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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. It helps to give
direction of care and concern when patients are in different stages.

I) 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 – They feel powerless and unable to change their situation.


HOPELESS – They believe their problems and feelings of despair can never be resolved.
ISOLATED – They feel alone in their pain and believe no one is able to understand.

II) Goals of MSS in Suicidal Case

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

i To prepare the handling strategy

2. INTAKE INTERVIEW

✧ Ice-breaking i To show concern and establish i Active listening i Within 1 - 2


rapport working days
i Offer acceptance after case is
i To engage the patient in the known to MSW
helping process i Encourage expression of feelings

i To give emotional support 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. 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

i To facilitate the smooth i Crisis counselling


communication with ward/other
professionals/relatives on i Work out the initial psychosocial
patient’s holistic care plan 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. 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

Case Known to MSW

Case Referred to MSW


1. DATA COLLECTION

Telephone contact, showing concern to 2. INTAKE INTERVIEW

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 Medium Risk High Risk

1. SUICIDE PLAN

(a) Details Undefined/Vague Some specifics Well-formed plan.


Knows when, where and
how.

(b) Availability Not available. Available close by Immediately at hand


of means Means yet to be obtained.

(c) Time No specific time set Suitable time determined Immediately

(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.

Lower Risk Medium Risk High Risk

2. SOURCES OF STRESS

(a) Stressors as No significant stressors Moderate reaction to Severe reaction to


experienced by significant loss or change both significant loss or change
suicidal person internal and/or external, both internal and/or
unmet needs. external, unmet needs.

3. INTERNAL COPING MECHANISMS

(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)

Lower Risk Medium Risk High Risk

(c) Self-directed Mild, tattooing, etc. Self-harm, self-abuse. Self-destructive


behaviour Risk taking behaviour. behaviour,
doing major harm to self.
(d) Previous suicide None One or two attempts, Many attempts or a major
attempt History of repeated threats, attempt with accidental
predictable discovery. discovery.
(e) Depression Mild, feels slightly Moderate – some moodiness, Overwhelmed with
down. sadness, irritability, loneliness feelings of sadness,
and decreased energy. helplessness,
Some “acting out” (children & hopelessness and
youth) worthlessness.
Extreme “acting out”
(children & youth)
(f) Perception Sense of future. Sense of short-term. Absence of future
Rational, problem Some periods of rational, consideration.
solving. Problem-solving behaviour. Irrational and fixed.

(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

HOSPITAL AUTHORITY Hospital No.: I.D.No.

CARITAS MEDICAL CENTRE Name : ( )

Deliberate Self Harm Assessment Report Sex : Age: Ward: Bed:

Medical Social Work Department:G/F Wai Ming Block 醫務社會工作部:懷明樓地下


Informant : Date of Assessment :
Social Background :
Marital Status : Single Cohabited for months / yrs
Married / separated / divorces / widowed for months / yrs
Family member (HK) : children siblings / parents Nil
Employment : Yes, occupation :
No, duration & reasons :
Financial Status : Stable / unstable income CSSA / SSA
No income 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 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

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

女青熱線 2715 7647

法律援助署 香港金鐘道 66 號金鐘政府合署 2537 7677


24 樓
九龍旺角火車站旺角政府合署
3樓

當值律師計劃 – 2521 3333


電話法律諮詢熱線

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