255

撒瑪利亞防止自殺會

(廣東話)

2382 0000

(多種語言) 2896 0000 2715 7647

女青熱線 法律援助署

當值律師計劃 – 電話法律諮詢熱線

香港金鐘道 66 號金鐘政府合署 24 樓 九龍旺角火車站旺角政府合署 3樓

2537 7677

2521 3333

MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.