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INTRODUCTION
The Service Protocol for Suicidal Cases serves as a service guide for MSS intervention in suicidal patients and their families. It helps to give
direction of care and concern when patients are in different stages.
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.
i Handle the immediate crisis, empower patient and restore patient’s hope
i Enhance patient’s coping ability in face of problems/mishaps
i Prevent the negative impact of suicidal incident on patient and the family
i 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. 1
III) Task and Intervention at Different Stages
(Please also refer to Flow Chart in Handling Suicidal Cases at Appendix I for reference.)
Recommended
Key Stages / Tasks Principle Intervention Time frame
1. DATA COLLECTION i To gather more background i Case discussion with referrer i Within 1
information on the suicidal i Medical record reading/clinical working day
incident and case background observation after case is
from other parties before i Discussion with family known to MSW
approaching patient who may be members/relatives/
too emotional/unmotivated to talk professional staff in hospital/
at that time. police
2. INTAKE INTERVIEW
MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002. 2
Recommended
Key Stages / Tasks Principle Intervention
Time frame
✧ Psychosocial Assessment i To assess immediate suicidal risk i Assess the triggering and i Within 1 - 2
underlying causes for the suicidal working days
i To explore the impact of the incident after case is
suicidal incident on patient and known to MSW
the family i Assess suicidal risk (Please refer to
Suicide Assessment Chart at
i To assess patient’s psychosocial Appendix II for reference.)
condition and formulate an
intervention plan i Crisis identification
MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002. 3
Recommended
Key Stages / Tasks Principle Intervention Time frame
3. CRISIS i To help patient and family i To start providing counselling on i Within 2 working
INTERVENTION/ members to understand the marriage, family and/or other related days after case is
PROBLEM SOLVING causes leading to the suicidal problems leading to the suicidal known to MSW
attempt attempt
i Mobilize patient’s formal and
i To minimize the impact of informal social networks
suicidal act on patient and the i Mobilize appropriate community
family resources
i Provide information on relevant
i To enhance their coping ability community resources
i Explore patient’s strengths, empower
i To discuss with medical staff on patient to create hope and confidence
formulation of discharge plan
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. 4
Recommended
Key Stages / Tasks Principle Intervention Time frame
4. PRE- i To conduct risk assessment on i To provide supportive counselling i Before discharge
DISCHARGE further suicidal tendency i To further conduct risk assessment (Please from hospital
INTERVIEW refer to Suicidal Assessment Chart at
i To engage patient for future Appendix II for reference.)
(For risky case, social work follow-up i To empower patient on stress management
goes back to crisis and problem solving skills
intervention) i 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
5. POST- i To monitor the psychosocial and Scenario (A): i Within 1 week
DISCHARGE emotional functioning of patient i To transfer risky case to appropriate after discharge
MONITORING after discharged home service unit for follow-up service from hospital
i To continue to provide support to immediately after discharge if necessary
patient’s adjustment at home Scenario (B): Reassessment: i Within 1 to 2
after the suicidal incident and 1. To reassess the suicidal risk and tendency, weeks after
discharge 2. To provide supportive counselling, discharge from
i To prevent further suicide 3. To further empower patient on stress hospital
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
MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002. 5
Appendix I
Flow Chart in Handling Suicidal Cases
ADMISSION of patient
Patient
DAMA
emotional stability).
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?
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.
1. SUICIDE PLAN
(d) Lethality of Pills, slash wrists Drugs/alcohol, car “accident”, Gun, hanging, jumping.
method* carbon monoxide.
(e) Chance of Others present most of time. Others available nearby or if No one nearby, isolated.
Intervention. called upon.
(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.
2. SOURCES OF STRESS
(a) Coping behaviours Daily activities Some disturbance to daily Gross disruption to
continue as usual with routines, e.g. sleep, eating, former routines and
little change. school/work, leisure, etc. functions.
Willing and able to use Reluctance to seek help and Unwilling to use help,
support systems, use support systems. support systems,
agencies, etc. agencies.
Irrational.
Parental model of suicide.
(b) Avoidance Responds to stress in Running away, withdrawing,
behaviour 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)
(g) Communication Direct and open Other directed suicide goals. No direct verbal
expressions of feelings “They’ll be sorry….. I’ll show expression of suicidal
including suicidal them.” intent, but strong indirect
thoughts. and non-verbal
expressions of suicidal
intent.
(h) Lifestyle Stable relationships, Instability of relationships, Suicidal behaviour in
personality and substance abuse, once only unstable personality,
school/work suicidal behaviour in a stable emotional disturbance,
performance. personality. repeated difficulties in
relating to peers, family,
teacher, fellow workers,
etc.
(i) Health status No significant health Short-term or psychosomatic Chronic debilitating or
problems illness acute catastrophic illness
(j) Substance abuse Little change in usage Increased dependence for Increase in drug mixture
pattern. mood swings. and dosage with
decreasing effect.
4. EXTERNAL COPING MECHANISMS
(a) Support systems Help available. Family and friends available No help available. Family
Significant others but unable or unwilling to and friends unavailable,
concerned and willing help consistently. hostile, exhausted or
to help. Limited availability of other injurious. No agencies
Range of agencies help. available. Not living with
available. Living family.
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
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
Problem identified :
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 :
Suicidal Risk :
High Moderate Low
Treatment Plan :
Discharge Plan :
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 先生/女士,
電話: 。此外,你亦可向以下機構求助。
( )
醫務社會服務部
________年 月 日
機構 地址 電話
MSW Service Protocol for Suicidal Cases has been endorsed by Co-ordinating Committee in Medical Social Service on 21 March 2002.